4.cp gs med book part 1Leurs effets sont essentiellement symptomatiques. La RMO parue au J. Il n'y a donc pas d'indication de ces inhibiteurs en pathologie ORL. Non-steroidal anti-inflammatory drugs NSAID belong to a variety of chemical classes with no common features except the absence of a steroid structure. Their primary effect is pain relief, but also with bulking carb cycling and inflamnatoire effects.
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Leurs effets sont essentiellement symptomatiques. La RMO parue au J. Il n'y a donc pas d'indication de ces inhibiteurs en pathologie ORL. Non-steroidal anti-inflammatory drugs NSAID belong to a variety of chemical classes with no common features except the absence of a steroid structure. Their primary effect is pain relief, but also with anti-pyretic and anti-inflammatory effects.
Basically prescribed for symptomatic relief, they do not have a curative effect on chronic disease processes. Inflammation basically results from the pro-algogenic and vascular effects of prostanoids. Their pro-algogenic effects are explained by sensitization of nociceptive nerve endings to the stimulating effect algogenic of kinins bradykinin , serotonin and histamine. In addition, production of prostanoids in the brain has a thermoregulatory effect.
COX-2 is an isoform predominantly expressed during the inflammatory process. COX-1 is implicated in the regulation of many physiological functions. It is classical to emphasize the interindividual variable anti-inflammatory and antalgesic effects of the different NSAID without developing a coherent explanation. In addition, it is very difficult to make objective comparisons between different NSAID because of the different sizes of the study populations, indications and dosages.
There is no evidence favoring a given NSAID on the basis of its anti-inflammatory or antalgesic effect in a given indication ; no hierarchy in terms of efficacy can be established. This antalgesic, antipyretic drug has no anti-inflammatory action. Its mechanism of action remains to be fully elucidated. There does not appear to be any difference in the anti-pyretic efficacy between NSAID and paracetamol. It this light, the official indications in France published on November 14, concerning ENT disease in children and adults without risk factors is most noteworthy.
It is stipulated that there is no need to institute NSAID treatment at an anti-inflammatory dose in combination with general antibiotic therapy, except when there is an important inflammatory component. Selective inhibitors are only indicated in two chronic inflammatory diseases: There is no indication for these inhibitors in ENT disease.
The only beneficial effect that has been demonstrated to date for the use of selective inhibitors of COX-2 is better digestive tract tolerance. It is insufficient to warrant use of NSAID in this disease, particularly due to the efficacy of anti-H1 and local corticosteroids. However, local application of lysine aceytlsalicylate at progressive doses from 20 mg to 4 mg can reduce relapse by half after polypectomy. There is no proof of the efficacy of NSAID in chronic sinusitis and their efficacy has not been studied in laryngitis.
The choice is generally guided by the frequency and severity of undesirable effects. These undesirable effects often appear during the first weeks of treatment. Symptomatic gastroduodenal ulcers, digestive bleeding, and perforations are the most serious adverse effects of NSAID. Nevertheless, the risk of such complications, compared with the number of prescriptions, is very low. At high dose anti-inflammatory dose , age over 60 years and history of severe gastrointestinal complications are factors increasing the risk of severe gastorintestinal adverse effects of NSAID.
Minor adverse effects, and more importantly severe adverse effects, are significantly reduced with selective COX-2 inhibitors compared with classical NSAID. It is important to note that these beneficial effects in terms of tolerance are not better than with NSAID treatments except for treatments at anti-inflammatory doses for more than one week.
Selective COX-2 inhibitors would have the same adverse effect on the kidney as classical NSAID, as pointed out by the precautions for use published by the manufacturers. COX-2 is not expressed by platelets. Specific inhibitors do not inhibit platelet aggregation and do not lengthen bleeding time.
Specific inhibitors, like classical NSAID, are not recommended for women desiring pregnancy, especially because the risk of a teratogenic effect has not been excluded. Journal page Archives Contents list. Access to the text HTML. Access to the PDF text. Access to the full text of this article requires a subscription. If you are a subscriber, please sign in 'My Account' at the top right of the screen.
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