The use of non steroidal anti-inflammatory drugs in detail, these precautions need to be vigilant.
non steroidal anti-inflammatory drugs (NSAIDs), as the first-line drugs for the treatment of rheumatic diseases, are a large class of drugs without corticosteroids and have anti-inflammatory, antipyretic and analgesic effects.
NSAIDs play an important role in the treatment of ankylosing spondylitis, but there are still many questions about its rational use.
let's talk about it today.
medication principle: NSAIDs commonly used in the treatment of ankylosing spondylitis include aspirin, indomethacin, ibuprofen, diclofenac, loxoprofen sodium, nimesulide, meloxicam, lornoxicam, celecoxib, irecoxib, etocoxib, etc.
because each patient's tolerance and efficacy of different drugs are different and individual differences are relatively large, it is necessary to select the appropriate NSAIDs type, dosage form and dosage according to the patient's age, disease condition, complications, weight, treatment response, etc.
★ basic medication principles: ① the elderly often choose drugs with short half-life, and the dosage should be smaller to ensure safety; ② patients with severe disease activity and pain usually choose acemetacin and indomethacin, etc.; ③ if patients are accompanied with 2-3 gastrointestinal risk factors, they should add drugs to prevent gastric ulcer or use selective cyclooxygenase-2 (COX-2) If there is a renal risk factor, NSAIDs should be selected carefully.
when there are more than two kinds of renal risk factors, NSAIDs should be avoided; ⑤ only one NSAIDs should be selected; if the effect is not good after 2-4 weeks of full use, consider replacing another NSAIDs (each person has different sensitive drugs, there is no medicine for all diseases); 6) generally, do not use two kinds of NSAIDs at the same time, because the side effects will increase, but the curative effect will not increase (this principle) For example, in order to reduce the side effects of gastrointestinal tract, one kind of oral NSAIDs and alternate use of NSAIDs were selected.
medication time NSAIDs can be taken after meals when patients have swelling, swelling, pain and dysfunction of joints and soft tissues.
the half-life of NSAIDs is different. NSAIDs with short half-life are usually given enough three times. The pain of rheumatic patients mostly occurs from 12:00 midnight to 2:00 a.m. rational drug use can reduce the dosage in the morning, and can be taken once in the evening.
for example: loxoprofen sodium tablets, 1 tablet each time, 3 times a day; ibuprofen capsules, 1 capsule each time, once every 12 hours; celecoxib, 1 capsule each time, twice a day, etc.
side effects of NSAIDs. The most common adverse reactions of NSAIDs were gastrointestinal discomfort (including poor appetite, anorexia, abdominal pain, etc.), followed by liver and kidney dysfunction.
before and after treatment, patients should be regularly checked blood and urine routine, liver and kidney function, if there is obvious gastrointestinal discomfort or stool color black and other manifestations, should be timely to the hospital for examination.
] gastrointestinal injury, with a high incidence, mainly manifested as nausea, vomiting, epigastric pain, reflux esophagitis, etc.; renal damage, mainly nephritis, edema, when combined with diuretics and hormones, may increase the incidence of renal damage; liver damage, NSAIDs can cause varying degrees of liver damage, but rarely serious liver damage and jaundice.
in general, this kind of situation will not happen.
it is recommended to take it after meals (generally half an hour after meals), and drink appropriate water;]; allergic reaction, aspirin is often caused, and it is forbidden for asthma patients.
drugs with simple structure or without nitrogen should be selected as far as possible. Drugs with short half-life, such as naproxen and loxoprofen sodium, should be selected; suppository, cream, flurbiprofen cataplasm can be used.
how to deal with gastrointestinal injury? The most common adverse reaction of NSAIDs is gastrointestinal reaction, but it can be completely avoided. As a first-line drug for the treatment of rheumatic diseases, we should weigh the advantages and disadvantages.
① use drugs with small gastrointestinal irritation, such as intestinal solvent, sustained-release agent, suppository, cream, clorbiprofen cataplasm, etc.; ② precursor drugs, as inactive drugs, are transformed into active drugs in vivo after gastrointestinal absorption, and can be used as the first choice for patients with severe gastrointestinal disorders (such as ibuprofen, loxoprofen sodium, etc.); ③ selective forefront Adenoids (pain causing substances) synthesis inhibitors have strong inhibitory effect on prostaglandin synthesis in inflammatory sites, but have little damage to gastrointestinal tract and kidney (ibuprofen, naproxen, etc.); ④ using COX-2 inhibitors, gastrointestinal tract stimulation is very small (such as celecoxib, etocoxib, etc.).
are NSAIDs analgesic or therapeutic? Many patients with ankylosing spondylitis only take medicine when they have low back pain. Especially, they have a wrong understanding of NSAIDs such as acemetacin, diclofenac sodium, ibuprofen and so on. They think that they are a kind of "painkiller", which can only relieve pain and is not conducive to the improvement of the disease itself. Moreover, long-term use of NSAIDs will be "addictive".
this is because many patients are still confused about anti-inflammatory drugs and painkillers.
first of all, we should clarify two points: 1. NSAIDs are not addictive. Painkillers have different degrees of addiction.
in our daily life, we often refer to the drugs that act on the central nervous system and relieve various kinds of pain, including narcotic analgesics and non narcotic analgesics (the representative drug of the former is morphine).
as long-term use of analgesics / analgesics is easy to lead to dependence (commonly known as addiction), so this kind of drugs belong to the national control drugs, and their clinical use is very strict.
and what we call NSAIDs is by no means a simple analgesic.
when there is inflammation in the human body, many inflammatory factors can be produced, which can lead to red, swelling, heat, pain, dysfunction of joints and surrounding soft tissues.
generally speaking, such drugs can block the production of pain causing factors, so as to achieve anti-inflammatory, antipyretic and analgesic effects.
NSAIDs are suitable for all kinds of acute and chronic arthritis, soft tissue rheumatism, pain, sports injury and fever caused by various diseases.