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Non-Steroidal Anti-

Inflammatory Drugs
(NSAIDs)

Disediakan Oleh : Nassruto


OBJEKTIF

1. Memberi definisi ‘Non-Steroidal


Anti-Inflammatory Drugs
(NSAIDs)’.
2. Menyatakan tujuan/ indikasi ubat.
3. Menyatakan dos dan contoh ubat.
4. Menyatakan kaedah pemberian
ubat.
5. Menyatakan tindakan ubat.
6. Menerangkan kesan sampingan
dan kontraindikasi ubat.
7. Memberikan nasihat spesifik
dalam pengambilan ubat.
NSAIDs
• Sejenis ubat analgesic (non-
narcotic)
• Tidak tergolong dalam
kumpulan ubat steroid.
• Maka tidak menghasilkan
kesan sampingan berkaitan
steroid.
• Walaupun bukan dari
kumpulan steroid, NSAIDs
mempunyai kesan
• Anti-inflammatory
• Analgesics
• Antipyretics
Tindakan ubat

• NSAIDs bertindak dengan


menghalang penghasilan
prostaglandin.
• Prostaglandin:
– A group of naturally
occurring fatty acids that
act within the body to:
• Regulate acid secretion in
stomach
• Regulate body temperature
• Regulate platelet aggregation
• Control inflammation
• Maka dengan pengurangan
prostaglandin, NSAIDs
menghasilkan kesan:
• Anti-Inflammatory
• Analgesics
• Antipyretics
General Indication
• Relief of symptoms of
- Osteoarthritis
- Rheumatoid arthritis
- Musculoskeletal disorders
• Mild to moderate pain relief
• Primary dysmenorrhea
• Fever reduction
Contoh ubat

• Diclofenac sodium
(Voltaren)
• Ibuprofen (Brufen)
• Indomethacin (Indocid)
• Ketoprofen (Orudis)
• Mefenamic Acid (Ponstan)
• Naproxen (Naprosyn)
• Piroxicam (Feldene)
1. Diclofenac sodium
(Voltaren)

Tindakan
• Antipyretics
• Analgesics
• Anti-inflammatory
Indication

• Rheumatoid arthritis
• Osteoarthritis
• Spondylitis
• Acute gout
• Post operative inflammation
1(a). Diclofenac sodium
50mg tablet
(Voltaren)
Category: B
Dose

• Rheumatoid & Osteoarthritis:


• 100-150mg/d PO (divided
doses)
• Spondylitis:
• 100-125mg/d PO (divided
doses)
• Long term:
• 75-100mg/day PO (2-3 divided
doses)
• Max: 150mg/day
• Peads > 1yr:
• 1-3mg/kg/day (divided dose)

Note: Take this medicine after food


1(b). Diclofenac sodium
75mg/3ml Inj
(Voltaren)
Category: A
Dose
• 75mg once daily IM
• Severe cases: 75mg bd IM
• Max 2 days
1(c). Diclofenac sodium
1% Emulgel
(Voltaren)
Category: A

Dose
• Apply tds-qid & gently rub
1(c). Diclofenac sodium
12.5mg/ 25mg/ 50mg suppositories
(Voltaren)
Category: A
Dose
• Adult:
• 75-150mg/day (divided dose)
• Peads 1-12 yr:
• 12.5-25mg/day
2. Ibuprofen 200mg tablet
(Brufen)
Category: B

Tindakan
• Antipyretics
• Analgesics
• Anti-inflammatory
Indication

• Mild to moderate pain


• Rheumatic & Arthritis
disorders
• Painful dysmenorrhea
Dose
• Adult:
• 200-400mg tds
• Max: 2.4g/day
• Peads:
• 20-30mg/kg/day (divided
dose)

Note: Take this medicine after food


3. Indomethacin
(Indocid)

Tindakan
• Antipyretics
• Analgesics
• Anti-inflammatory
Indication
• Rheumatoid arthritis
• Spondylitis
• Mild to moderate
osteoarthritis
• Acute gouty arthritis
• Acute shoulder pain
3(a). Indomethacin
25mg capsule
(Indocid)

Category: B
Dose
• Adult:
• 50-200mg/day (divided dose)
• Peads:
• Not recommended

Note: Take this medicine after food


3(b). Indomethacin
100mg suppository
(Indocid)

Category: B
Dose
• Adult:
• 100mg ON
• Peads:
• Not recommended
4. Ketoprofen
(Orudis)

