TIPURI DE ANALGEZIE NON OPIOIDE N NGRIJIRILE PALIATIVE Analgezice non-opioide

C lasa farmacologic Derivai de aminofenol: paracetamol As pirina Derivai de acid propionic: ibuprofen ketoprofen #eli$erare normal% ketoprofen #eli$erare prelungit% Derivai de acid acetic ndometacin Diclofenac Derivai de acid enolic ,iroxicam -eloxicam Inhibitori s electivi de C OX-2 C elecoxi$ C lasa terapeutic Analgezice nonopioide Analgezice nonopioide: A !" Analgezice nonopioide: A !" Dozaj 4-6 ore Doza iniial 500 mg Doza maxim zilnic 4000 mg

4-6 ore

500 mg

4000 mg

4-6 ore 6-& ore

400-&00 mg 50-(5 mg

*'00 mg *00 mg

'4 ore

)00-)50 mg

'00+ *00 mg

Analgezice nonopioide: A !" &-)' ore &-)' ore Analgezice nonopioide: A !" )'-'4 ore )'-'4 ore Analgezice nonopioide: A !" )'-'4 ore )00-'00 mg 400 mg '0 mg (.5-)5 mg 40 mg )5 mg '5-(5 mg '5-(5 mg '00 mg )50 mg

Derivai de aminofenol - PARACETAMOL Forma farmaceutic: comprimat 500mg Indicaii: D rere !oar" !i medie# fe$r"% Mod de administrare: Oral: ad li !i copii pe&te '( ani: 500mg la fiecare )-* ore+&e va re&pecta n interval minim de , ore -ntre pri.e/% Pe termen l ng do.a ma0im"1.i &e red ce la (#5g% Copii: 2ntre ) !i '( ani: (50-500mg la )-* ore# copii -ntre 3 !i ) ani: '(5-(50 mp la )-* ore% Reacii adverse: Er pii c tanate -n&oite de rticarie% 4-a &emnalat ca. ri de agran locito."# anemie# dermatit" !i trom$icitopenie% 5tili.area cronic" a nor do.e mari de paracetamol poate d ce la o reacie 6epatoto0ic" &a la o in& ficien" renal" grav"% Orice tip de reacie alergic" imp ne oprirea admini&tr"rii paracetamol l i% Contraindicaii: 7iper&i$ilitate la paracetamol &a la acid l aceti&alicilic# ri&c la $olnavii c in& ficien" 6epatic"# 6epatit" viral"# in& ficien" renal" ac t"# alcooli&m%

