1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

2. NSAIDs - Effects
Anti-inflammatroy - inhibit synthesis of prostaglandins by blocking the cyclooxygenase (COX) enzyme
Types
COX –1 – found in stomach
COX –2 – found at injury site

3. Pain-Spasm Cycle Stimulus Release of Chemical Mediators
(Prostaglandins)
Pain
Cell Death
Spasm
Hypoxia

4. Anti-inflammatory Effects
Inhibits chemical mediator –
prostaglandin
Prostaglandin produces stomach mucosa
Inhibition of prostaglandin = less stomach mucosa = GI effects

5. NSAIDs – Other Effects Analgesic - decrease pain
Antipyretic - decrease fever
Anti-platelet - slows blood clotting (increases clotting time)

6. Anti-platelet Effects
Binds to COX-1 enzyme preventing production of thromboxane
Aspirin binds permanently
++ Decrease risk of heart attack & stroke
-- Discontinue before surgery
-- Bruising effects in athletes in contact sports

7. Aspirin (and other Salicylates)
acetylsalicylic acid
In US since 1899
Cheaper than other NSAIDS
Other uses
Prevent heart attack & strokes
Decrease risk of colon & G.I. cancer
Usually orally administered
Not banned …. but some combination products may be
No performance enhancing effect

8. Types of Aspirin Buffered aspirin
Antacids added to neutralize stomach acid & GI effects
Delayed release aspirin
Special coating delays dissolving action until in the small intestine
What is also delayed?
Aspirin with caffeine
Acts faster – enhances effects

9. Other Salicylates Choline salicylate (Arthropan) - liquid form
- less potent – need more
Magnesium salicylate (Doan’s)
- contains magnesium
Topical salicylates
- methyl salicylate (Icy Hot,
Ben-Gay)
- trolamine salicylate (Aspercreme)
Bismus Subsalicylate (Pepto Bismal)
Salsalate
- Disalcid is available only by Rx.

10. Dosing Recommendations
Normal dose
24 hr max
How long before effect?
Food
1st sign of OD
Children’s Aspirin
Reyes syndrome
10 days for pain / 3 days for fever

11. Dose Protocols Acetylsalicytic acid 650 mg. 4000 mg.
Every 4 hrs. 24 hr. max
Acetylsalicytic acid mg mg.
Choline salicylate mg mg.
Magnesium salicylate mg mg.
Children’s doses mg. Tablets / # determined by wt.
** initial loading dose of 975 mg. allowable but only one time!
** No more than 10 consecutive days!!

12. Aspirin Precautions More side effects than other NSAIDs Bruising
Not used w/ clotting disorders, etc
GI side effects
Nephrotoxicity
Not w/ Gout
Allergic Rxn OD
Decreases effect of antacid

13. Avoid Aspirin if…. Child/Adolescent Pregnant Low back pain
Bleeding disorders
Hx of GI problems
Long distance runners
Asthma
Kidney or liver problems

14. Avoid Aspirin in combo w/…
Anticoagulants
Corticosteroids
Other NSAIDS
Alcohol

15. Aspirin Guidelines for the ATC
Short term
Alcohol?
Recognize allergy / OD signs
Appropriate for …?
Reyes Syndrome
Before exercise
Runner’s bleed

16. Pros / Cons of Aspirin Very effective for mild – moderate pain relief
Decreases risk of heart disease
Has anti-inflammatory and analgesic effects
Cheap and accessible
GI effects
Very powerful anti-platelet effects
Nephrotoxicity
Allergic reactions
Reyes syndrome

17. Nonsalicylate NSAIDS Definition Table 4.1 and NSAID Handout
Differentiated by:
Availability - OTC vs prescription
Duration of action
Potency

18. Indications and Uses
Anti-inflammatory, analgesic, antipyretic, and anti-platelet
1st analgesic then anti-inflammatory
Mild to moderate pain, inflammation
Anti-platelet effect less pronounced

19. Indications (con’t)….. Act similar to salicylates in body
Not necessarily better than aspirin - but less side effects (Gentler on stomach)
Arthritis, menstrual cramps, etc

20. Administration Orally – pills vs liquid Ophthalmic Injection
Topicals – not in US
Analgesic vs. anti-inflammatory regime
Limit to 3 days for fever, 10 for pain

21. Dosing Protocols for OCT’s
***Stronger than aspirin so lower dose
Ibuprofen (Advil)
2 tablets (400 mg) every 4-6 hrs
Naproxen Sodium (Aleve)
1 tablet (220mg) every 8-12
Ketoprofen (Orudis KT)
1 tablet (12.5mg) every 4-6 hrs

22. Side Effects / Adverse Reactions
Similar to aspirin
Nephrotoxicity
Anaphylatic reaction
Overdose symptoms
Tinnitis, headache, nausea, dizziness
Toxicity
Breathing, irregular HB, tarry stools, hematuria, jaundice

23. Contraindications Aspirin intolerance Pregnancy
Don’t take if allergic to aspirin
In combination with
Corticosteroids, anticoagulants, aspirin, alcohol

24. Considerations for ATCs
Long term use?
Not on banned substances list
Does not interfere with energy metabolism
May have negative long term effect on collagen formation
Regular liver testing for….
Care with distance runners / alcohol
Use w/ PRICE