Paper I
2015 February (2010 Scheme) · 40 marks · 120 min

Question

Enumerate four groups of non-steroidal anti-inflammatory drugs with the example each. Describe the pharmacological actions, adverse effects and therapeutic uses of any one of them. (2+2+1+1=6)

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Answer

Four groups of NSAIDs with examples

  • Salicylates: Aspirin
  • Propionic acid derivatives: Ibuprofen, Naproxen
  • Acetic acid derivatives: Diclofenac, Indomethacin
  • Selective COX-2 inhibitors (coxibs): Celecoxib

Pharmacological actions, adverse effects and uses of Aspirin

Actions

  • Analgesic (moderate, peripherally acting)
  • Antipyretic
  • Anti-inflammatory (at higher doses)
  • Antiplatelet (low dose — irreversible COX-1 inhibition in platelets, preventing thromboxane A2 synthesis)
  • Uricosuric at high dose (uricosuric); uric acid retaining at low dose

Mechanism: Irreversibly inhibits cyclooxygenase (COX-1 and COX-2), blocking prostaglandin and thromboxane synthesis

Adverse effects

  • Gastric irritation/peptic ulceration, GI bleeding
  • Bronchospasm in aspirin-sensitive asthmatics
  • Reye’s syndrome in children with viral infections
  • Salicylism (tinnitus, vertigo) with chronic high-dose use
  • Bleeding tendency

Uses

  • Analgesic-antipyretic for mild-moderate pain, fever
  • Anti-inflammatory in rheumatic disorders (high dose)
  • Antiplatelet — secondary prevention of myocardial infarction/stroke (low dose)

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