Drugs

Who is at risk for NSAID induced gastroduodenal ulcer disease? Older age (>65–70 years; relative risk [RR] 5–6× increased). Multiple NSAIDs (including ASA; RR 9×). History of peptic ulcer disease, with or without NSAIDs (RR 6×). Higher dose, prolonged use of NSAIDs (RR 7×). Chronic disease status such as rheumatoid arthritis, chronic obstructive pulmonary disease, …

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How common are NSAID induced gastritis and peptic ulcers? Gastritis and peptic ulcers are among the most common side effects of these drugs. Approximately 1% to 2% of patients treated with NSAIDs develop serious GI complications annually (bleeding, perforation, or obstruction) with a hospitalization mortality rate of 5% to 6%. The absolute risk of serious …

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How do PGs protect the gastric mucosa? PGE1 and PGE2 effects on gastric mucosa: • Induce protective superficial mucous barrier. • Induce bicarbonate output. • Increase mucosal blood flow in the superficial gastric cell layer. • Inhibit gastric acid synthesis.

GI side effects of NSAIDs Dyspepsia, indigestion, and vomiting. Gastroesophageal reflux/esophagitis. Gastroduodenal ulcers. GI hemorrhage and perforation. Small and large bowel ulceration. Small bowel webs (especially with piroxicam). Colonic diverticuli perforation. Diarrhea (especially with meclofenamate).

hepatotoxicity of NSAIDs The clearance of NSAIDs is predominantly by hepatic metabolism, with the production of inactive metabolites that are excreted in urine. An elevation of liver enzymes, especially the aminotransferases (aspartate transaminase and alanine transaminase), can occur with all NSAIDs (up to 15% of regular users can have significant, reversible elevations). Diclofenac may cause …

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Who is at risk for a hypersensitivity reaction to NSAIDs? A severe asthmatic with nasal polyps is at most risk for a hypersensitivity reaction to NSAIDs; up to 78% may react to ASA ( Samter’s triad = asthma, nasal polyps, ASA sensitivity). Patients with isolated asthma (10%–20% ASA sensitivity overall), nasal polyps, or chronic urticaria are also …

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What have efficacy studies of NSAIDs found? In general, there are no important differences among the various NSAIDs in terms of “comparative effectiveness”, although there are clear individual variations in response. In some arthritic diseases, specific NSAIDs have been traditionally used as first-line agents over others. This is typically based on the evidence of clinical …

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