NONSTEROIDAL ANTI-INFLAMMATORY DRUGS TOXICITY

Course overview

AS A CLASS, NONSTEROIDAL ANTI-INFLAMMATORY DRUGS, COMMONLY ABBREVIATED AS NSAIDS, ARE CHEMICALLY VARIED, YET SHARE SIMILAR THERAPEUTIC AND ADVERSE EFFECTS. ALL DRUGS WITHIN THE CLASS WORK TO REDUCE INFLAMMATION, PAIN, AND FEVER THROUGH INHIBITION OF ENDOPEROXIDE SYNTHESIS ENZYMES, KNOWN AS CYCLOOXYGENASE (COX) ENZYMES. BOTH CYCLOOXYGENASE ISOZYMES, COX-1 AND COX-2, CONVERT ARACHIDONIC ACID INTO ITS ENDOPEROXIDE METABOLITES, WHICH INCLUDE PROSTACYCLIN, PROSTAGLANDINS, AND THROMBOXANE; THESE ALL HAVE DIVERSE BIOLOGIC ACTIVITY, RANGING FROM INFLAMMATION, SMOOTH MUSCLE TONE, AND THROMBOSIS. COX-1 IS CONSTITUTIVELY EXPRESSED AND IS CONSIDERED THE PRIMARY SOURCE OF PROSTANOIDS NEEDED FOR PHYSIOLOGIC HOMEOSTASES, SUCH AS PROTECTION OF GASTRIC EPITHELIUM. COX-2, ON THE OTHER HAND, IS INDUCIBLE, AND ITS PRODUCTION OF PROSTANOIDS IS SIGNIFICANTLY UPREGULATED DURING CONDITIONS OF STRESS AND INFLAMMATION. NSAIDS CAN ALSO RESULT IN TOXICITY BY THE SAME PHARMACOLOGY THAT MAKES THEM SO EFFECTIVE THERAPEUTICALLY. THIS ACTIVITY REVIEWS THE ETIOLOGY, PRESENTATION, EVALUATION, AND MANAGEMENT OF NSAID TOXICITY AND REVIEWS THE ROLE OF THE INTERPROFESSIONAL TEAM IN EVALUATING, DIAGNOSING, AND MANAGING THE CONDITION.