AĞRI VE NON-STEROİD ANTİİNFLAMATUAR İLAÇLAR
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AĞRI VE NON-STEROİD ANTİİNFLAMATUAR İLAÇLAR. Prof. DR. IŞIK AYDINLI. AĞRI. % 80. Başvurnun en sık nedeni . NONOPİOİD. SİSTEMİK FARMAKOLOJİK TEDAVİ. OPİOİD. ADJUVAN. BAŞARI % 85. KRONİK AĞRI TEDAVİSİ. AKUT AĞRI TEDAVİSİ. KUVVETLİ OPİOİD. ±. 10. NONOPİOİD. 10.

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AĞRI VE NON-STEROİD ANTİİNFLAMATUAR İLAÇLAR

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AĞRI VE NON-STEROİD ANTİİNFLAMATUAR İLAÇLAR

Prof. DR. IŞIK AYDINLI


AĞRI

% 80

Başvurnun en sık nedeni


NONOPİOİD

SİSTEMİK

FARMAKOLOJİK

TEDAVİ

OPİOİD

ADJUVAN

BAŞARI % 85


KRONİK AĞRI TEDAVİSİ

AKUT AĞRI TEDAVİSİ

KUVVETLİ OPİOİD

±

10

NONOPİOİD

10

AĞRI ŞİDDETİ

± ADJUVAN

ZAYIF OPİOİD

±

NRS

NONOPİOİD

NRS

± ADJUVAN

AĞRI ŞİDDETİ

NONOPİOİD

± ADJUVAN

0

0

Zaman

Zaman

BASAMAK PRENSİBİ

WHO, 1986


?

Asetilsalisilik asid

SALİSİLİK ASİD

GLİKOSİD SALİSİN

Sodyum salisilat

Romotizmada

N:50

Ateş

tedavisinde

STONE, 1763

1827

HOFFMAN,1899

DESCARTES’ 1664

Wallace, 1997


2005

COX-1

COX-2

COX-3

Asetilsalisilik

asid

NSAİİ

COX

1971

De Witt 1993, Botting 2003, Bela 2003


ARAKİDONİK ASİD

COX

İNFLAMASYON

KORTEKS

HIPP

COX-3

COX-2

PG

M

G

T

COX-2

COX-1

COX-1

DAMAR

TROMBOSİT

RENAL TÜP

GİS MUKOZA

PG

PG

(A δ,C)

COX-2

KEMİK

RENAL KORT.

ÜRGS

MS

Aydınlı,

Keskinbora

De Witt 1993, Botting 2003, Bela 2003, Zhu 2003


PERİFERİK HASSASLAŞMA

Doku

hasarı

Semp. eff.

İmmun

hücre

IL- 8

G

TTXs-Na+

IL- 6

TNF-α

Na+

NA

IL -1

M

VDCC

trkA

α-2

CGRP

SP

Ca++

BDNF

VR1

LTB4

EP

NGF

Mast h.

PG

B1/2

Primer aff.

BK

5-HTR

TTX r-Na+

5-HT

Na+

H+

Damar

T

ASIC

UYARILABİLİRLİK


Spinal Nöronda

Hipereksitasyon

PIC

mRNA

Spinal

glia hücresi

trkB

GLUTAMAT

IL-1β

TNFα

NKA

SP

BDNF

PG

NMDA

IL 6

Mg++

IL8

Krax -24

BDNF

Ca+2

NGF

Jun-d

DRG

AMPA

c-fos

Na+

ER

Gl

Ca+2

mGluR

G

NO

NO

Ca+2

SP

PG

PG

Aδ ,C

VDCC

NK1

G

NKA

NK2

NK2

Spinal

nöron


İrreversbl

inhibisyon

Reversbl kompetatif

inhibisyon

COX-1

COX-2

30 milyon kişi/gün/dünya

COX-1

COX-2

NSAII

NSAİİ

NSAİİ

COX-1 COX-2

S-ENANTİOMER

NSAİİ

NSAİİ

DEKSKETOPROFEN

NSAİİ

NSAİİ

NSAİİ

NSAİİ

NSAİİ

NSAİİ

Zamana bağlı,yavaş Selektif

inhibisyon

Zamana bağlı,yavaş

inhibisyon

COX-1

COX-2

COX-2


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