Facts on File Encyclopedia of Health and Medicine

well, the NSAID preparations are generally acids,
which further irritate stomach tissues.

Therapeutic Applications

Doctors prescribe or recommend NSAIDs for pain
relief and to reduce fever and inflammation, such
as from musculoskeletal injuries. NSAIDs have
widespread therapeutic applications and are
among the most commonly used medications in
the United States. Though all NSAIDs share the
same mechanism of action, some are more effec-
tive for specific conditions. Ibuprofen, naproxen,
and ketoprofen are effective for general relief.
Other NSAIDs more aggressively block COX, mak-
ing them especially useful for moderate
OSTEOARTHRITIS, RHEUMATOID ARTHRITIS, and inflam-
matory disorders such as SYSTEMIC LUPUS ERYTHE-
MATOSUS(SLE).
The original NSAID is aspirin, first isolated and
used as a therapeutic preparation in the late
1800s. Aspirin, a nonselective COX inhibitor,
remains the most commonly used medication in
the world, primarily for its ability to relieve pain
and fever. In the 1970s cardiologists began recom-
mending daily aspirin for people at high risk for
HEART ATTACK. During an inflammatory response
prostaglandins combine with other substances to
make the surfaces of platelets (clotting cells)
sticky. This encourages PLATELET AGGREGATION, the
first step of COAGULATION(clot formation). Blocking
prostaglandin synthesis reduces the likelihood for
BLOODclots to form in the blood vessels. This effect
is unique to aspirin among the NSAIDs; other
NSAIDs have only very mild antiplatelet effect.
In the late 1990s and early 2000s several selec-
tive COX-2 NSAIDs became available. These COX-
2 inhibitors had the ability to selectively target
and block only COX-2, allowing COX-1-mediated
prostaglandin synthesis to continue unimpeded
while preventing COX-2-mediated synthesis to
reduce inflammation. However, widespread use of
COX-2 inhibitors revealed that these medications
carried increased risk for heart attack, and several
were withdrawn from the US market. Nonselec-
tive (classic) NSAIDs do not appear to carry the
same risk, though may increase the risk for heart
attack in people who have recently had OPEN HEART
SURGERY.

People who have recently had OPEN

HEART SURGERYor HEART ATTACKshould

check with their doctors before taking

any nonsteroidal anti-inflammatory

drug (NSAID) preparation, including

cold and flu products that contain an

NSAID.

Risks and Side Effects

The most common risk of NSAIDs is gastric upset

and PEPTIC ULCER DISEASE. Extended use of an

NSAID diminishes the amount of prostaglandins

in the stomach, reducing the ability of the gastric

mucosa (stomach lining) to protect itself from the

acid normally present in the stomach as well as

the acid of the NSAID itself. Some NSAIDs have

more of this affect. Other common side effects

include allergic reaction and interaction with

other drugs. NSAIDs interact with numerous

drugs as well as with each other. TINNITUS(ringing

in the ears) is an early indication of excessive

NSAID consumption. Long-term, high-DOSE

NSAID use can cause permanent kidney and LIVER

damage and failure of these organs.

See alsoASPIRIN THERAPY; CORTICOSTEROID MEDICA-

TIONS; DISEASE-MODIFYING ANTIRHEUMATIC DRUGS

(DMARDS); DRUG INTERACTION; EAR; IMMUNOSUPPRES-

SIVE MEDICATIONS; KIDNEYS; LIVER FAILURE; MAST CELL;

PLATELET; RENAL FAILURE.

nose-associated lymphoid tissue (NALT)

Loosely organized collections of LY M P H tissue

embedded in the mucous membrane lining

(mucosa) of the nasal passages and sinus cavities.

Nasal mucous, which the nasal mucosa secretes, is

one of the body’s front-line protective mecha-

nisms, providing a physical barrier that repels or

traps foreign substances such as BACTERIA, viruses,

toxins, and inhaled particles. Many pathogens

gain entry to the body through the NOSE. NALT

contains numerous B-cell lymphocytes and T-cell

lymphocytes that detect and respond to invading

pathogens. Macrophages, eosinophils, and other

phagocytic cells are also concentrated in NALT to

clean up cellular debris that NALT traps or collects.

The mucous membrane lining of the nose is the

first point of contact for inhaled allergens. Its mast

nose-associated lymphoid tissue (NALT) 287