NSAID

PHARMAKOKINETICS PHARMAKODYNAMICS
CU AE CI DI
Metabol PB MOA Dose
SALICYLIC ACID
Aspirin Rapidly Salicylate Irreversible  HD: uricosuric ↓incidence of ischemic attack  Respi rate & depth ↓  Hemophilia  ↓conc: indomethacin,
hidrolyzed: acetic nonlinier inhibiton of  Kronic LD: Unstable angina  Alkalosis respi  krn PCO2  Tx preeclampsia naproxen, ketoprofen,
acid & salicylate bound to platelet COX: lower colon Ca Coronary artery thrombosis w ↓ – eclampsia fenoprofen
albumin anti platelet incidence myocardial infarction  Nephrotoxicity  Fever caused by  Antagonis of
efek last 8-10  <1000mg   Thrombosis after bypass grafting  Periferal vessel dilate viral inf in spironolactone-induced
days analgetic & Oral formulation  IBD , ulcerative  Pendrhn GIT children  reye natriuresis  antagonis
antipiretik colitis  Insulin like effect ↑sensi syndrome aldosteron
Least toxic  3-4g  Rectal enema  mild – moderate reseptor insulin  Blockade active transpor
antilinflamasi ulcerative colitis, procitis,  Ototoxic penicilin dr CSF k drh
Eliminasi: proctosigmoidistis
alkalinisasi  Rectal supository  active UC
 RA & ankylosing spondylitis
 Keratolytic action  fungal dkk
 Liniments
 <efektif for ankylosing spondytilytis
NONACETYLATED SALICYLATE
Celecoxib CYP2C9  COX2 selective  Asthma  Sulfonamide derivat  may   Warfarin  CYP2C9
Meloxicam inhibitor w/ bleeding tendency cause rash metabolism
 Inhibit vasc w/ renal dysfunction (close  AE GI ↓
endothelium supervision  No impact on platelet
prostacycline aggregation
synthesis  not  Renal toxicity (krn COX2 aktif
offer Cardio d ginjal)
protective effect  MELO: Fewer than
piroxicam, diclofenac,
naproxen
NON SELECTIVE COX INHIBITOR
Diclofenac  More liver func  IM adm  + misoprotol : GIU, diare
abnorm  + omeprazole: U bleeding, renal
ADR
 Opthalmic  Post op. Ophtalmic inflamm
prep
 Topical  Solar keratosis
 Oral mouth wash
Diflusinal  Not metab to salic  RA: 500-1000  Cancer pain w bone metastase
acid/ salicylate  Pain control in dental surgery
 Enterohepatic  RA
cycle
 Capacity limited
metabolism
 Renal klirens
flurbiprofen  Extensive hepatic  Topical  Intraoperative miosis inhibition
metabolism opthalmic
 IV  Minor preoperative analgesia

 Lozenge  Sore throat

Ibuprofen  Less fluid  PO<2400  Analgesic  Rare agranulocytosis &  Nasal polyp  Aspirin antagonizes
retention than  2400  Anti inflamm anemia aplastik  Angiodema irreversible plt induced
indomethacin  PO/IV  Closing PDA  Bronchospastic by Aspirin
 Least toxic reactivity to Decrease total anti
aspirin inflam effect
Indomethacin  Potent non  Opthalmic  Conjunctival inflamm, traumatic  Accelerated PDA
selective COX prep corneal abration reduce pain  Pancreatitits
inhibition  Oral rinse  Gingival inflam  Dizzines
 Inhibit: PLA & C  Epidural inj  Post laminectomy sy  Confusion
 Reduce netruphil  Depression
migration  Hallucination
 Decrease T & B  Great toxicity
cell proliferation
ketoprofen  (-) COX & LOX  GIT  (+)probenecid: elevates
 CNS ketiprofen level &
prolong HL
Ketolorac  IM  Systemic use analgesic. Not anti
inflam
 IV  Replace morphine in post op pain
 Oral  Reduce opioid dose
 Ophtalmic  Limited use (GI, renal SE)
prep
Nabumetone  HL: >24 hrs  Pseudophorphyria  Renal impairment
 Enterohepatic  Photosensitivity  doubling HL
cycle (-)
Naproxen  SR, oral susp,  Rheumatologic  alergic pneumonitis
topical,  leukocytoclastic
opthalmic sol  vasculitis
 OTC  GIT Bleedingibuprofen  ps.phorphyria
Piroxicam  HD: (-) PMN  Rheumatic  Peptic ulcer bleeding (9,5
migration & times other NSAID)
limfosit
function.
↓oxygen
radical prod
Sulindac  Enterohepatic  RD  Thrombositopenia
cycle  Agranulocytosis
 DOA 12-16 jam  Nephrotic sy
 Aminotransferase> 
cholestatic liver damage 
stop!