Non-Steroidal+Anti-Inflammatory+Drugs

toc =Salicylates (Aspirin)=

Pharmacology

 * pKa 3.5
 * absorbed from stomach, intestine
 * hydrolized to active metabolite, salicylic acid
 * excreted in urine

Uses

 * inflammatory disease
 * pyrolytic
 * analgesic
 * thrombolytic

Adverse Effects
Gastrointestinal effects >> include nausea,emesis, diarrhea, constiaption, dyspepsia, bleeding, and ulceration Hypersensitivity >> associated with viral infections >> 35% mortality >> emesis, hepatic disturbances, encephalopathy
 * 70% experience GI effects
 * enteric-coated or nonacetylated salicylates may reduce GI effects
 * includes rash, b ronchospasm, rhinitis, edema, or anaphylaxis
 * intolerance highest in ashtmatic patients, or those with nasal polyps, recurrent rhinitis, r urticaria
 * cross-sensitive with yellow dye tartrazine
 * Reyes Syndrome

Other Side Effects >> if severe, can lead to ischemic nephrosis >> Made worse w/ acetaminophen or ACE inhibitors >> often in pt w/ SLE, RA, RF
 * Decrease in renal blood flow
 * mild hepatitis
 * Bleeding
 * Premature closure of ductus arteriosis

Interactions

 * binds to serum albumin
 * enhances hypoglycemic action of sulfonylureas
 * interacts with uricosuric agents
 * competes with penecillin g for tubular resporption
 * Corticosteroids increase renal clearance of salicylates
 * Alchohol worsens chance of bleeding

Toxicity
> tinnitus, hearing loss, vertigo > increases medullary response to CO2, resulting in hyperventiation, respiratory alkalosis >> Nausea, vomiting, tahycardia, hyperpnea, dehydration, coma Treatment: support acid-base physiology, electrolyte replacement, cooling, alkalinization of urine with bicarbonate, diuresis, lavage or emesis =Proprionic Acids (Ibuprofen, Naproxen)=
 * Salicylism
 * hyperventilation & acidosis
 * can cause hyperthermia and hypoglycemia from uncoupling of oxidative phosphorylation
 * fenoprofen reported as nephrotoxic

=Indols (Indomehtacin)=
 * Drug of choice for ankylosing spondylitis and Reiter's syndrome
 * Also used for gout
 * Used to close PDA in premature neonates
 * Bleeding ulceration, headache, tinnitus, dizziness common S/E

=Pyrrol Acetic Acids=

=Enolic Acids=

=Alkanones=

=Acetaminophen=