NON-STEROIDAL ANTI-INFLAMMATORY

DRUGS (NSAIDs)

PREPARED BY : VISHAL GOHIL (21) FINAL YR BDS

GUIDED BY : DR. VEENA PATEL DR. JIGAR JOSHI DR. NIMESH PATEL

VISHAL GOHIL

CONTENTS

•INTRODUCTION

•MECHANISM OF ACTION

•CLASSIFICATION

• THERAPEUTIC USES

• DOSES OF FEW DRUGS

• ADVERSE EFFECTS

•DENTAL CONSIDERATIONS

VISHAL GOHIL

NSAIDs• Non-steroidal anti-inflammatory

drugs• Large & chemically diverse group of

drugs with the following properties :

- Analgesic- Anti-inflammatory- Antipyretic

VISHAL GOHIL

• It inhibits cyclooxygenase ( COX ) enzymes, which is responsible for the formation of prostaglandins that promote pain & inflammation.

NSAIDs : Mechanism of Action

VISHAL GOHIL

NSAIDs : Mechanism of Action• Analgesic effect : Blocks the undesirable

effects of prostaglandin which causes pain.

• Anti-inflammatory effect : Inhibit the leukotriene pathway or the prostaglandin pathway or both.

• Antipyretic effect : Inhibit prostaglandin E2 ( dinoprostone ) within the area of the brain

that controls temperature

VISHAL GOHIL

CLASSIFICATION• A. Nonselective COX inhibitors ( traditional NSAIDs ) : 1. Salicylates : Aspirin 2. Propionic acid derivatives : Ibuprofen, Ketoprofen,

Naproxen 3. Anthranilic acid derivative : Mephenamic acid 4. Aryl-acetic acid derivatives : Diclofenac, Aceclofenac 5. Oxicam derivatives : Piroxicam, Tenoxicam 6. Pyrrolo-pyrrole derivative : Ketorolac 7. Indole derivative : Indomethacin 8. Pyrazolone derivatives : Phenylbutazone,

Oxyphenbutazone

VISHAL GOHIL

B. Preferential COX-2 inhibitors : Nimesulide, Meloxicam

C. Selective COX-2 inhibitors :Celecoxib, Etoricoxib

D. Analgesic - antipyretics with poor antiinflammatory action :

1. Paraaminophenol derivative : Paracetamol2. Pyrazolone derivatives : Metamizol3. Benzoxazocine derivative : Nefopam

VISHAL GOHIL

THERAPEUTIC USES• Relief of mild to moderate pain• Acute gout• Various bone, joint & muscle pain• Osteoarthritis• Rheumatoid arthritis• Juvenile rheumatoid arthritis• Dysmenorrhea

VISHAL GOHIL

VISHAL GOHIL

ADVERSE EFFECTS

Gastric irritation, erosions, peptic

ulceration, gastric bleeding/perforation,

esophagitis

NA+ & water retention, chronic

renal failure, interstitial nephritis,

papillary necrosis ( rare )

VISHAL GOHIL

Raised transaminases,

hepatic failure ( rare )

Headache, mental confusion,

behavioural disturbances,

seizure precipitation

Bleeding, thrombocytopenia, hemolytic anemia,

agranulocytosis

VISHAL GOHIL

OTHERS• Asthma exacerbation• Nasal polyposis : Soft, painless,

noncancerous growths on the lining of nasal passages or sinuses.

• Skin rashes• Pruritus : Severe itching of the skin• Angioedema : Rapid swelling of the

dermis, subcutaneous tissue, mucosa & submucosal tissues.

VISHAL GOHIL

DENTAL CONSIDERATIONS• If patient is allergic to any NSAID, you will have to avoid them.• Paracetamol is the safest NSAID.• Ibuprofen is contraindicated in asthma patients as it

causes bronchoconstriction. - It is not recommended for pregnant or nursing women.• If the patient is taking aspirin, then no surgery or even

simple extraction should be done. - As it can lead to profuse bleeding because of its

antiplatlet-action. Aspirin should be stopped before 7-10 days of any surgical procedure till 2-3 days after procedure.

- Young children are highly susceptible to aspirin poisoning (therapeutic overdose).

VISHAL GOHIL

REFERENCE• ESSENTIALS OF PHARMACOLOGY FOR

DENTISREY BY K D TRIPATHI 2ND EDITION

• BURKET’S ORAL MEDICINE 12TH EDITION

• TEXTBOOK OF ORAL & MAXILLOFACIAL SURGERY BY S M BALAJI 2ND EDITION

• WIKIPEDIA

VISHAL GOHIL

THANK YOU