Nonsteroidal anti-inflammatory drugs are some of the most
prolifically prescribed and prolifically used drugs in the world.
They are used in inflammation and for pain. They also may be
used for a mild anti-fever or antipyretic effect,
and they've been used to inhibit polyp formation in patients
who have familial adenomatous polyposis.
The long term use of these medications actually reduces the
risk of colon cancer through an unknown mechanism.
Let's talk about some commonly used nonsteroidal
anti-inflammatory agents. Every single patient that you see
will have some kind of exposure to these drugs. So it's
important that you know them.
Ibuprofen is a low potency, short acting agent. Naproxen is a
low potency, long acting agent. Indomethacin is a medium potency.
And ketorolac, is a medium potency agent. Indomethacin and
ketorolac have greater anti-inflammatory effects
than the other two. And ketorolac is a very good anti-pain
medication. Side effects can occur with these medications.
Predominantly their uses include headache and acute pain. So
it depends on what type of pain you are describing.
That will generally determine what kind of anti-inflammatory
agent we're going to use.
Ibuprofen is used predominantly for headache and acute pain.
Naproxen is generally used for joint pain and gout.
Indocid or indomethacin is generally used for arthritis, and
that's severe arthritis. It can be used for pericarditis.
We use to use it 50 milligrams three times a day for
pericarditis. And ketorolac is a very potent arthritic medication.
And we also use it in athletes who have been injured. Now
remember that this ketorolac is the only agent that's available
in an IV or IM or subcutaneous form. So it's the only NSAID
available in parenteral form.
In terms of adverse events, they have a shorter duration of
antiplatelet effect than aspirin does.
However, the bleeding risk is almost the same as aspirin.
There is an increased GI toxicity with these patients,
and in fact you can still get reduced gastric mucoprotection
just like aspirin. There is a general consensus
though that they are not as bad as aspirin. There is an
increased renal risk, once again prostaglandin mediated
autoregulation issues can cause kidney function issues.
Remember this drug also is excreted via the kidney.
So patients who have chronic renal failure, are at risk for
toxicity from these pills.
Renal damage and GI damage can occur with high dose parenteral
ketorolac prescription. And that's usually after 72 hours.
So you have to watch these patients fairly closely. Now there
are some hematologic reactions associated with indomethacin.
So once again you have to look at blood work on these patients
that you're prescribing indomethacin to.