Tindakan
• Analgesics
• Anti-inflammatory
Indication

• Mild to moderate pain


• Rheumatoid disorders
• Painful dysmenorrhea
4(a). Ketoprofen
100mg/2ml Inj
(Orudis)
Category: A*
Dose
• Adult:
• 50-100mg q 4 hr deep IM
• Max: 200mg/day for up to 3
days
• Peads:
• Not recommeded
4(b). Ketoprofen
200mg Slow Release capsule
(Orudis)
Category: A
Dose
• Adult:
• 100-200mg/day
• Peads:
• Not recommeded

Note: Take this medicine after food


4(c). Ketoprofen
2.5% gel (Orudis)

Category: A

Dose
• Apply twice daily
• Max: 20g/day
4(d). Ketoprofen
30mg transdermal patch (Orudis)

Category: A

Dose
• Apply 1 plaster to the
affected area bd
5. Mefenamic Acid
250mg capsule/ tablet
(Ponstan)
Category: B
Tindakan
• Antipyretics
• Analgesics
• Anti-inflammatory
Indication

• Moderate pain (does


not exceed 1 week)
Dose
• Adult:
• 250-500mg tds PO (PRN)
• Limits to 7 consecutive
days

Note: Take this medicine after food


• Peads > 6 months:
• 6.5-25mg/kg tds-qid PO
(PRN)
• Limits to 7 consecutive
days

Note: Take this medicine after food


6. Naproxen 250mg tablet
(Naprosyn)
Category: A

Tindakan
• Analgesics
• Anti-inflammatory
Indication

• Mild to moderate pain


• Rheumatoid arthritis
• Osteoarthritis
• Spondylitis
• Acute gout
Dose

• Arthritis & spondylitis:


• 500-1000mg/day (2 divided
dose)
• Acute gout:
• Initial: 750mg then 250mg q 8
hr (jika perlu)
• Musculoskeletal disorders &
dysmenorrhea:
• Initial: 500mg the 250mg q 6-8
hr (jika perlu)

Note: Take this medicine after food


7. Piroxicam 10mg capsule
(Feldene)
Category: A

Tindakan
• Analgesics
• Anti-inflammatory
Indication
• Mild to moderate pain
• Rheumatoid arthritis
• Osteoarthritis
• Spondylitis
• Acute gout
• Primary dysmenorrhea
Dose
• Arthritis & spondylitis:
• 20mg/day
• Maintenance: 10-30mg/day
(single or divided dose)

• Acute gout:
• 40mg/day (single or divided
dose) for 4-6 days
• Musculoskeletal disorders:
• 40mg/day (single dose or
divided dose) for 2 days
• Then 20mg/day for 7-14
days

Note: Take this medicine after food


Kesan sampingan
• Gastrointestinal:
– Nausea
– Vomiting
– Diarrhea
– Epigastric distress
– Intestinal ulceration
– GI bleeding
• CNS:
– Dizziness
– Anxiety
– Insomnia
– Depression

• Renal:
– Hematuria
– Elevated blood urea
nitrogen
• Cardiovascular:
– Congestive heart failure
– Decreased or increased BP

• Hematologic:
– Pancytopenia
– Leukopenia
– Thrombocytopenia
– Aplastic anemia
• Skin:
– Rash
– Irritation
– Skin eruption
– Steven-Johnson syndrome

• Metabolic/ endocrinologic:
– Decreased appetite
– Weight increase or decrease
– Menstrual disorders
• Special senses:
– Visual disturbances
– Blurred vision
– Photophobia
– Tinnitus
– rhinitis
Contraindication
• Allergic to NSAIDs
• Pregnancy
• Lactation
• Labor
• Renal & hepatic impairment
• Bleeding disorders
Cautious
• Impaired hearing
• Cardiovascular disease
• GI condition
• Hypertension
• Elderly
Interactions
• Anti-coagulants, lithium
– Risiko pendarahan
• Diuretics, anti-hypertensives
– Kesan diuretics &
antihypertensives berkurang
• Paracetamol (long-term)
– Renal impairment
Nasihat
• Ubat diambil selepas sarapan
(kurangkan GI symptom)
• Periksa simptom pendarahan
salur GI (najis gelap)
• Elakkan pengambilan alkohol
• Monitor berat badan selalu
(kehadiran edema)
• Lapor kepada pegawai
perubatan & hentikan
pengambilan ubat jika berlaku
kesan sampingan seperti:
– Vertigo, ruam, hematuria,
gangguan pendengaran &
pengelihatan
Soalan
1. Berikan definisi ubat NSAIDs?
2. Terangkan cara tindakan ubat
NSAIDs?
3. Senaraikan contoh ubat NSAIDs
dan indikasinya?
4. Nyatakan kesan sampingan dan
kontraindikasi ubat NSAIDs?