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AC8D ACET8L4AL8C8L8C - A4P8R89A Forma farmaceutic: Comprimate conin:nd acid acetil&alicilic 500mg# comprimate tamponate conin:nd acid acetil&alicilic 500mg !i gl coioolactat de calci '50mg; comprimate conin:nd acid aceti&alicilic <5-'00mg ca antiagregant plac6etar% Aciune terapeutic: analge.ic# antipiretic# antiinflamator !i antire matic# antiagregant plac6etar# in6i$itor al contraciilor terine# efectele apar datorit" -mpiedic"rii form"rii pro&taglandinelor% Indicaii: re mati&m poliartic lar ac t# poliartrit" re matoid" !i alte $oli re mati&male: nevralgii# mialgii# d reri dentare# cefalee# &t"ri fe$rile+-n $oli infecioa&e# grip"# r"ceal" etc%/ profila0ia trom$o.elor arteriale la nivel l coronarelor !i va&elor cere$rale# com$aterea t l$ r"rilor provocate de agregarea plac6etelor -n trom$ocitemie; di&monoree# profila0ia ar& rilor &olare% Mod de administrare: Ad li: pentr aci nea anlage.ic" !i antipiretic" n comprimat de 0#5g o dat"# repet:nd event al la )-* ore ca antiinflamator# -n $olile re maticecronice 35g1.i# -n cele ac te ,-<g1.i+-n ,-) pri.e/; ca antiagregant plac6etar pentr profila0ia trom$o.elor arteriale# n comprimat la .i% Copii: p:n" la ( ani 0#'-0#( g1.i; (-= ani 0#(-'g1.i; pentr = ani '-'#5g1.i+-n (-3 pri.e/; -n $olile re matice )0-'00mg1>g corp la .i+-n ,-) pri.e/% Comprimatele &e de&fac -n ap" !i &e ia imediat d p" me&e; la copii comprimatele &e de&fac -n p in lapte% Reacii adverse: epiga&trologii# grea"# vom"# micro6emoragii dige&tive# neori anemie# rareori 6emateme.a &a melen"; alte 6emoragii+prin in& ficiena plac6etar"/ oca.ional cre!terea tran&amina.elor; reacii alergice diver&e: er pii c tanate# $ron6o&pa&m# cefalee# & doraie# grea"# vom"# &tare conf .ional"+la do.e mari/; poate prel ngi travali l# -nt:r.ia na!terea !i favori.a 6emoragia po&t part m% Acid l acetil&alicilic tamponat e&te mai $ine & portat dige&tiv% Contraindicaii: alergie la &alacilai# intolerana la &alicilai &a antiinflamatoriile ne&teroidiene# lcer ga&tro-d odenal -n evol ie# $oli 6emoragice !i ri&c de 6emoragii; pr den" -n $oala lceroa&" neevol tiv"# a&tm $ron!ic la renali !i -n timp l &arcinii+&e evit" prim l trime&tr !i ltima l n"/% Pr den" &a &e evit" d pa ca. a&ocierea c anticoag lante# c marinice+ri&c cre&c t de 6emoragii/# gl cocorticoi.i# metotre0at# & lfamide antidia$etice# pro$enecid !i & lfinpira.ona# &pironolactona+&cade efect l di retic/% Substan activ: 8?5PRO@E9% Forma farmaceutic: comprimate filamte (00mg !i ,00mg% Aciune terapeutica: Antiiflamator# analge.ic !i antipiretic c eficacitate a&em"n"toare acid l i acetil&alicilic% Indicaii: Tratament &imptomatic ale afeci nilor d reroa&e !i al fe$rei; tratament l poliartritei re matoide# artritei g toa&e !i artritei p&oria.ice% Mod de administrare: Ad li: ,00-'*00mg la .i divi.at -n 3-, pri.e# ma0im (,00mg1.i% Copii: &e recomand" tili.area concentraiilor !i formelor farmace tice adecvate% Reacii adverse: Piro.i&# anore0ie# grea"# vom"# di&pep&ie# di&confort a$dominal# diaree# lcer activ# 6emoragii ga&tro-inte&tinale# cefalee# conf .ie# tinit &# &omnolen"# t l$ r"ri p&i6otice# rticarie# prorit# prel ngirea timp l i de &:ngerare# anemie 6emolitic" !i apla&tic"# icter# retenie 6idro&alin"%

