tailieunhanh - Thuốc chống viêm

Thuốc chống viêm không steroid (NSAIDs) là một trong những quy định hầu hết các đại lý dược trong y học. Khả năng của những loại thuốc này để giảm tình trạng viêm có liên quan đến tác dụng ức chế sự tổng hợp prostaglandin. Cơ chế này cũng có kết quả nhiễm độc có thể gây loét và chảy máu đường tiêu hóa | Nonsteroidal Anti-inflammatory Drugs Making the Right Choices Robert G. Berger MD Abstract Nonsteroidal anti-inflammatory drugs NSAIDs are among the most prescribed pharmacologic agents in medicine. The ability of these drugs to decrease inflammation is linked to their inhibitory effect on the synthesis of prostaglandins. This mechanism also results in toxicity that can cause gastrointestinal ulceration and bleeding renal failure and worsening of preexisting congestive heart failure. The superiority of one NSAID over another has not been clinically demonstrated in musculoskeletal conditions nor has the efficacy of NSAIDs in noninflammatory rheumatic conditions been shown to be better than that of simple analgesics such as acetaminophen. The use of these drugs particularly in the elderly patient with osteoarthritis should be carefully considered and alternative less toxic therapies should be sought whenever possible. J Am Acad Orthop Surg 1994 2 255-260 Physicians in the United States have more than 15 nonsteroidal antiinflammatory drugs NSAIDs in their arsenal of pharmacologic weapons against musculoskeletal ailments Table 1 . Which drug is the best for a given disease Which has the fewest side effects Should the latest agent be used simply because it is the newest Why are so many on the market anyway In this review I will try to answer these questions and will suggest an approach to the reasonable use of these drugs in rheumatic conditions. The following fictitious but common case-presentation scenarios will serve as a springboard for discussions of the efficacy toxicity and pharm a-cologic differences among the many NSAIDs. After reading the history for each scenario take a minute and jot down the pharmacologic agent you currently might recommend as first therapy. Then after reading the ens u-ing discussion decide whether your initial choice still seems appropriate. Scenario 1 History A 35-year-old woman presents with a 6-month history of symmetrical hand .