课件：疼痛科常用药物.ppt

* Cyclooxygenase (COX) is the enzyme that converts arachidonic acid into various forms of prostaglandins. It exists in two distinct forms: COX-1 and COX-2.1 Nonspecific NSAIDs inhibit both forms of the enzyme, causing a beneficial decrease in pain and inflammation but an adverse alteration in normal body homeostasis1 COX-2 specific inhibitors were developed to inhibit only the COX-2 enzyme, resulting in a reduction in pain and inflammation without the degree of adverse effects that result from COX-1 inhibition1 Reference: 1. Needleman P, Isakson PC. The discovery and function of COX-2. J Rheumatol. 1997;24(Suppl 49):6-8. * The major problem with use of nonspecific NSAIDs is the occurrence of adverse events, which can limit their utilization in perioperative analgesia. Gastrointestinal: Gastropathy associated with the use of both Rx and OTC nonselective NSAIDs is the most frequent adverse drug event in the U.S. It was conservatively estimated that it is associated with approximately 16,500 deaths and 107,000 hospitalizations annually in patients with arthritis1 Hematologic: Hematologic reactions associated with nonspecific NSAIDs include inhibition of platelet aggregation and function, which can lead to an increased risk of bleeding and bruising2 Cardiorenal: Nonspecific NSAIDs can increase blood pressure and interfere with the blood pressure-lowering effects of certain antihypertensive agents, especially the ACE inhibitors, beta blockers, and diuretics.3 Because they inhibit renal prostaglandins, use of nonspecific NSAIDs can result in acute renal failure, fluid and electrolyte imbalances, exacerbation of chronic renal insufficiency, interstitial nephritis, and nephrotic syndrome4 References: 1. Singh G. Recent considerations in nonsteroidal anti-inflammatory drug gastropathy. Am J Med. 1998;105(1B):31S-38S. 2. Atcheson R, Rowbotham DJ. Pharmacology of acute and chronic pain. In: Rawal N, ed. Management of Acute and Chronic Pain. London, England: BMJ Books;