2. Non steroid anti inflammatory
drug
Shereen Abdelsalam Elwan
Lecturer of Rheumatology and Rehabilitation
Tanta university
3. NSAID
O Weak organic acids bind to serum proteins so accumulate
at site of inflammation (inflamed joint often have a lower
PH than clinically uninvolved joints)
5. NSAID
O work by inhibiting the activity of cyclooxygenase enzymes (COX-1
or COX-2). In cells, these enzymes are involved in the synthesis of key
biological mediators, namely prostaglandins, which are involved in
inflammation, and thromboxanes, which are involved in blood clotting
O . Corticosteriod inhibit the release of arachidonic acid metabolites,
namely prostaglandins (PGs) and leukotrienes,, via the induction of a
phospholipase A2 inhibitory protein, called lipocortin.
6.
7.
8.
9. NSAID
Mechanism of action :
Inhibition of cyclooxygenase cause decrease in
prostaglandin production (Cox1 and Cox2)
Inhibition of lipoxygenase
Inhibition of superoxide formation
Inhibition of neutrophil aggregation
10. NSAID
Inhibition of degenertive enzyme
Inhibition of cytokine production by inhibition of NF,Kb
Suppression of proteoglycan degredation in cartilage
12. NSAID
COX1 Specific (COX1 selective): low dose aspirin
Cox non specific ( cox non selective): Ibuprofen,
indomethcin , naproxen
Cox2 perferential (cox2 selective ) : meloxicam,
diclofenac
Cox2 specific (cox2 highly selective): celecoxib
13. NSAID
O Most NSAIDs are non-selective and inhibit the activity of both
COX-1 and COX-2. These NSAIDs, while reducing
inflammation, also inhibit platelet aggregation (especially
aspirin) and increase the risk of gastrointestinal ulcers/bleeds.
O COX-2 selective inhibitors have less gastrointestinal side
effects but promote thrombosis and substantially increase the
risk of heart attack.
17. NSAID
Risk for NSAID induced gastroduodenal ulcer:
Old age
History of peptic ulcer disease
Higher dose, prolonged use of NSAID
Chronic disease
Concomitant corticosteriod, warfarin ,low dose aspirin
Suspected risk factor tobacco, alcohol,infection with
helicobacter pylori
18. NSAID
Nephrotoxic side effect :
Vasoconstriction leading to decrease glomular filteration rate and
increase creatinine
Increase sodium retention and blood volume
Pupillary necrosis
Hyperkalemia
Hyponatremia
Interstital nephritis
19. NSAID
Prostaglandin is vasodilator for renal arteries
Increase renin release
Increase sodium loss
20. NSAID
Cardiovascular side effect :Except for aspirin
Sodium and fluid retention
Inhibition of cox2 increase risk of myocardial infarction ,stress
and thermboembolism
Cox2 activity on endothelium serve as main source of
prostacyclin production which inhibit vessel constriction and
platelet aggregation
21. NSAID
increased blood pressure
All NSAIDS can increase blood pressure whether or not you already
have high blood pressure .
NSAIDs may also reduce the effect of some blood pressure
medications.
On average, NSAIDs can increase blood pressure by 5 millimeters of
mercury
22. NSAID
Hepatotoxicity
Clearance of NSAID is predominantly by hepatic metabolism
Elevation of liver enzymes
Diclofenac cause transminitis more common than other NSAID
Severe hepatitis reported with indomethcin
23. NSAID
Allergic reactions
Allergic reactions to NSAIDs are rare
Bruising or bleeding
NSAIDs can reduce your blood’s ability to clot. This may cause
you to bruise more easily. Small cuts may take longer to stop
bleeding.
The effect can be serious if you also take warfarin (Coumadin).
24. NSAID
The cox2 enzyme play several role in female reproductive cycle
As cox2 mediated prostaglandin are involoved in follicle rupture
Cox2 important in implantation of embryo in the uterus
Prostaglandin have role in uterine contraction during labour
25. NSAID
NSAID and pregnancy:
NSAID in first and second trimester is relatively safe
(categeroy B)
Use of NSAID after 32 weeks of gestation should be avoided as
prostaglandin are necessary in late pregnancy to maintain
patent ductus arteriosus ,for fetal kidney devlopment and for
labour progression
26. NSAID
Hyper sensitivty reaction:
Asthma, nasal polyp, aspirin sensitivty ( samter triad)
Sensetivity not allergy because it is not immunoglobulin E mediated
Caused by cyclooxygenase inhibition result in decrease prostaglandin
production E2 an important bronchodilator
5 fold increase bronchial expresion of leukotriene c4 when aspirin or
other NSAID block cyclooxgynease the archodonic acid are diverted
down the leukotrien pathway result in excessive production of
leukotrienes C,D and E
27. NSAID
Possible effects on bone and soft tissue healing:
O It has been hypothesized that NSAIDs may delay healing from bone
and soft-tissue injuries by inhibiting inflammation.
O On the other hand, it has also been hypothesized that NSAIDs might
speed recovery from soft tissue injuries by preventing inflammatory
processes from damaging adjacent, non-injured muscles.
O There is moderate evidence that they delay bone healing.Their overall
effect on soft-tissue healing is unclear
28. NSAID
Aspirin cause
injury of superficial mucosa (no perforation)
Anti platelet
if given with other NSAID can cause perforation
Aspirin taken 8 hours after NSAID
NSAID taken 2 hours after aspirin
Aspirin at low dose increase uric acid
High dose aspirin decrease uric acid