Author/Editor		Krčevski-Škvarč, Nevenka; Rozman-Marčič, Jasna; Ivanuša, Marijan
Title		Nekateri novejši pogledi na nesteroidne antirevmatike
Translated title		Some contemporary views on non-steroidal anti-inflammatory drugs
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 70, št. 7-8
Publication year		2001
Volume		str. 405-13
Language		slo
Abstract		Background. Non-steroidal anti-inflammatory drugs (NSAID) are important for the treatment of inflammation and pain. In equal doses these drugs provide more or less equal effects. As a result of the prostaglandin inhibition they cause gastrointestinal adverse effects, disturbances of kidney function and blood coagulation. Clinically significant are their gastrointestinal adverse effects, manifested as perforations, ulcerations and hemorrhages. Non-steroidal anti-inflammatory drugs differ in their potency of inhibition of two cyclooxygenase isoforms. Their adverse effects are primarily due to the inhibition of constitutive cyclooxygenase 1. Consequently, the treatment of choice is a less harmful nonsteroidal anti-inflammatory drug, which is a less potent inhibitor of cyclooxygenase 1. The newer drugs of the class of coxibs have a less potent effect on the gastrointestinal prostaglandins, so they cause fewer gastrointestinal adverse effects, however they inhibit the constitutive cyclooxygenase 2 in the kidneys. In this way they reduce prostaglandin synthesis and blood flow in the kidneys. Contraindications for their use are similar to those characteristic of conventional nonsteroidal anti-inflammatory drugs, especially heart and kidney failure, gastrointestinal ulcerations and bleeding, and inflammatory bowel disease. An additional new indication has been established for these drugs-treatment of familial adenomatous polyposis. Conclusions. The conventional nonsteroidal anti-inflammatory agents are relatively safe drugs when used in lower doses and for the shortest possible time. Safe use of these drugs is based on correct intake, careful selection of patients and protection of patients who present with risk factors for gastrointestinal adverse effects.
Summary		Izhodišča. Nesteroidne antirevmatike (NSAR) uporabljamo za zdravljenje vnetja in bolečine. Vsi so približno enako učinkoviti v enakovrednih odmerkih. Zaradi zaviranja prostaglandinov povzročajo neželene učinke na prebavilih, motnje v delovanju ledvic in strjevanju krvi. Klinično pomembni so neželeni učinki na prebavilih v obliki perforacij, razjed in krvavitev. Nesteroidni antirevmatiki se med seboj razlikujejo po jakosti zaviranja dveh izooblik ciklooksigenaze. Njihovi neželeni učinki nastanejo predvsem zaradi zaviranja konstitutivne ciklooksigenaze 1. Za zdravljenje zato izbiramo nesteroidni antirevmatik, ki manj zavira ciklooksigenazo 1 in je zato manj škodljiv. Novejša zdravila iz skupine koksibov imajo manjši vpliv na prostaglandine v prebavilih, zato povzročajo manj neželenih učinkov na prebavilih. Zavirajo pa konstitutivno ciklooksigenazo 2 v ledvicah, zato zmanjšajo sintezo prostaglandinov in pretok krvi v ledvicah. Kontraindikacije za njihovo uporabo so podobne kontraindikacijam za konvencionalne nesteroidne antirevmatike, predvsem srčna in ledvična okvara, razjede in krvavitve iz prebavil in vnetna črevesna bolezen. Za ta zdravila so ugotovili tudi novo indikacijo: zdravljenje adenomatozne polipoze. Zaključki. Konvencionalni nesteroidni antirevmatiki so relativno varna zdravila, če jih uporabljamo v manjših odmerkih čim krajši čas. Varna uporaba teh zdravil je zasnovana na pravilnem jemanju, pravilni izbiri bolnikov in zaščiti bolnikov z dejavniki ogrožanja za nastanek stranskih učinkov na prebavilih.
Descriptors		ANTI-INFLAMMATORY AGENTS, NON-STEROIDAL GASTROINTESTINAL SYSTEM CYCLOOXYGENASE INHIBITORS STOMACH DISEASES DUODENAL DISEASES ASPIRIN RISK FACTORS ALCOHOL DRINKING SMOKING HELICOBACTER PYLORI KIDNEY DISEASES THROMBOSIS