Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Oct 17 2023

Anti-inflammatory Medications

Images
https://upload.orthobullets.com/topic/9060/images/arach.jpg
https://upload.orthobullets.com/topic/9060/images/ulcer.jpg
  • Introduction
    • Non-steroidal anti-inflammatory drugs (NSAIDS) have the following effects
      • anti-inflammatory
      • antipyretic
      • analgesic
      • antiplatelet
    • Mechanism
      • inhibit the COX (cyclooxygenase) enzymes ultimately inhibiting the synthesis and release of prostaglandins
        • COX enzymes catalyze the formation of prostaglandins and thromboxane from arachidonic acid
      • There are two different COX enzymes targeted
        • COX inhibitors
          • target both COX-1 and COX-2
        • COX-2 specific inhibitors
          • target COX-2 alone and do not affect COX-1 function
    • Indications
      • pain
      • heterotopic ossfication prophylaxis
    • Contraindications
      • severe renal disease
      • gastric ulcers
  • COX Inhibitors
    • NSAIDS inhibit both COX-1 and COX-2
      • Aspirin (ASA)
        • salicylate that irreversibly binds a serine COX enzyme residue
        • half life >1 week
        • binds to COX and blocks active site
        • inhibits thromboxane A2 blocking platelet aggregation
      • ibuprofen
        • reversible competitive COX inhibitor
      • indomethacin
        • acts on the lipoxygenase side of the arachidonic metabolic pathway
        • inhibibits leukotriene inflammatory mediators
  • COX-2 Specific Inhibitors
    • Introduction
      • selectively target COX-2 enzymes and do not affect COX-1 function
        • examples
          • celecoxib (Celebrex)
          • rofecoxib (Vioxx)
    • Benefits
      • selective inhibition of COX-2 results in anti-inflammatory action without disrupting the beneficial effects of COX-1 (maintaining gastric mucosa, regulating renal blood flow, influencing platelet aggregation)
      • can be used in the perioperative period because they do not affect platelet function
      • no more efficacious in treating osteoarthritis than non-specific COX inhibitors
    • Side effects
      • cardiac toxicity
  • Side Effects
    • Renal dysfunction
    • Gastrointestinal side effects
      • pain and dyspepsia
      • peptic ulcer perforation, bleeding, or obstruction
        • 2% to 4% occurence in chronic users
      • risk factors
        • concurrent anticoagulant use (most important)
        • age >60 years
        • history of previous gastrointestinal disorder
    • Delayed fracture healing
      • animal fracture models have shown decreased endochondral ossification in the absence of a COX-2 enzyme
      • delayed union and nonunion due to inhibition of chondrogenic differentiation of mesenchymal stem cells
        • inhibit callus formation by inhibiting endochondral ossification
        • secondary bone healing more likely to be effected than primary bone healing
      • Increased risk with prolonged use, large doses, and adult patients
        • no effect demonstrated in pediatric fracture healing
    • Platelet dysfunction
    • Cardiac Toxicity
  • Corticosteroids (Systemic)
    • Steroid Dose Pack
      • efficacy
      • side effects
  • Corticosteroid Intra-articular-Injections
    • Efficacy
    • Side Effects
      • Local flare
      • Fat atrophy
      • Skin pigmentation changes
      • Facial flushing
Card
1 of 18
Question
1 of 11
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options