What is the traditional nsaids?

Non-steroidal anti-inflammatory drugs are a kind of anti-inflammatory drugs without steroid structure. Since aspirin was first synthesized in 1898, more than 100 non-steroidal anti-inflammatory drugs have been on the market. These drugs include aspirin, acetaminophen, indomethacin, naproxen, naproxen, diclofenac, ibuprofen, nimesulide, rofecoxib and celecoxib. These drugs have anti-inflammatory, anti-rheumatic, analgesic, antipyretic and anticoagulant effects, and are widely used in clinic to relieve osteoarthritis, rheumatoid arthritis, various fever and various pain symptoms. At present, NSAIDs are one of the most widely used drugs in the world. About 30 million people around the world use it every day. With the increasing use of non-steroidal anti-inflammatory drugs, the safe use of these drugs has attracted more and more attention from clinicians, pharmacists, patients, society and government. In particular, Merck announced on June 5438+00, 2004 that it would voluntarily withdraw Vioxx from the global market. Recently, the US Food and Drug Administration (FDA) thinks that NSAIDs have potential risks of cardiovascular and gastrointestinal bleeding, and requires these drug manufacturers to warn them in their instructions, which makes the safe use of NSAIDs a hot issue in the global medical community. Pharmacological action NSAIDs have different chemical structures, but they all exert antipyretic, analgesic and anti-inflammatory effects by inhibiting the synthesis of prostaglandin. 1. antipyretic effect Non-steroidal anti-inflammatory drugs play an antipyretic role by inhibiting the synthesis of central prostaglandin. These drugs can only lower the body temperature of patients with fever, but have no effect on normal body temperature. Febrile drugs are only symptomatic treatment, and the body temperature will rise again after the drugs are eliminated in the body. Therefore, patients with fever should pay attention to the etiology and treatment, and only use it when there is high fever. 2. Analgesic effect NSAIDs have moderate analgesic effect, and the analgesic effect is mainly in the periphery. It is ineffective for severe pain and visceral smooth muscle colic caused by various trauma. It has a good curative effect on chronic pain such as headache, joint muscle pain and toothache. During tissue injury or inflammation, pain-causing substances are locally produced and released, and prostaglandin synthesis increases. Prostaglandins increase the sensitivity of pain receptors to pain-causing substances and amplify inflammatory pain. At the same time, PGE 1, PGE2 and PGF2α are pain-causing substances, which cause pain. The analgesic mechanisms of NSAIDs are as follows: ① Inhibition of prostaglandin synthesis; ② Inhibit lymphocyte activity and activate the differentiation of T lymphocytes, and reduce the stimulation to afferent nerve endings; ③ Directly acting on nociceptors to prevent the formation and release of pain-causing substances. 3. Anti-inflammatory effects Most non-steroidal anti-inflammatory drugs have anti-inflammatory effects. NSAIDs play an anti-inflammatory role by inhibiting prostaglandin synthesis, leukocyte aggregation, bradykinin formation and platelet aggregation. The pharmacological mechanism of adverse reaction NSAIDs is mainly to inhibit cyclooxygenase, reduce the production of prostaglandin, and produce anti-inflammatory, analgesic and antipyretic effects. Like any other drugs, NSAIDs will also produce some harmful reactions that have nothing to do with the purpose of medication, that is, adverse drug reactions. The adverse reactions of NSAIDs are mainly manifested in the following aspects. (1) Adverse gastrointestinal reactions: indigestion symptoms such as epigastric discomfort, dull pain, nausea, vomiting, fullness, belching and loss of appetite may occur. About 10% ~ 25% of patients who take NSAIDs orally for a long time have peptic ulcer, and less than 1% of them have serious complications such as bleeding or perforation. (2) Adverse liver reactions: At the therapeutic dose, 65,438+00% patients may have biochemical abnormalities with mild liver injury, but the incidence of significant increase of alanine aminotransferase is less than 2%. (3) Adverse reactions of nervous system: headache, dizziness, tinnitus, deafness, amblyopia, lethargy, insomnia, paresthesia, numbness, etc. Some symptoms are uncommon, such as hyperactivity, excitement, hallucination, tremor and so on. And the incidence is generally less than 5%. (4) Adverse reaction of urinary system: it can cause urinary protein and cast, red blood cells and white blood cells can appear in urine, and in severe cases, it can cause interstitial nephritis. In a multicenter clinical study, the risk of renal disease in patients taking NSAIDs for a long time is 2. 