Nesteroidni antireumatici

Palliative medicine takes care of terminally ill patients who cannot be cured. It cares for patients with progressive non-malignant diseases (. COPD, neurological diseases), patients with cancer, and patients in the terminal stage of life. Pain is the most common symptom that needs to be reduced or eliminated in order to improve the quality of life of patients and their families. Pharmacotherapy is the basis for the treatment of pain. In addition to the pharmacotherapy, non-pharmacological methods and procedures for the treatment of pain must be applied. For the treatment of pain, non-steroidal antirheumatics, non-opioid analgesics, coxibs, opioids and additional analgesics (anticonvulsants and antidepressants) are applied. It is necessary to take into account the health status of patients, the pharmacokinetics and pharmacodynamics of drugs, drug interactions and side effects when administering analgesics. Using a combination of drugs in lower doses, those having a different mechanism of action, pain can successfully be treated and the incidence of side effects reduced. Side effects should be prevented (. stool blockage, vomiting) and treated, thus facilitating the patients’ health condition. 

Glukokortikoidi su lijekovi za koje se dugo vremena smatralo da su teratogeni u trudnoi. Naime, prijasnje studije povezivale su ih s poveanom ucestalosu rascjepa usnica i nepca. Iako novije studije nisu pokazale poveanu ucestalost malformacija s uzimanjem navedenih lijekova, oni (i inhalacijski i sistemski) nose FDA kategoriju rizika C u trudnoi. Dvadesetogodisnja studija trudnica s aktivnim ulceroznim kolitisom lijecenih kortikosteroidima ili kortikosteroidima i sulfasalazinom nije pokazala poveanu ucestalost malformacija. Druga studija (531 trudnica lijecena kortikosteroidima zbog upalne bolesti crijeva) takoer nije pokazala veu ucestalost kongenitalnih malformacija. Neke studije ukazale su na mogunost poveane incidence novoroencadi niske poroajne tezine (npr. antenatalna primjena deksametazona zbog sazrijevanja fetalnih plua kod ocekivanih prijevremenih poroaja), a neonatalna adrenalna insuficijencija opisana je vrlo rijetko. Opisuje se i mogunost leukemoidne reakcije kod novoroenceta koja spontano prolazi u prvim tjednima zivota. Ovu grupu lijekova svakako treba primijeniti u trudnoi ukoliko za to postoji prava indikacija (npr. lijecenje astme inhalacijskim kortikosteroidima). (9,10,11)

Nesteroidni antireumatici

nesteroidni antireumatici

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