TAILIEUCHUNG - EMERGENCY SEDATION AND PAIN MANAGEMENT - PART 3

Đồng thời sử dụng NSAID với các thuốc ức chế ACE có thể làm giảm chức năng thận và làm giảm tác dụng hạ huyết áp của chất ức chế ACE. Thuốc lợi tiểu. Tránh sử dụng thuốc NSAID ở bệnh nhân đang dùng thuốc lợi tiểu. | Pharmacology of Commonly Utilized Analgesic Agents 47 Table 8-2. Risk of GI effects of nonselective NSAIDS Lowest risk Ibuprofen 400 mg Intermediate risk Aspirin indomethacin naproxen sulindac ibuprofen 800 mg High risk Ketorolac tolmentin ketoprofen and piroxicam NSAIDs inhibit vasodilatory prostaglandins that increase renal flow and glomerular filtration rate and may cause renal ischemia and functional damage in volume-depleted patients. Sodium and water retention hypertension hyperkalemia and acute renal failure may also ensue especially in patients with congestive heart failure but have otherwise acceptable symptom control. Headache tinnitus drowsiness lightheadedness and mild dermatologic reactions are among the adverse effects that patients may report. Severe liver problems and bone marrow suppression have been reported but these occur rarely Table 8-3 . DRUG INTERACTIONS Oral anticoagulants. The antiplatelet effects of NSAIDs added to the anticoagulant properties of coumadin compound the risk of significant bleeding complications especially from GI ulcers. Furthermore NSAIDs displace protein-bound coumadin and cause subsequent increases in prothrombin time at a constant coumadin dose. Avoid adding NSAIDs to patients on warfarin. ACE inhibitors. Concurrent use of NSAIDs with ACE inhibitors may impair renal function and impair the antihypertensive effects of ACE inhibitors. Diuretics. Avoid using NSAIDs in patients who are taking diuretics. They have a greater risk of developing renal failure because of NSAID-mediated decreased renal blood flow. Also the natriuretic response to diuretics depends in part on prostaglandin-mediated vasodilatation. Glucocorticoids. Patients on corticosteroids will have increased risk of PUD. Addition of NSAIDs should be used cautiously if at all. Lithium. NSAIDs enhance lithium reabsorption and may directly reduce lithium excretion leading to increased lithium levels. Central nervous system CNS symptoms drowsiness confusion .

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