Non-Steroidal Anti-Inflammatory Drugs

(NSAIDs)

Disediakan Oleh : Nassruto

1. Memberi definisi ‘Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)’.

2. Menyatakan tujuan/ indikasi ubat.3. Menyatakan dos dan contoh ubat.

OBJEKTIF

4. Menyatakan kaedah pemberian ubat.

5. Menyatakan tindakan ubat.6. Menerangkan kesan sampingan

dan kontraindikasi ubat.7. Memberikan nasihat spesifik

dalam pengambilan ubat.

• Sejenis ubat analgesic (non-narcotic)

• Tidak tergolong dalam kumpulan ubat steroid.

• Maka tidak menghasilkan kesan sampingan berkaitan steroid.

NSAIDs

• Walaupun bukan dari kumpulan steroid, NSAIDs mempunyai kesan • Anti-inflammatory• Analgesics• Antipyretics

• NSAIDs bertindak dengan menghalang penghasilan prostaglandin.

Tindakan ubat

• 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

• Maka dengan pengurangan prostaglandin, NSAIDs menghasilkan kesan:• Anti-Inflammatory• Analgesics• Antipyretics

• Relief of symptoms of- Osteoarthritis- Rheumatoid arthritis- Musculoskeletal disorders

• Mild to moderate pain relief• Primary dysmenorrhea• Fever reduction

General Indication

• Diclofenac sodium (Voltaren)

• Ibuprofen (Brufen)• Indomethacin (Indocid)

Contoh ubat

• Ketoprofen (Orudis)• Mefenamic Acid (Ponstan)• Naproxen (Naprosyn)• Piroxicam (Feldene)

1. Diclofenac sodium (Voltaren)

• Antipyretics• Analgesics• Anti-inflammatory

Tindakan

• Rheumatoid arthritis• Osteoarthritis• Spondylitis• Acute gout• Post operative inflammation

Indication

1(a). Diclofenac sodium 50mg tablet (Voltaren)

Category: B

• Rheumatoid & Osteoarthritis: • 100-150mg/d PO (divided

doses)• Spondylitis:

• 100-125mg/d PO (divided doses)

Dose

• 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

1(b). Diclofenac sodium 75mg/3ml Inj (Voltaren)

Category: A

• 75mg once daily IM• Severe cases: 75mg bd IM • Max 2 days

Dose

1(c). Diclofenac sodium 1% Emulgel (Voltaren)

Category: A

• Apply tds-qid & gently rub

Dose

1(c). Diclofenac sodium 12.5mg/ 25mg/ 50mg suppositories

(Voltaren)

Category: A

• Adult:• 75-150mg/day (divided dose)

• Peads 1-12 yr:• 12.5-25mg/day

Dose

2. Ibuprofen 200mg tablet(Brufen)

• Antipyretics• Analgesics• Anti-inflammatory

Tindakan

Category: B

• Mild to moderate pain• Rheumatic & Arthritis

disorders• Painful dysmenorrhea

Indication

• Adult: • 200-400mg tds• Max: 2.4g/day

• Peads: • 20-30mg/kg/day (divided

dose)

Dose

Note: Take this medicine after food

3. Indomethacin (Indocid)

• Antipyretics• Analgesics• Anti-inflammatory

Tindakan

• Rheumatoid arthritis• Spondylitis• Mild to moderate

osteoarthritis• Acute gouty arthritis• Acute shoulder pain

Indication

3(a). Indomethacin 25mg capsule

(Indocid)

Category: B

• Adult: • 50-200mg/day (divided dose)

• Peads: • Not recommended

Dose

Note: Take this medicine after food

3(b). Indomethacin 100mg suppository

(Indocid)

Category: B

• Adult: • 100mg ON

• Peads: • Not recommended

Dose

4. Ketoprofen (Orudis)

• Analgesics• Anti-inflammatory

Tindakan

• Mild to moderate pain• Rheumatoid disorders• Painful dysmenorrhea

Indication

4(a). Ketoprofen 100mg/2ml Inj

(Orudis)

Category: A*

• Adult: • 50-100mg q 4 hr deep IM• Max: 200mg/day for up to 3

days• Peads:

• Not recommeded

Dose

4(b). Ketoprofen 200mg Slow Release capsule

(Orudis)

Category: A

• Adult: • 100-200mg/day

• Peads: • Not recommeded

Dose

Note: Take this medicine after food

4(c). Ketoprofen 2.5% gel (Orudis)

Category: A

• Apply twice daily• Max: 20g/day

Dose

4(d). Ketoprofen 30mg transdermal patch (Orudis)

Category: A

• Apply 1 plaster to the affected area bd

Dose

5. Mefenamic Acid 250mg capsule/ tablet

(Ponstan)

Category: B

• Antipyretics• Analgesics• Anti-inflammatory

Tindakan

• Moderate pain (does not exceed 1 week)

Indication

• Adult: • 250-500mg tds PO (PRN)• Limits to 7 consecutive

days

Dose

Note: Take this medicine after food

• Peads > 6 months: • 6.5-25mg/kg tds-qid PO

(PRN)• Limits to 7 consecutive

days

Note: Take this medicine after food

6. Naproxen 250mg tablet (Naprosyn)

• Analgesics• Anti-inflammatory

Tindakan

Category: A

• Mild to moderate pain• Rheumatoid arthritis• Osteoarthritis• Spondylitis• Acute gout

Indication

• Arthritis & spondylitis: • 500-1000mg/day (2 divided

dose)

Dose

• 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

7. Piroxicam 10mg capsule (Feldene)

• Analgesics• Anti-inflammatory

Tindakan

Category: A

• Mild to moderate pain• Rheumatoid arthritis• Osteoarthritis• Spondylitis• Acute gout• Primary dysmenorrhea

Indication

• 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

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

• Gastrointestinal: – Nausea– Vomiting– Diarrhea– Epigastric distress– Intestinal ulceration– GI bleeding

Kesan sampingan

• CNS: – Dizziness– Anxiety– Insomnia– Depression

• Renal: – Hematuria– Elevated blood urea

nitrogen

• Cardiovascular: – Congestive heart failure– Decreased or increased BP

• Hematologic: – Pancytopenia– Leukopenia– Thrombocytopenia– Aplastic anemia

• Skin: – Rash– Irritation– Skin eruption– Steven-Johnson syndrome

• Metabolic/ endocrinologic: – Decreased appetite– Weight increase or decrease– Menstrual disorders

• Special senses: – Visual disturbances– Blurred vision– Photophobia– Tinnitus– rhinitis

• Allergic to NSAIDs• Pregnancy• Lactation• Labor• Renal & hepatic impairment• Bleeding disorders

Contraindication

• Impaired hearing• Cardiovascular disease• GI condition• Hypertension• Elderly

Cautious

• Anti-coagulants, lithium– Risiko pendarahan

• Diuretics, anti-hypertensives– Kesan diuretics &

antihypertensives berkurang• Paracetamol (long-term)

– Renal impairment

Interactions

• Ubat diambil selepas sarapan (kurangkan GI symptom)

• Periksa simptom pendarahan salur GI (najis gelap)

• Elakkan pengambilan alkohol• Monitor berat badan selalu

(kehadiran edema)

Nasihat

• Lapor kepada pegawai perubatan & hentikan pengambilan ubat jika berlaku kesan sampingan seperti:– Vertigo, ruam, hematuria,

gangguan pendengaran & pengelihatan

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?