NEKATERI NOVEJŠI POGLEDI NA NESTEROIDNE ANTIREVMATIKE

Avtorji

  • Nevenka Krčevski Škvarč Oddelek za anesteziologijo, intenzivno terapijo in terapijo bolečin, Učna bolnišnica Maribor, Ljubljanska 5, 2101 Maribor
  • Jasna Rozman Marčič Medicinsko-farmacevtski center, Krka d. d., Dunajska 65, 1000 Ljubljana
  • Marijan Ivanuša Medicinsko-farmacevtski center, Krka d. d., Dunajska 65, 1000 Ljubljana

Ključne besede:

nesteroidni antirevmatiki (NSAR), koksibi, ciklooksigenaza 1 (COX 1), ciklooksigenaza 2 (COX 2), delovanje, neželeni učinki

Povzetek

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.

Prenosi

Podatki o prenosih še niso na voljo.

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2017-04-16

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1.
NEKATERI NOVEJŠI POGLEDI NA NESTEROIDNE ANTIREVMATIKE. ZdravVestn [Internet]. 2017 Apr. 16 [cited 2024 Oct. 8];70(7-8). Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/2576