1. IV. Relevance to Physical Therapy Practice
1.1. Symptomatic relief from pain and swelling in chronic joint disease and in acute inflammatory conditions
1.1.1. If you are trying to get patients to get started in movement & exercise in moderate MSK pain, this is helpful both before, as well as after exercise.
1.1.2. However, keep in mind, that pain is protective. So, suppression of pain before exercise may lead to inadvertent injury
1.1.3. Symptomatic Fatigue Observed with Mobility & Exercise must be counter-checked against gastric symptoms - Check Hemoglobin if Labs available
1.2. Anti-thrombotic therapy for vascular prophylaxis & treatment
1.2.1. This also lends to risk of undue bleeding - Patient will not stop bleeding from cuts or injuries
1.2.2. May develop hemorrhagic events e.g. Gastrointestinal Bleeding (as evidenced by Melena & low Hemoglobin). So, check hemoglobin if patient c/o fatigue &/or weakness
2. I. Mechanism of Action - Blocks Prostaglandin Synthesis
2.1. Works by Blocking Normal Prostaglandin Synthesis - Prostaglandins are strange - they are responsible for somatic pain, but they also have cardioprotective and GI protective effects
3. Back to Analgesics
4. How to Use this Mind-map
4.1. Numbered Progression
4.2. Use embedded links to get a more in-depth understanding
4.3. See the PT Relevance Section
4.4. A Quizlet link is provided
4.5. This is a sub-Mind-map for Analgesics - When done here, return to Analgesics using link at bottom
5. QUIZLETS on NSAIDs:
5.1. 1 -
5.2. 2 -
5.3. 3 -
6. II. Effects
6.1. Anti-inflammatory
6.1.1. Inhibition of prostaglandin production
6.2. Anti-pyretic
6.2.1. Decrease production of the prostaglandins that sensitise nociceptors to inflammatory mediators such as bradykinin
6.3. Analgesic
6.3.1. Decrease in prostaglandin E2 and prostacyclin reduces vasodilation and, indirectly, oedema
6.4. Anti-platelet Activity
6.4.1. Reduces platelet aggregation
7. III. Side effects
7.1. Loss of Prostaglandin Protection against acid in stomach
7.1.1. Gastric Irritation
7.1.2. Gastric Ulcers
7.1.2.1. Upper GI Bleeding
7.1.2.1.1. Low Hemoglobin
7.1.2.1.2. Melena
7.2. COX-2 Inhibitors > COX-1 Inhibitors - Increased likelihood for platelet aggregation and vasoconstriction
7.2.1. Cardiac & Vascular Complications
7.2.1.1. Myocardial infarction
7.2.1.2. Strokes
7.3. Renal Complications
7.3.1. Mostly Reversible on NSAID withdrawal
7.3.2. Rare Papillary Necrosis - NOT reversible
7.4. Occult Bleeding
7.4.1. Leads to Hemoglobin Drop
7.4.1.1. Fatigue & Exercise Intolerance
7.5. PICTURE SUMMARY OF SIDE-EFFECTS from NSAIDS - Check the normal role of Prostaglandins as a natural derivative of Arachidonic Acid. See how and where NSAIDS block this natural activity, thus causing the specific side-effects
7.5.1. nsaid_harm.png [TUSOM | Pharmwiki]