non-steroidal anti-inflammatory drugs (nsaids)
TRANSCRIPT
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Non-Steroidal Anti-Inflammatory Drugs
(NSAIDs)
Disediakan Oleh : Nassruto
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1. Memberi definisi ‘Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)’.
2. Menyatakan tujuan/ indikasi ubat.3. Menyatakan dos dan contoh ubat.
OBJEKTIF
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4. Menyatakan kaedah pemberian ubat.
5. Menyatakan tindakan ubat.6. Menerangkan kesan sampingan
dan kontraindikasi ubat.7. Memberikan nasihat spesifik
dalam pengambilan ubat.
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• Sejenis ubat analgesic (non-narcotic)
• Tidak tergolong dalam kumpulan ubat steroid.
• Maka tidak menghasilkan kesan sampingan berkaitan steroid.
NSAIDs
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• Walaupun bukan dari kumpulan steroid, NSAIDs mempunyai kesan • Anti-inflammatory• Analgesics• Antipyretics
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• NSAIDs bertindak dengan menghalang penghasilan prostaglandin.
Tindakan ubat
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• Prostaglandin:–A group of naturally
occurring fatty acids that act within the body to:• Regulate acid secretion in
stomach• Regulate body temperature• Regulate platelet aggregation• Control inflammation
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• Maka dengan pengurangan prostaglandin, NSAIDs menghasilkan kesan:• Anti-Inflammatory• Analgesics• Antipyretics
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• Relief of symptoms of- Osteoarthritis- Rheumatoid arthritis- Musculoskeletal disorders
• Mild to moderate pain relief• Primary dysmenorrhea• Fever reduction
General Indication
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• Diclofenac sodium (Voltaren)
• Ibuprofen (Brufen)• Indomethacin (Indocid)
Contoh ubat
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• Ketoprofen (Orudis)• Mefenamic Acid (Ponstan)• Naproxen (Naprosyn)• Piroxicam (Feldene)
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1. Diclofenac sodium (Voltaren)
• Antipyretics• Analgesics• Anti-inflammatory
Tindakan
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• Rheumatoid arthritis• Osteoarthritis• Spondylitis• Acute gout• Post operative inflammation
Indication
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1(a). Diclofenac sodium 50mg tablet (Voltaren)
Category: B
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• Rheumatoid & Osteoarthritis: • 100-150mg/d PO (divided
doses)• Spondylitis:
• 100-125mg/d PO (divided doses)
Dose
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• Long term: • 75-100mg/day PO (2-3 divided
doses)• Max: 150mg/day
• Peads > 1yr:• 1-3mg/kg/day (divided dose)
Note: Take this medicine after food
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1(b). Diclofenac sodium 75mg/3ml Inj (Voltaren)
Category: A
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• 75mg once daily IM• Severe cases: 75mg bd IM • Max 2 days
Dose
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1(c). Diclofenac sodium 1% Emulgel (Voltaren)
Category: A
• Apply tds-qid & gently rub
Dose
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1(c). Diclofenac sodium 12.5mg/ 25mg/ 50mg suppositories
(Voltaren)
Category: A
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• Adult:• 75-150mg/day (divided dose)
• Peads 1-12 yr:• 12.5-25mg/day
Dose
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2. Ibuprofen 200mg tablet(Brufen)
• Antipyretics• Analgesics• Anti-inflammatory
Tindakan
Category: B
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• Mild to moderate pain• Rheumatic & Arthritis
disorders• Painful dysmenorrhea
Indication
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• Adult: • 200-400mg tds• Max: 2.4g/day
• Peads: • 20-30mg/kg/day (divided
dose)
Dose
Note: Take this medicine after food
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3. Indomethacin (Indocid)
• Antipyretics• Analgesics• Anti-inflammatory
Tindakan
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• Rheumatoid arthritis• Spondylitis• Mild to moderate
osteoarthritis• Acute gouty arthritis• Acute shoulder pain
Indication
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3(a). Indomethacin 25mg capsule
(Indocid)
Category: B
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• Adult: • 50-200mg/day (divided dose)
• Peads: • Not recommended
Dose
Note: Take this medicine after food
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3(b). Indomethacin 100mg suppository
(Indocid)
Category: B
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• Adult: • 100mg ON
• Peads: • Not recommended
Dose
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4. Ketoprofen (Orudis)
• Analgesics• Anti-inflammatory
Tindakan
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• Mild to moderate pain• Rheumatoid disorders• Painful dysmenorrhea
Indication
