Pharmacology of NSAIDs and Corticosteroids

Treatment Overview

• NSAIDs: Ibuprofen, Naproxen, Diclofenac

  • Mechanism: Decrease inflammation and pain by inhibiting COX enzymes.
  • Benefits: Alleviate symptoms effectively.
  • Side Effects: Gastrointestinal irritation and potential renal complications with long-term use.

• Corticosteroid Injections

  • Indication: For severe or persistent inflammation.
  • Mechanism: Strong local anti-inflammatory effect by suppressing immune response.
  • Benefits: Reduce swelling and intense pain effectively.
  • Side Effects: Risk of local infections and tissue weakening at injection site.

• Rest and Physical Therapy

  • Benefits: Support healing and prevent recurrence of pain through reduced strain on affected areas.

Rhinitis

• Symptoms: Include runny nose, nasal congestion, sneezing, itchy sensations in nose/eyes/throat, and postnasal drip.

• Treatment Options:

  • Antihistamines: Loratadine, Cetirizine
    • Benefits: Alleviate sneezing and itchy sensations.
    • Side Effects: Drowsiness varies by medication type.
  • Corticosteroid Nasal Sprays: Fluticasone, Mometasone
    • Benefits: Decrease nasal congestion and reduce sneezing.
    • Side Effects: Nasal irritation and occasional nosebleeds.
  • Decongestants: Pseudoephedrine, Phenylephrine
    • Benefits: Target and alleviate congestion.
    • Side Effects: May increase blood pressure and cause insomnia.

Sinusitis

• Symptoms: Pain and swelling around sinuses, nasal congestion, thick discharge, headaches, reduced sense of smell/taste, fever, and cough.

• Treatment Options:

  • NSAIDs: Ibuprofen, Naproxen, Diclofenac
    • Benefits: Help relieve pain and symptoms.
  • Corticosteroid Nasal Sprays: Fluticasone, Budesonide
    • Benefits: Reduce swelling and congestion.
  • Antibiotics: Amoxicillin, Doxycycline
    • Benefits: Address bacterial infections effectively.
    • Side Effects: Potential GI upset and allergic reactions.
  • Decongestants: Pseudoephedrine, Phenylephrine
    • Benefits: Provide symptomatic relief from congestion.
  • Rest and Hydration
    • Benefits: Essential for effective recovery without side effects.

Postoperative Pain Management

• NSAIDs: Ibuprofen, Naproxen, Diclofenac, Aspirin

  • Mechanism: Inhibition of COX enzymes reduces prostaglandin production.
  • Benefits: Effective for mild to moderate pain and inflammation.
  • Considerations: Risk of GI irritation and bleeding; select carefully.

• Opioids: Morphine, Oxycodone

  • Mechanism: Bind to CNS opioid receptors, altering pain perception.
  • Benefits: Effective for moderate to severe pain management.
  • Side Effects: Sedation, constipation, and potential for dependence; administered intravenously or orally.

• Multimodal Analgesia

  • Strategy: Combines different pain medications to improve relief and minimize opioid use.
  • Examples: NSAIDs or acetaminophen with opioids for better control.

Chronic Pain Conditions

• Non-Opioid Analgesics: Acetaminophen, NSAIDs

  • Usage: First-line treatments for osteoarthritis and chronic low back pain.

• Vascular Response in Inflammation:

  • Vasodilation: Enhances blood flow to affected areas.
  • Increased Permeability: Facilitates entry of plasma proteins and leukocytes.

• Cellular Response:

  • Leukocyte Recruitment: Neutrophils and macrophages migrate to injury sites for cleanup.
  • Phagocytosis: Leukocytes engulf and destroy pathogens and debris.

Outcomes of Inflammation

• Resolution: Clearance of harmful stimuli and repair of tissues.
• Chronic Inflammation: Ongoing damage and repair if stimulus persists.
• Fibrosis: Excessive scar tissue formation from connective tissue deposition.
• Abscess Formation: Localized pus collection due to infection.

Types of Anti-Inflammatory Agents

• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Reduces inflammation via COX enzyme inhibition.
• Corticosteroids: Suppress inflammation and immune response.
• Disease-Modifying Anti-Rheumatic Drugs (DMARDs): Target underlying inflammation in chronic diseases.

Detailed NSAID Information

• Ibuprofen:

  • Brand Names: Advil, Profinal.
  • Uses: Pain relief for mild to moderate pain.
  • Dosage: 200-800 mg every 6-8 hours; Side Effects: GI irritation, renal impairment.

• Naproxen:

  • Brand Names: Napreben, Nopain DS.
  • Uses: Relieves arthritis and menstrual pain.
  • Dosage: 250-500 mg every 8-12 hours; Side Effects: Increased cardiovascular risk.

• Aspirin:

  • Brand Names: Aspicor, Aspicot.
  • Uses: Pain relief, anti-inflammatory, anti-platelet action.
  • Dosage: 325-650 mg every 4-6 hours; Side Effects: GI bleeding, Reye's syndrome in children.

• Diclofenac:

  • Brand Names: Voltaren, Cataflam.
  • Uses: Pain relief for various conditions.
  • Dosage: Depends on indication; Side Effects: GI bleeding, cardiovascular risks.

• Celecoxib:

  • Brand Names: Celebrex.
  • Uses: COX-2 selective, used for arthritis and pain relief.
  • Dosage: 100-200 mg once or twice daily; Side Effects: CV risks and contraindicated for sulfa allergy.

• Rofecoxib:

  • Brand Names: Vioxx.
  • Uses: COX-2 selective, similar to Celecoxib.
  • Dosage: Varies by condition; Side Effects: Increased heart attack/stroke risk, GI bleeding.

Corticosteroids

• Mechanism: Mimic cortisol effects, suppress inflammation and immune response.
• Effects: Bind to glucocorticoid receptors, regulate gene expression to influence inflammation, improve cell membrane stability to reduce inflammatory mediator release.