Published on March 8, 2016
1. NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs) PREPARED BY : VISHAL GOHIL (21) FINAL YR BDS GUIDED BY : DR. VEENA PATEL DR. JIGAR JOSHI DR. NIMESH PATEL
2. CONTENTS • INTRODUCTION • MECHANISM OF ACTION • CLASSIFICATION • THERAPEUTIC USES • DOSES OF FEW DRUGS • ADVERSE EFFECTS • DENTAL CONSIDERATIONS VISHAL GOHIL
3. NSAIDs • Non-steroidal anti-inflammatory drugs • Large & chemically diverse group of drugs with the following properties : - Analgesic - Anti-inflammatory - Antipyretic VISHAL GOHIL
4. • It inhibits cyclooxygenase ( COX ) enzymes, which is responsible for the formation of prostaglandins that promote pain & inflammation. NSAIDs : Mechanism of Action VISHAL GOHIL
5. NSAIDs : Mechanism of Action • Analgesic effect : Blocks the undesirable effects of prostaglandin which causes pain. • Anti-inflammatory effect : Inhibit the leukotriene pathway or the prostaglandin pathway or both. • Antipyretic effect : Inhibit prostaglandin E2 ( dinoprostone ) within the area of the brain that controls temperature VISHAL GOHIL
6. CLASSIFICATION • A. Nonselective COX inhibitors ( traditional NSAIDs ) : 1. Salicylates : Aspirin 2. Propionic acid derivatives : Ibuprofen, Ketoprofen, Naproxen 3. Anthranilic acid derivative : Mephenamic acid 4. Aryl-acetic acid derivatives : Diclofenac, Aceclofenac 5. Oxicam derivatives : Piroxicam, Tenoxicam 6. Pyrrolo-pyrrole derivative : Ketorolac 7. Indole derivative : Indomethacin 8. Pyrazolone derivatives : Phenylbutazone, Oxyphenbutazone VISHAL GOHIL
7. B. Preferential COX-2 inhibitors : Nimesulide, Meloxicam C. Selective COX-2 inhibitors : Celecoxib, Etoricoxib D. Analgesic - antipyretics with poor antiinflammatory action : 1. Paraaminophenol derivative : Paracetamol 2. Pyrazolone derivatives : Metamizol 3. Benzoxazocine derivative : Nefopam VISHAL GOHIL
8. THERAPEUTIC USES • Relief of mild to moderate pain • Acute gout • Various bone, joint & muscle pain • Osteoarthritis • Rheumatoid arthritis • Juvenile rheumatoid arthritis • Dysmenorrhea VISHAL GOHIL
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10. ADVERSE EFFECTS Gastric irritation, erosions, peptic ulceration, gastric bleeding/perforation, esophagitis NA+ & water retention, chronic renal failure, interstitial nephritis, papillary necrosis ( rare ) VISHAL GOHIL
11. Raised transaminases, hepatic failure ( rare ) Headache, mental confusion, behavioural disturbances, seizure precipitation Bleeding, thrombocytopenia, hemolytic anemia, agranulocytosisVISHAL GOHIL
12. OTHERS • Asthma exacerbation • Nasal polyposis : Soft, painless, noncancerous growths on the lining of nasal passages or sinuses. • Skin rashes • Pruritus : Severe itching of the skin • Angioedema : Rapid swelling of the dermis, subcutaneous tissue, mucosa & submucosal tissues. VISHAL GOHIL
13. DENTAL CONSIDERATIONS • If patient is allergic to any NSAID, you will have to avoid them. • Paracetamol is the safest NSAID. • Ibuprofen is contraindicated in asthma patients as it causes bronchoconstriction. - It is not recommended for pregnant or nursing women. • If the patient is taking aspirin, then no surgery or even simple extraction should be done. - As it can lead to profuse bleeding because of its antiplatlet- action. Aspirin should be stopped before 7-10 days of any surgical procedure till 2-3 days after procedure. - Young children are highly susceptible to aspirin poisoning (therapeutic overdose). VISHAL GOHIL
14. REFERENCE • ESSENTIALS OF PHARMACOLOGY FOR DENTISREY BY K D TRIPATHI 2ND EDITION • BURKET’S ORAL MEDICINE 12TH EDITION • TEXTBOOK OF ORAL & MAXILLOFACIAL SURGERY BY S M BALAJI 2ND EDITION • WIKIPEDIA VISHAL GOHIL
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