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4(a). Ketoprofen 100mg/2ml Inj
(Orudis)
Category: A*
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• Adult: • 50-100mg q 4 hr deep IM• Max: 200mg/day for up to 3
days• Peads:
• Not recommeded
Dose
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4(b). Ketoprofen 200mg Slow Release capsule
(Orudis)
Category: A
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• Adult: • 100-200mg/day
• Peads: • Not recommeded
Dose
Note: Take this medicine after food
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4(c). Ketoprofen 2.5% gel (Orudis)
Category: A
• Apply twice daily• Max: 20g/day
Dose
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4(d). Ketoprofen 30mg transdermal patch (Orudis)
Category: A
• Apply 1 plaster to the affected area bd
Dose
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5. Mefenamic Acid 250mg capsule/ tablet
(Ponstan)
Category: B
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• Antipyretics• Analgesics• Anti-inflammatory
Tindakan
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• Moderate pain (does not exceed 1 week)
Indication
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• Adult: • 250-500mg tds PO (PRN)• Limits to 7 consecutive
days
Dose
Note: Take this medicine after food
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• Peads > 6 months: • 6.5-25mg/kg tds-qid PO
(PRN)• Limits to 7 consecutive
days
Note: Take this medicine after food
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6. Naproxen 250mg tablet (Naprosyn)
• Analgesics• Anti-inflammatory
Tindakan
Category: A
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• Mild to moderate pain• Rheumatoid arthritis• Osteoarthritis• Spondylitis• Acute gout
Indication
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• Arthritis & spondylitis: • 500-1000mg/day (2 divided
dose)
Dose
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• Acute gout: • Initial: 750mg then 250mg q 8
hr (jika perlu)• Musculoskeletal disorders &
dysmenorrhea: • Initial: 500mg the 250mg q 6-8
hr (jika perlu)
Note: Take this medicine after food
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7. Piroxicam 10mg capsule (Feldene)
• Analgesics• Anti-inflammatory
Tindakan
Category: A
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• Mild to moderate pain• Rheumatoid arthritis• Osteoarthritis• Spondylitis• Acute gout• Primary dysmenorrhea
Indication
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• Arthritis & spondylitis: • 20mg/day• Maintenance: 10-30mg/day
(single or divided dose)
Dose
• Acute gout: • 40mg/day (single or divided
dose) for 4-6 days
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Note: Take this medicine after food
• Musculoskeletal disorders: • 40mg/day (single dose or
divided dose) for 2 days• Then 20mg/day for 7-14
days
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• Gastrointestinal: – Nausea– Vomiting– Diarrhea– Epigastric distress– Intestinal ulceration– GI bleeding
Kesan sampingan
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• CNS: – Dizziness– Anxiety– Insomnia– Depression
• Renal: – Hematuria– Elevated blood urea
nitrogen
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• Cardiovascular: – Congestive heart failure– Decreased or increased BP
• Hematologic: – Pancytopenia– Leukopenia– Thrombocytopenia– Aplastic anemia
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• Skin: – Rash– Irritation– Skin eruption– Steven-Johnson syndrome
• Metabolic/ endocrinologic: – Decreased appetite– Weight increase or decrease– Menstrual disorders
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• Special senses: – Visual disturbances– Blurred vision– Photophobia– Tinnitus– rhinitis
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• Allergic to NSAIDs• Pregnancy• Lactation• Labor• Renal & hepatic impairment• Bleeding disorders
Contraindication
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• Impaired hearing• Cardiovascular disease• GI condition• Hypertension• Elderly
Cautious
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• Anti-coagulants, lithium– Risiko pendarahan
• Diuretics, anti-hypertensives– Kesan diuretics &
antihypertensives berkurang• Paracetamol (long-term)
– Renal impairment
Interactions
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• Ubat diambil selepas sarapan (kurangkan GI symptom)
• Periksa simptom pendarahan salur GI (najis gelap)
• Elakkan pengambilan alkohol• Monitor berat badan selalu
(kehadiran edema)
Nasihat
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• Lapor kepada pegawai perubatan & hentikan pengambilan ubat jika berlaku kesan sampingan seperti:– Vertigo, ruam, hematuria,
gangguan pendengaran & pengelihatan
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Soalan
1. Berikan definisi ubat NSAIDs?2. Terangkan cara tindakan ubat
NSAIDs?3. Senaraikan contoh ubat NSAIDs
dan indikasinya?4. Nyatakan kesan sampingan dan
kontraindikasi ubat NSAIDs?