疼痛科常用药物.ppt

**Cyclooxygenase(COX)istheenzymethatconvertsarachidonicacidintovariousformsofprostaglandins.Itexistsintwodistinctforms:COX-1andCOX-2.1NonspecificNSAIDsinhibitbothformsoftheenzyme,causingabeneficialdecreaseinpainandinflammationbutanadversealterationinnormalbodyhomeostasis1COX-2specificinhibitorsweredevelopedtoinhibitonlytheCOX-2enzyme,resultinginareductioninpainandinflammationwithoutthedegreeofadverseeffectsthatresultfrom

COX-1inhibition1Reference:1.NeedlemanP,IsaksonPC.ThediscoveryandfunctionofCOX-2.JRheumatol.1997;24(Suppl49):6-8.**ThemajorproblemwithuseofnonspecificNSAIDsistheoccurrenceofadverseevents,whichcanlimittheirutilizationinperioperativeanalgesia.Gastrointestinal:GastropathyassociatedwiththeuseofbothRxandOTCnonselectiveNSAIDsisthemostfrequentadversedrugeventintheU.S.Itwasconservativelyestimatedthatitisassociatedwithapproximately16,500deathsand107,000hospitalizationsannuallyinpatientswitharthritis1Hematologic:HematologicreactionsassociatedwithnonspecificNSAIDsincludeinhibitionofplateletaggregationandfunction,whichcanleadtoanincreasedriskofbleedingandbruising2Cardiorenal:NonspecificNSAIDscanincreasebloodpressureandinterferewiththebloodpressure-loweringeffectsofcertainantihypertensiveagents,especiallytheACEinhibitors,betablockers,anddiuretics.3Becausetheyinhibitrenalprostaglandins,useofnonspecificNSAIDscanresultinacuterenalfailure,fluidandelectrolyteimbalances,exacerbationofchronicrenalinsufficiency,interstitialnephritis,andnephroticsyndrome4References:1.SinghG.Recentconsiderationsinnonsteroidalanti-inflammatorydruggastropathy.AmJMed.1998;105(1B):31S-38S.2.AtchesonR,RowbothamDJ.Pharmacologyofacuteandchronicpain.In:RawalN,ed.ManagementofAcuteandChronicPain.London,England:BMJBoo