Non-steroidal anti-inflammatory drugs (NSAIDs)

摘要: A 70 year old obese woman asks if more can be done for her knee and low back pain, due to osteoarthritis. She used smoke has type 2 diabetes. Her orthopaedic surgeon does not consider the clinical presentation radiographic changes in knees severe enough surgery. height is 160 cm, weight 85 kg, blood pressure 130/80 mm Hg, with normal renal function, plasma cholesterol concentration 5.5 mmol/L, HDL 0.9 mmol/L. present drug treatment paracetamol (4 g daily) metformin. NSAIDs act by inhibiting cyclo-oxygenase-1 (COX-1) COX-2 enzymes, which are involved prostaglandin synthesis, resulting their analgesic, anti-inflammatory, antipyretic effects (figure⇓). Although boundary blurred, there two broad groups of NSAIDs—the older, traditional, non-selective NSAIDs that inhibit both COX-1 newer, selective inhibitors predominantly The NSAID aspirin primarily its antiplatelet effect, thus reducing risk myocardial re-infarction stroke. Arachidonic acid metabolised cyclo-oxygenase isoenzymes intermediate prostaglandins (PGG2, then PGH2), converted other mediators inflammation, fever, gastroprotective. Thromboxane A2 causes platelet aggregation, prostacyclin produces vasodilation. By blocking COX synthesis prostaglandins, prostacyclin, thromboxane A2. depend largely on selectivity these enzymes. Aspirin works irreversibly mediated A2, aggregation Table 1⇓ shows indications effectiveness various NSAIDs. There little difference mean efficacy, although a review individual patient data indicates patients vary …