Contraindicaii: 7iper&en&i$ilitate la i$ profen !i alte A894# lcer peptic activ# 6emoragii ga&trointe&tinale# colit" lceroa&"# t l$ r"ri 6epatice &a renale% Substan activ: AETOPRO@E9 B eli$erare normal"% Forma famaceutic: Comprimate filmate conin:nd fiecare '00mg >etoprofen% @orma de pre.entare: c tie c (0 comprimate filmate% Aciune terapeutic: A894# analge.ic# antipiretic% Indicaii: Tratament l &imptomatic ale afeci nilor re matice inflamatorii degenerative !i meta$olice; d rere po&toperatorie# di&monoree# d rere o&oa&" din meta&ta.ele t morale# d rere po&ttra matic"# artrit" re matoid"# &pondiloartrit" &eronegativ"# g t"# p&e dog ta# artro.e# re mati&m e0trartic lar% Tratament l local &imptomatic al d rerilor m &c lare &a o&teoartic lare de nat r" tra matic" &a re matice% Mod de administrare: Ad li !i copii c v:r&ta pe&te '5 ani% Do.a . al" recomandat" e&te de '00-(00mg >etoprofen1.i% Reacii adverse: Reacii alergice% Pot ap"rea t l$ r"ri dige&tive c m ar fi gre ri# vom"# diaree; t l$ r"ri ale aparat l i e0cretor; di& rie; t l$ r"ri ale 49C# a&tenie# &omnolen"# cri.e a&tmatice% Contraindicaii: 7iper&en&i$ilitatea la >etoprofen# la alte A894 &a la oricare dintre componentele prod & l i% Contraindicat la copii c v:r&ta & $ '5 ani% Substan activ: AETOPRO@E9 B eli$erare prel ngit"% Forma farmaceutic: Cap& le eli$erate prel ngit (00mg% Aciune terapeutic: Antiinflamator ne&teroidian analge.ic% Indicaii: Tratament l afeci nilor re matice inflamatorii# d rere po&toperatorie# d rere o&oa&" din meta&ta.ele t morale# d rere po&ttra matic"# artrit" re matoid"# &pondiloartrit" &eronegativ"# artro.e# re mati&m e0trartic lar% Mod de administrare: Oral: do.a . al" e&te de 50-'00mg de 3 ori1.i% Do.a . al" pentr preparate c eli$erare prel ngit" e&te de '50mg de ( ori1.i% 8ntram &c lar '00mg de '-( ori1.i# ma0im 300mg% Perf .ie intraveno& ma0im 300mg1.i% Cel l &e aplic" pe piele de '( ori1.i# ma&:nd !or% 4praD l &e p lveri.ea." de 3-, ori 1.i &e ma&ea." !or% Reacii adverse: Reacii alergice# cri.e a&matiforme% Contraindicaii: 7iper&e&i$ilitate la >etoprofen# la alte A894 &a la oricare dintre componentele prod & l i; lcer peptic activ la copii% E0tern B -n pl"ci infectate# ec.eme# ar& ri% Substan activ: 89DOMETAC89% Forma farmaceutic: cap& le conin:nd indometacin" (5mg &i 50mg# & po.itoare indometacin" 50 mg% Aciune terapeutic: antire matic# antiinflamator ne&teroidian foarte activ# analge.ic !i antipiretic% Indicaii: Poliartrit" re matic"# artrit" ac t"+incl &iv cri.e de g t"/; &pondilo.a anc6ilo.ant"# di&f ncii inflamatorii re matice ale coloanei verte$rale% Mod de administrare: Oral# iniial o cap& l"+(5mg1(-3 ori1.i# d p" me&e/# la nevoie &e cre!te treptat p:n" la cel m lt * cap& le pe .i% Dac" apar reacii adver&e minore# do.ele &e red c# iar pacient l tre$ ie monitori.at% Reaciile adver&e maEore imp n -ntrer perea tratament l i%

