2112 Nonsteroidal antiinflammatory drugs NSAIDs

Pharmacology

NSAIDs are the mainstay of antirheumatic therapy. Pregnancy-related conditions such as premature labor, polyhydramnios, and pregnancy induced hypertension have also been indications for treatment with NSAIDs.

This group of medications includes many drugs, and the number is still growing, so it is impossible to review them all. The most commonly used are acemetacin, azapropazon, diclofenac, etofenamat, fenbufen, flufenamic acid, flurbiprofen, ibuprofen, indomethacin, indoprofen, hetoprofen, ketorolac, lonazolac, lornoxicam, mefenamic acid, meloxicam, nabumetone, naproxen, niflumic acid, nimesulide, piroxicam, proglumetacine, sulindac, suprofen, tenoxicam, and tiaprofenic acid. Many of these can be obtained over the counter. The principal mode of action of this comprehensive group of drugs rests on inhibition of the synthesis of the prostaglandins; most of the currently available compounds are non-selective inhibitors of cyclooxy-genase (COX), with an effect on the housekeeping COX-1 (inhibiting gastric, platelet and renal prostaglandin production), and COX-2, which is induced by inflammation. Meloxicam and nimesulide inhibit principally (but not selectively) COX-2. Most of these agents are reported to cross the placenta readily. Diclofenac has been shown in fetal tissues during the first trimester in concentrations similar to

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