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• Aspirin

  • is the oldest anti-inflammatory drug
• • Aspirin (ASA) is a potent inhibitor of prostaglandin and produces adverse effects like gastric intolerance and bleeding.
• Aspirin is also a good anti platelet aggregation making it useful in preventing heart attacks.
• What are the 1st generation NSAIDS?

  1. Salicylates
  2. Para-chlorobenzoic acid derivatives, or indoles
  3. Phenylacetic acids
  4. Propionic acid derivatives
  5. Fenamates
  6. Oxicams
• What is the 2nd generation NSAIDS?

  • Selective COX-2 inhibitors
• What are the 5 Cardinal Signs of Inflammation?

  1. Calor (Heat)
  2. Dolor (Pain)
  3. Rubor (Redness)
  4. Tumor (Swellling)
  5. Functio Laesa (Loss of Function)
• INFLAMMATION

  A reaction to tissue injury caused by the release of chemical mediators that trigger both a vascular response and the migration of fluid and cells (leukocytes, or white blood cells) to the injured site.
• What are the chemical mediators under the inflammation?

  • The chemical mediators are (1) histamines, (2) kinins, and (3) prostaglandins.
• • Infection is caused by microorganisms and results in inflammation, but not all inflammations are caused by infections.
• Prostaglandins - cause pain, fever, and swelling.
• Kinins - cause pain and increase blood flow to the area.
• Acetaminophen does not affect platelets so it doesn't cause bleeding problems like aspirin can do.
• Relieve pain (analgesic), reduce elevated body   temperature   (antipyretic),   and inhibit platelet aggregation (anticoagulant).
• • NONSTEROIDAL ANTI- INFLAMMATORY DRUG
  • Used to decrease inflammation and pain for patients who have some type of musculoskeletal condition
• • NSAIDS- Mimic the effects of corticosteroids (cortisone), but they are not chemically related to corticosteroids
• • Maybe classified as Salicylates and Nonsalicylates.
• • ASPIRIN- Most frequently used anti-inflammatory agent before the introduction of ibuprofen
• • Aspirin decreases platelet aggregation, and thus blood clotting is decreased.
• Hypersensitivity: tinnitus, vertigo, bronchospasm
• • Salicylates are present in numerous foods such as prunes, raisins, and licorice and in spices such as curry and paprika.
• • ASPIRIN: It can cause GI distress, which includes anorexia, nausea, vomiting, diarrhea, and abdominal pain, so it should be taken with water, milk, or food.
• • It should not be taken during the last trimester of pregnancy because it could cause premature closure of the ductus arteriosus in the fetus.
• Aspirin should not be taken by children with flu symptoms because it may cause the potentially fatal Reye syndrome.
• • ASPIRIN: The onset of action for aspirin is within 30 minutes. It peaks in 1 to 2 hours, and the duration of action is an average of 4 to 6 hours.
• PARA-CHLOROBENZOIC ACID: INDOMETHIACIN
• INDOMETHACIN

  • Used for rheumatoid arthritis (RA), gouty arthritis, and osteoarthritis and is a potent prostaglandin inhibitor.
• INDOMETHIACIN is Very irritating to the stomach and should be taken with food
• PARA-CHLOROBENZOIC ACID DERIVATIVE

  • Sulindac & Tolmetin
• PARA-CHLOROBENZOIC ACID DERIVATIVE

  • Produce less severe adverse reactions than indomethacin.
  • May cause sodium and water retention, and increased blood pressure.
• PHENYLACETIC ACID DERIVATIVES

  • Diclofenac sodium and Ketorolac
• DICLOFENAC SODIUM

  • Antiinflammatory effects are similar to those of aspirin, but it has minimal to no antipyretic effects.
  • It is indicated for RA, osteoarthritis, and ankylosing spondylitis.
• KETOROLAC

  • First injectable NSAID
  • Has greater analgesic properties.
  • Recommended for short-term management of pain.
  • For postsurgical pain, it has shown analgesic efficacy equal or superior to that of opioid analgesics.
• PROPIONIC ACID DERIVATIVES

  • These drugs are aspirin-like but have stronger effects and create less GI irritation
  • Gastric upset occurs, but it is not as severe as with aspirin and indomethacin.   Ibuprofen is the most widely used propionic acid
• • Five other propionic acid agents are:
  • Fenoprofen calcium
  • Naproxen
  • Ketoprofen
  • Flurbiprofen
  • Oxaprozin
• IBUFROPEN

  • Because ibuprofen can increase the effects of warfarin, sulfonamides, many of the cephalosporins, and phenytoin, it should be avoided with these drugs.
• • Hypoglycemia may result when ibuprofen is taken with insulin or an oral hypoglycemic drug.
  • Risk of toxicity is high when ibuprofen is taken concurrently with calcium channel   blockers. 
• FENAMATES

  • Includes potent NSAIDs used for acute and chronic arthritic conditions.
  • Gastric irritation is a common side effect; patients with a history of peptic ulcer should avoid taking fenamates.
  • Side effects include edema, dizziness, tinnitus, and pruritus.
• • Two fenamates: (1) meclofenamate sodium monohydrate and (2) mefenamic acid.
• OXICAMS

  • Piroxicam, Meloxicam, Oxicams, are indicated for long-term arthritic conditions such as RA and osteoarthritis.
• • OXICAMS: They too can cause gastric problems such as ulceration and epigastric distress, but the incidence is lower than for some other NSAIDs.