Nonsteroidal anti-inflammatory drugs in the first aid kit

nsaidsNon-steroidal anti-inflammatory drugs (NSAIDs) because of the numerous indications for the use of different age groups of patients are very often present in medicine.

Variety of forms and doses, as well as the availability of some form of non-prescription NSAIDs is also the cause of the high popularity among patients. Basic knowledge among doctors and patients the indications for the use of NSAIDs and contraindications and possible side effects associated therapies will reduce the number and severity of unpleasant and sometimes serious complications.

The mechanism of action of NSAIDs

The mechanism of action is inhibition of cyclooxygenase (COX) responsible for the synthesis of prostanoids from arachidonic acid released from cell membrane phospholipids by phospholipase A2. Isolated two forms of this enzyme, constitutive (COX-1) and induced always occurs (COX-2). COX-1 is responsible for the synthesis of prostaglandins meet the physiological functions. COX-2 is responsible for the synthesis of pro-inflammatory prostaglandins at the inflammation site.

Anti-inflammatory, analgesic and antipyretic activity is due to classical NSAIDs inhibit the activity of COX-2 is responsible for the production of prostaglandins that cause inflammation. In contrast, the side effects of NSAIDs, such as gastric mucosa injury, impairment of blood flow through the kidneys and associated platelet function is the inhibition of COX-1 saline.

Most traditional NSAIDs (e.g. acetylsalicylic acid, indomethacin, diclofenac, naproxen, Ibuprom) to a similar extent inhibits the activity of COX-1 and COX-2. Newly developed NSAIDs are selective COX-2 inhibitors (rofecoxib, Celecoxib) for inhibiting COX-2 over 100 times more potent than COX-1. Some of the previously used NSAID, nimesulide, meloxicam or nabumetone have a higher affinity for COX-2, but smaller than the selective COX-2 blockers. Group these drugs zaliczmy to preferential inhibitors (or selective).

Indications for the use of NSAIDs

The most common indications are associated with the use of the fundamental mechanisms of action of the NSAID or analgesic effect, an antipyretic and anti-inflammatory.

Classical NSAIDs (aspirin, indomethacin, diclofenac, ibuprofen, naproxen) are used to treat a number of rheumatic diseases, such as rheumatoid arthritis, osteoarthritis, juvenile chronic arthritis, ankylosing spondylitis and other seronegative spondyloarthropathies, tendonitis and bursitis, and attacks of gout. The effectiveness of these drugs is estimated at 50-70%. It can also be used as analgesics in pain mild or moderate intensity eg dysmenorrhea. NSAID forms for external use may be used in the pains of muscles and joints, injuries and sprains. Use of a combination of menthol and chloral hydrate contributes positively to faster and deeper into the tissues. The indication for chronic use of NSAIDs preferentially or selectively blocking COX-2 are rheumatic diseases. Less and less severe side effects of these drugs increase the safety of the treatment. NSAIDs may be used in the treatment of cancer pain. Generally recognized standard pharmacological treatment is the three-stage analgesic ladder developed under the auspices of the WHO. NSAIDs are a group of simple analgesics administered alone or in combination with weak or strong opioids, often in combination with drugs such as anxiolytics complementary. It is also used to treat neuralgia, migraine headaches and painful periods. NSAIDs are among the most commonly used drugs for oral or topical analgesic in the procedure after surgery one day. Aspirin prevents production of thromboxane by inhibition of cyclooxygenase. This effect also takes place in the area of ​​the vascular endothelium. This effect is used in the prevention of cardiac and neurological. The use of aspirin at low doses reduces the risk of heart attack, stroke or sudden cardiac death. Experimental and epidemiological studies suggest the possibility of the use of NSAIDs in preventing colorectal cancer by affecting the system properly crafted nucleotides. Regular intake of non-steroidal anti-inflammatory drugs significantly reduced the risk of breast cancer. Epidemiological studies indicate the presence of the protective effect of ibuprofen for tumors occurring in men. Regular use of ibuprofen is associated with a reduction in the risk of prostate cancer by 66%. In recent years, also showed that daily treatment with non-steroidal anti-inflammatory drugs prevents occurrence of lung cancer in smokers. Non-steroidal anti-inflammatory drugs also protect against the occurrence of malignant melanoma. As shown, the effect is also maintained in the population of frequent users of sunbathing.

5 aminosalicylic acid (5-ASA) is used in the treatment of inflammatory bowel diseases (Crohn’s disease, ulcerative colitis). 5-ASA acts on the metabolism of arachidonic acid. The mechanism for this is not clear, as cyclooxygenase inhibitors do not affect the course of inflammation in non-specific inflammatory bowel disease.

Classical NSAIDs are used in the symptomatic treatment of respiratory infections by exploiting their antipyretic, analgesic and anti-inflammatory.

Popularity NSAIDs available without a prescription among patients increases the risk of improper use of medication and exposure to the occurrence of adverse symptoms. This requires practitioners to inform patients about the potential dangers of self-medication, especially prolonged.

Especially the lack of efficacy should encourage patients to self-medicate not to renew NSAIDs. The complaints resulted in the implementation of self-medication may be symptoms of serious illnesses that require different treatment of causal and symptomatic.

Selective COX-2 inhibitors are registered in Poland for the treatment of rheumatoid arthritis (RA) and osteoarthritis (OA). Compared to conventional NSAIDs has the same inflammatory and analgesic efficacy and better tolerance of the gastrointestinal tract, greater safety of use. Reducing the severity of the side effects associated with chronic NSAID treatment of RA and OA significantly reduces the cost of treating complications.

In order to reduce the risk of adverse effects it is important to comply with the indications for use and dosage of NSAIDs. Self-NSAIDs should be limited to incidental use of the drug in the treatment of pain, fever and respiratory infections. Chronic use of NSAIDs should be done only under medical supervision.