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ALL / Rheumatology
Non-steroidal anti-inflammatory drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDs work by inhibiting the activity of cyclooxygenase enzymes (COX-1 and/or COX-2) thus reducing the production of key mediators involved in inflammation such as prostaglandins. They also have an antipyretic action as prostaglandin E2 is involved in the thermoregulation centre in the hypothalamus.Examples of NSAIDs include
- ibuprofen
- diclofenac
- naproxen
- aspirin
Important and common side-effects
- peptic ulceration
- exacerbation of asthma
COX-2 selective NSAIDs
COX-2 selective NSAIDs were developed to reduce the incidence of side-effects seen with traditional NSAIDs, in particular, peptic ulceration. Examples include celecoxib and etoricoxib. Coxibs are not widely used due to ongoing concerns about cardiovascular safety. This led to the withdrawal of rofecoxib ('Vioxx') in 2004.
Cardiovascular adverse effects of celecoxib:
- increased risk of thrombotic effects → myocardial infarction and stroke
- fluid retention → exacerbation of existing heart failure
- worsening of hypertension
+PassMedicine Notes
NSAIDs work by inhibiting the activity of cyclooxygenase enzymes (COX-1 and/or COX-2) thus reducing the production of key mediators involved in inflammation such as prostaglandins. They also have an antipyretic action as prostaglandin E2 is involved in the thermoregulation centre in the hypothalamus.
Examples of NSAIDs include- ibuprofen
- diclofenac
- naproxen
- aspirin
- peptic ulceration
- exacerbation of asthma
COX-2 selective NSAIDs
COX-2 selective NSAIDs were developed to reduce the incidence of side-effects seen with traditional NSAIDs, in particular, peptic ulceration. Examples include celecoxib and etoricoxib. Coxibs are not widely used due to ongoing concerns about cardiovascular safety. This led to the withdrawal of rofecoxib ('Vioxx') in 2004.
Cardiovascular adverse effects of celecoxib:- increased risk of thrombotic effects --> myocardial infarction and stroke
- fluid retention --> exacerbation of existing heart failure
- worsening of hypertension