1 times that of the general population. (5) Adverse reactions of blood system: Some NSAIDs can cause granulocytopenia, aplastic anemia and coagulation disorders. (6) Allergic reaction: People with specific physique may have allergic reactions such as rash, angioneurotic edema and asthma. (7) Adverse reactions of cardiovascular system: Some studies have found that non-steroidal anti-inflammatory drugs can obviously interfere with blood pressure and increase the average arterial pressure. It is also reported that the relative risk of cardiovascular events (such as heart attack and stroke) increases after taking rofecoxib 18 months. (8) Adverse reactions during pregnancy: NSAIDs are considered as a potential factor to induce acute fatty liver during pregnancy; Pregnant women taking aspirin can lead to bleeding before, after and during delivery; Indomethacin may cause some fetal short limb malformations and penile hypoplasia. Although non-steroidal anti-inflammatory drugs can cause the above-mentioned adverse reactions, most patients have mild adverse reactions when taking such drugs for a short time, which can be tolerated. After stopping taking them, the adverse reactions can disappear and will not affect the curative effect of such drugs. At present, many kinds of NSAIDs have been used as over-the-counter drugs (OTC), and patients can buy OTC varieties directly in pharmacies without a doctor's prescription. Therefore, it is necessary to remind patients of the safe use of non-steroidal anti-inflammatory drugs and understand the knowledge of safe use of non-steroidal anti-inflammatory drugs. Drug prevention In the actual use of NSAIDs, we should guard against adverse drug reactions from the following aspects. (1) Try to avoid unnecessary large doses and long-term use of NSAIDs. When long-term medication is needed, it should be used under the guidance of a doctor or pharmacist, and the possible damage to various systems, organs and tissues should be monitored during medication. When using OTC varieties, you should read the drug instructions carefully and use drugs in strict accordance with the dosage and course of treatment of the drug instructions. (2) NSAIDs should be banned or used with caution in the following situations: active peptic ulcer and recent gastrointestinal bleeding, allergic to aspirin or other NSAIDs, liver insufficiency, renal insufficiency, patients with severe hypertension and congestive heart failure, cytopenia, pregnant women and lactating women. (3) If there are any suspicious adverse reactions during the medication, stop taking the drug immediately, consult a doctor or pharmacist to decide whether to continue the medication, and deal with the adverse reactions appropriately if necessary. (4) It is not advisable to drink alcohol during medication, otherwise it will aggravate the stimulation to gastrointestinal mucosa. It is not advisable to use it with anticoagulants (such as warfarin) because it may increase the risk of bleeding. (5) It is not advisable to use two or more NSAIDs at the same time, because it will lead to the superposition of adverse reactions. Pay special attention to more than one drug, and drugs with the same chemical composition may appear under different commodity names to avoid repeated use. For example, acetaminophen, also known as paracetamol, has trade names such as Baifuning, Tylenol and Bilitong. Diclofenac, also known as diclofenac, has trade names of Yingtaiqing, Futalin, Dai Fen, Aobei and so on. (6) Don't blindly think that new drugs, imported drugs and high-priced varieties in NSAIDs have no potential safety hazards. New varieties of non-steroidal anti-inflammatory drugs are constantly on the market, often imported and expensive, but there are also some potential dangers. Merck announced on June 5438+00, 2004 that it would voluntarily withdraw Vioxx from the global market, which is a good example. (7) Faced with the hot issue of safe use of NSAIDs, patients need not worry too much about the increased risk of cardiovascular adverse events and gastrointestinal bleeding caused by NSAIDs. In the case reports and literature resources of adverse reactions of non-steroidal anti-inflammatory drugs in China, there are many adverse reactions involving digestive system, cardiovascular system, blood system and central nervous system, among which cardiovascular events and gastrointestinal bleeding account for a small proportion. Therefore, not all patients who have used NSAIDs are necessarily at risk of cardiovascular events and gastrointestinal bleeding. In a word, only doctors, pharmacists, patients and society pay close attention to the problem of safe drug use, insist on rational drug use, and try to avoid and reduce the harm of adverse drug reactions, can we really build a barrier to safe drug use.