Action: Analgesic decreases prostaglandin formation. Prostaglandin allows bradykinin to be perceived as painful. Anti-inflammatory, prostaglandin increases capillary blood flow and permeability. There is decreased prostaglandin. Anti-pyretic, inhibits prostaglandin synthesis by hypothalamus which reduces temperature.
Use: Treat mild to moderate pain, fever, transient ischemic attacks, thromboembolic disorders, rheumatoid arthritis, rheumatic fever, osteoarthritis, gout (high dose), and treat and prophylaxis for myocardial infarction.
Dental Considerations: Local anesthesia with vasoconstrictor ok. Increased oral bleeding (chronic, high doses), headache, blood dyscrasias and tinnitus. If possible avoid one week prior to surgery. Pregnancy and lactation, no.
Medical Considerations: >10%; nausea, vomiting, dyspepsia, epigastric discomfort, heartburn. 1-10%; GI ulceration. 0.2% aspirin allergy; asthmatic syndrome, wheezing, bronchiolar constriction.
Medical Considerations: Other adverse reactions; coma, convulsion, stimulation, drowsiness, dizziness, confusion, flushing, hallucinations, rapid pulse, pulmonary edema, hepatitis, diarrhea and anorexia, hyperpnea, hearing loss, rash, urticaria, bruising, hypoglycemia, hyponatremia and hypokalemia.
Salicylate NSAIDs (continued)
Dental Drug Interactions: Increased bleeding risk oral anticoagulants. May reduce effect of other NSAIDs. Avoid corticosteroids and acetaminophen.
Medical Drug Interactions: Can cause toxicity of acetazolamide (CNS) and methotrexate (hepatic). Increased GI bleeding and complaints alcohol. Increased risk
bleeding valproic acid, dipyridamole. Increased toxicity lithium and zidovudine. Decreased effects of probenecid and sulfinpyrazone.
Contradictions: Don’t use if bleeding or platelet disorder, renal and hepatic dysfunction, ulcer disease and allergic to tartazine dye. Children <16 with chickenpox or flu symptoms (Reyes Syndrome). Use with caution in asthmatics.
Naproxen (Aleve, Anaprox, Naprosyn) Decreases effects of furosemide. Pregnancy B (D 3rd trimester). Also treat fever.
Ibuprofen (Advil, Motrin, Midol, Nuprin, Rufen) Juvenile rheumatoid arthritis, ankylosing spondylitis, acute migraine headache. Antiplatelet effect only lasts as long as drug in blood. Pregnancy B (D in 3rd trimester).
Acetic Acid derivative NSAIDs
Use: Mainly arthritis.
Dental & Medical Considerations: Same as other proprionics plus 1-10%; nervousness, itching, fluid retention. <1%; hypertension, congestive heart failure, arrhythmias, Erythema multiforme and toxic epidermal necrolysis.