Ağrı Tedavisinde Non-Steroid Antiinflamatuar İlaçlar
Özet
Ağrı, Uluslararası Ağrı Araştırmaları Derneği tarafından gerçek veya olası doku hasarıyla ilişkili ya da bu hasarla ilişkili deneyime benzeyen, hoş olmayan duyusal ve duygusal bir deneyim olarak tanımlanmaktadır. Patofizyolojik mekanizmasına göre nosiseptif, nöropatik ve nosiplastik olarak sınıflandırılan ağrı, akut veya kronik seyir gösterebilir. Non-steroid antiinflamatuvar ilaçlar (NSAİİ), analjezik, antiinflamatuvar ve antipiretik etkileri nedeniyle dünya genelinde en yaygın kullanılan ilaç grupları arasında yer almaktadır. Başlıca etki mekanizmaları, siklooksijenaz (COX) enzimlerini inhibe ederek prostaglandin sentezini azaltmalarına dayanır. COX-1 ve COX-2 izoformlarına yönelik seçicilik düzeyi, bu ilaçların terapötik etkileri ile gastrointestinal, kardiyovasküler, renal ve hematolojik güvenlilik profillerinin belirlenmesinde önemli rol oynamaktadır. Bu bölümde NSAİİ’ler, kimyasal yapıları ve COX seçicilikleri temelinde sınıflandırılmış; non-selektif ajanlardan ibuprofen, naproksen, diklofenak, indometazin ve piroksikam ile seçici COX-2 inhibitörlerinden selekoksib, etorikoksib ve parekoksibin etki mekanizmaları, klinik kullanım alanları, kontrendikasyonları ve advers etki profilleri ayrıntılı olarak ele alınmıştır. Ayrıca gebelik ve ileri yaş gibi özel hasta gruplarında NSAİİ kullanımına ilişkin güncel yaklaşımlar değerlendirilmiştir. NSAİİ tedavisinin, hastanın gastrointestinal, kardiyovasküler ve renal riskleri dikkate alınarak bireyselleştirilmesi; mümkün olan en düşük etkili dozun en kısa süreyle kullanılması ve tedavi süresince hastanın uygun şekilde izlenmesi gerekmektedir.
Pain is defined by the International Association for the Study of Pain as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. According to its pathophysiological mechanism, pain may be classified as nociceptive, neuropathic, or nociplastic and may follow an acute or chronic course. Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medications worldwide because of their analgesic, anti-inflammatory, and antipyretic effects. Their principal mechanism of action involves inhibition of cyclooxygenase (COX) enzymes, thereby reducing prostaglandin synthesis. The degree of selectivity for the COX-1 and COX-2 isoforms plays an important role in determining both the therapeutic effects and the gastrointestinal, cardiovascular, renal, and hematological safety profiles of these agents. In this chapter, NSAIDs are classified according to their chemical structure and COX selectivity. The mechanisms of action, clinical indications, contraindications, and adverse-effect profiles of the non-selective agents ibuprofen, naproxen, diclofenac, indomethacin, and piroxicam and the selective COX-2 inhibitors celecoxib, etoricoxib, and parecoxib are discussed in detail. Current approaches to NSAID use in special populations, including pregnant and older patients, are also evaluated. NSAID therapy should be individualized according to the patient’s gastrointestinal, cardiovascular, and renal risk profile, with the lowest effective dose administered for the shortest possible duration and appropriate monitoring maintained throughout treatment.
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