Home' Australian Pharmacist : Australian Pharmacist October 2016 Contents Australian Pharmacist October 2016 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
KEY LEARNING POINTS
COX-2 inhibitors, high doses of
diclofenac, and possibly ibuprofen
are associated with increased
High dose naproxen is safer than
many NSAIDs as it has less risk of
Administration of ibuprofen,
and other non-selective NSAIDs,
may interfere with aspirin’s
Use of NSAIDs should be avoided in
The lowest effective dose of NSAID
should be used for the shortest
duration of time, consistent with
individual patient goals. To reduce the
risk of cardiovascular events, alternate
therapies should be considered for
patients at high risk.
Where can I get more information
Further information is available at
the NPS MedicineWise webpage on
Nonsteroidal anti-inflammatory drugs
You explain to David that given his current
work situation and the fact that he is
taking amlodipine for his hypertension,
this means he is at risk of cardiovascular
adverse events with the long-term use
of an NSAID. Cardiovascular risk is
associated with conditions including
hypertension, hyperlipidaemia, diabetes
mellitus, or smoking. If he takes an NSAID,
this will put him at risk of having a higher
absolute incidence of thromboembolic
events due to his increased baseline
risk. His options include continuing with
physiotherapy and commencing on a
trial of paracetamol. If paracetamol
does not fully control his pain, and he
needs to use a NSAID, then naproxen
be appropriate. Diclofenac and COX-2
inhibitors should be avoided if possible.
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COUNSELLING IN PRACTICE
1. Which ONE of the following
statements is CORRECT?
a) The cardio-protective effect of low-dose
aspirin is not opposed by certain non-
b) NSAIDs may increase the effect of
ACEIs by blocking the vasodilator and
natriuretic effects of prostaglandins and
c) The risk of bleeding is decreased when
SSRIs are used in combination with
NSAIDs compared to when used alone.
d) Glucocorticoids increase the risk of
peptic ulcer diseases when combined
with NSAIDs compared to when used
2. The risk of vascular death was
reported to be the highest with
which set of NSAIDs according to a
a) Ibuprofen and diclofenac.
b) Diclofenac and naproxen.
c) Naproxen and ibuprofen.
d) COX-2 inhibitors and diclofenac.
3. Which NSAID is the safest to
prescribe for patients with an
increased CVD risk due to its lower
risk of cardiovascular events?
d) COX-2 inhibitors.
4. Which treatment for musculoskeletal
pain should be avoided in patients
with or at high risk of CVD?
b) Weak opioids.
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