Nonsteroidal Antiinflammatory Drugs

G. Richard Bruno WaNace A. Carter

Pharmacodynamics Pharmacokinetics

Significant.,Druq-DrugJnteraction Warfarin

Diuretics. and Other .An.tih.yperten.sion. Agents Decrease ..Renaiciearance. .o.f.D.rygs

çiinicai..presentati.on.of..Toxicity Toxicity. ..of. . nsaids. . .at . Th,e,rape,w,$ic..D1oses Centrai.. .Nervous.. System puimonarySystem Gastrointestinal-Hepatic.. .System

Hepatic..System RenalSystem

Hematoiogicsystem Dermatoiogic. .System

Pregnancy

Presentation.of.Acute..Oyerdose

Centrai. .Nervous.. .System

Cardioyascuiar. System Eiectroiytes

Gastrointestinal-Hepatic.. .System RenaLFaiiure Treatment

LaboratoryEyaiuation

Decontamination.. and. .iEnhanced,..,Eiimination

Disposition..of..Patients..with..AcuteOyerdoses Prognosis

Chapter.. .References

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used and prescribed drugs in the United States. They are effective antipyretics, nonnarcotic analgesics, and anti-inflammatory agents. There are between 35 and 70 million NSAID prescriptions written in United States each year, and several agents are now available over the counter.1 The world market for NSAIDs is reported to be a 6 billion dollars per year industry. Given the tremendous use and easy availability of NSAIDs, they are relatively safe agents with respect to acute ingestion and overdose. The American Association of Poison Control Centers (AAPCC) reports 261,795 NSAID exposures resulting in 2130 major outcomes (life-threatening signs and symptoms or significant residual disability) and 26 deaths between

1992 and 1996. These cumulative data compare favorably to aspirin and acetaminophen, with fewer major outcomes and deaths per exposure ( Table 16.6.-1). The morbidity from NSAIDs in acute overdose is far overshadowed by complications of NSAIDs at therapeutic doses. It is estimated that NSAID-related gastrointestinal (GI) bleeding accounts for 7500 deaths and 75,000 hospitalizations annually in the United States. 2 NSAIDs have also be reported to account for a substantial proportion of drug-induced renal failure. This chapter reviews basic pharmacology of NSAIDs, significant interactions of NSAIDs with other drugs, side effects of chronic NSAIDs use, clinical presentation of acute overdose, and management of overdose.

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Dealing With Back Pain

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