Indications
Arthritis
Bronchorrhea (see Bronchorrhea, [[Bronchorrhea]])
Dysmenorrhea (see Dysmenorrhea, [[Dysmenorrhea]])
Fever (see Fever, [[Fever]])
Pain
- Post-Operative Pain
- Soft Tissue/Musculoskeletal Injury
To Decrease the Risk of Malignancy
Contraindications
- Chronic Kidney Disease (CKD) (see Chronic Kidney Disease, [[Chronic Kidney Disease]])
- Due to Risk of Worsening Chronic Kidney Disease
- Chronic Liver Disease (see End-Stage Liver Disease, [[End-Stage Liver Disease]])
- Due to Frequent Co-Existing Chronic Kidney Disease (and Risk of Hepatorenal Syndrome) (see Hepatorenal Syndrome, [[Hepatorenal Syndrome]])
- Due to Risk of Gastrointestinal Hemorrhage (see Gastrointestinal Hemorrhage, [[Gastrointestinal Hemorrhage]])
Pharmacology
Metabolism
Administration
- PO: xxx
- INH (Bronchiectasis): xxx
Dose Adjustment
Adverse Effects
Endocrinologic Adverse Effects
Drug-Induced Hyporeninemic Hypoaldosteronism (see Hypoaldosteronism, [[Hypoaldosteronism]])
- Physiology
- Class effect, common to all NSAID’s
- Dose-dependent COX-inhibition -> decreased renal prostaglandin synthesis -> results in drug-induced hyporeninemic hypoaldosteronism
- Clinical
Gastrointestinal Adverse Effects
Peptic Ulcer Disease (PUD) (see Peptic Ulcer Disease, [[Peptic Ulcer Disease]])
- Physiology: class effect, common to all NSAID’s
Pulmonary Adverse Effects
Aspirin-Intolerant Asthma (see Asthma, [[Asthma]])
- Physiology: class effect, common to multiple NSAID’s
Drug-Induced Pulmonary Eosinophilia (see Drug-Induced Pulmonary Eosinophilia, [[Drug-Induced Pulmonary Eosinophilia]])
- Associated Agents
- Acetylsalicylic Acid (Aspirin) (see Acetylsalicylic Acid, [[Acetylsalicylic Acid]])
- Diclofenac (Aclonac, Cataflam, Voltaren) (see Diclofenac, [[Diclofenac]])
- Diflunisal (Dolobid)
- Fenbufen
- Fenoprofen (see Fenoprofen, [[Fenoprofen]]): case reports
- Ibuprofen (Advil, Brufen, Motrin, Nurofen) (see Ibuprofen, [[Ibuprofen]]): case reports
- Indomethacin (Indocin) (see Indomethacin, [[Indomethacin]])
- Loxoprofen
- Meloxicam (see Meloxicam, [[Meloxicam]])
- Naproxen (Naprosyn, Aleve) (see Naproxen, [[Naproxen]]): appears to be more frequent with naproxen than other NSAID’s
- Nimesulide
- Phenylbutazone
- Piroxicam (Feldene) (see Piroxicam, [[Piroxicam]])
- Pranoprofen
- Sulindac (Clinoril) (see Sulindac, [[Sulindac]]): case reports
- Tenidap
- Tiaprofenic Acid
- Tolfenamic Acid
- Diagnosis
- Lung Biopsy: poorly defined granulomas with infiltrating eosinophils
- Clinical
- Cough
- Dyspnea
- Fever
- Peripheral Eosinophilia
- Pulmonary Infiltrates
Renal Adverse Effects
Acute Kidney Injury (see Acute Kidney Injury, [[Acute Kidney Injury]])
Acute Interstitial Nephritis (see Acute Interstitial Nephritis, [[Acute Interstitial Nephritis]])
- Physiology: class effect, common to all NSAID’s
Hyperkalemia (see Hyperkalemia, [[Hyperkalemia]])
- Mechanism: due to drug-induced hyporeninemic hypoaldosteronism
Increased Renal Sodium Reabsorption with Peripheral Edema
- Risk Factors
- Advanced Age
- Diabetes Mellitus (see Diabetes Mellitus, [[Diabetes Mellitus]])
- Volume Contraction
- Physiology: decreased PGE2 -> increased renal sodium reabsorption
- Class Effect: common to all NSAID’s
- Dose-Dependent Effect
- Clinical: typically occurs during the first week of therapy
Type 4 Renal Tubular Acidosis (RTA) (see Type 4 Renal Tubular Acidosis, [[Type 4 Renal Tubular Acidosis]])
- Physiology: due to NSAID-induced hyporeninemic hypoaldosteronism
- Clinical
Other Adverse Effects
References