Reacii adverse: Relativ frecvent cefalee# ameeli# anoretie# grea"# vom"# d reri a$dominale# diaree# lceraii ale m coa&ei ga&tro-inte&tinale; rareori t l$ r"ri de vedere# 6epatit" to0ic" !i icter# t l$ r"ri de a .-tinit &# rareori & rditate# &omnolen"# conf .ie mintal"# &tare depre&iv"# c6iar t l$ r"ri p&i6otice# conv l&ii# nefrit" periferic"# edeme# 6iperten&i ne# 6emat rie# alopecie# eritem nodo&% Contraindicaii: Le.i ni lcerative ga&tro Binte&tinale# alergie &a intoleran" la indometacin"# alte antiinflamatorii ne&teroidiene# &alicilai% 4e va evita -n timp l &arcinii# al"pt"rii !i la copii & $ ', ani; &e evit" &a pr den" la $"tr:ni; pr den" -n in& ficiena renal" !i 6epatic"# in& ficiena cardiac"# 7TA# la $olnavii c t l$ r"ri de coag lare# la p&i6otici# epileptici# par>in&onieni# -n pre.ena infeciilor% Substan activ: D8CLO@E9AC% Forma farmaceutic: gel# & po.itoare# draEe ri# fiole% Aciune terapeutic: Antiinflamator ne&teroidian# c efecte antiinflamatorii# analge.ice !i antipiretice inten&e acion:nd ca in6i$itor al cicloo0igena.ei; e&te n antire matic eficace% Indicaii: Poliartrita re matoid"# &pondiloartrita anc6ilopatic"# artro.e# afeci ni re matice e0traartic lare# cri.e de g t" &t"ri inflamatorii d reroa&e po&toperator# po&tra matice# d p" e0tracii dentare etc% Mod de administrare: Do.a iniial" e&te de '00-'50mg# ' fiol" pe .i la ad li# -n ca. ri mai &evere &e admini&trea." ( inEecii &eparate de n interval de c:teva ore# fiecare -n c:te o fe&"% 9 &e recomand" admini&trarea de fiole la copii% 4 po.itoare: '00-'50mg# -n terapie de l ng" d rat"# <5-'00mg fracionat" -n (-3 pri.e+la ad li/% Do.a ma0im" .ilnic" n tre$ ie &" dep"!ea&c" '50mg% Copii: Do.a .ilnic" e&te de 0#5-(mg1>g de corp fracionat" -n (-3 pri.e -n f ncie de &everitatea ca. l i% Cel l aplicat local pe piele de 3-, ori pe .i local !i &e ma&ea." !or% Reacii adverse: 5neori grea"# diaree# epiga&tralgii# &:nger"ri dige&tive minore# oca.ional er pii c tanate# edeme periferice# cefalee# ameeli% Rareori afectarea ficat l i c cre!terea tran&amina.elor# afectarea rinic6i l i; foarte rar reacii anafilactoide care & nt com ne pentr toate A894# t l$ r"ri ale 6ematopoe.ei# & po.itoarele provoac" neori iritaie local"-pr rit# &en.aie de ar& r"# tene&me% Contraindicaii: 5lcer ga&tro-d odenal activ# &:nger"ri ga&trointe&tinale# le copenie# trom$ocitopenie# porfirie# intoleran" la antiinflamatorii in6i$itoare ale cicloo0igena.ei; pr den" -n ca. de antecedente lceroa&e# la a&tmatici e0i&t" ri&c l apariiilor reaciilor anafilactice; la cardiaci !i 6iperten&ivi# la renali# -n in& ficien" 6epatic"; pr den" -n timp l &arcinii# n &e admini&trea." -n ltim l trime&tr !i la termen; pr den" la copii !i la $"tr:ni% A&ocierea c gl corticoi.ii &a alte A894 cre!te ri&c l &:nger"rilor dige&tive !i al lcer l i; diclofenac l m"re!te concentraia pla&matic" al liti l i !i digo0inei favori.ea." reinerea pota&i l i & $ infl ena &pirono-lactonei# mic!orea." efect l f ro&emid l i !i al medicaiei anti6iperten&ive% Substan activ: P8ROF8CAM% Forma farmaceutic: Comprimate conin:nd piro0icam (0mg # & po.itoare conin:nd piro0icam (0mg !i ,0mg% Aciune terapeutic: A894# analge.ic# antipiteric; e&te n antire matic eficace c efect d ra$il+e&te & ficient" o &ing r" do." pe .i/;

Indicaii: Poliartrit" re matoid"# o&teoartrit"# afeci ni m &c lo-&c6eletice ac te# cri.e de g t"% Mod de administrare: Oral &a rectal# -n $olile re matice o$i!n it ' comprimat &a n & po.itor a (0mg .ilnic; -n afeci nile m &c lo-&c6eletice ac te ,0mg1.i primele ( .ile apoi (0mg1.i '-( &"pt"m:ni; -n cri." de g t" ,0mg1.i 5-< .ile% 5ng ent l &e aplic" local# pe piele# c ma&aE !or de '-( ori1.i% Reacii adverse:5neori iritaie a m coa&ei dige&tive-&tomatit"# anore0ie# grea"# nepl"cere epiga&tric"# d reri a$dominale# rareori lceraii !i &:nger"ri ga&tro-inte&tinale# con&tipaie# ameeli# cefalee# a&tenie# &omnolen" &a in&omnie# nervo.itate# depre&ie# conf .ie# t l$ r"ri vi. ale# pr rit !i er pii c tanate etc%# & po.itoarele pot provoca iritaie local"% Contraindicaii: 5lcer ga&tro-d odenal activ &a rec rent -n antecedente# alergie !i piro0icam# intoleran" la piro0icam# acid acetil&alicilic !i intoleran" la alte A894; in& ficien" 6epatic" &a renal" &ever"; pr den" -n perioada &arcinii# n &e admini&trea." -n ltim l trime&tr !i -n perioada al"pt"rii% 4 po.itoarele n tre$ ie folo&ite -n ca. l le.i nilor inflamatorii &a &:nger"rilor acorectale% Piro0icam l n &e a&ocia." c acid acetil&alicilic; pr den" c:nd &e admini&trea." -n timp l tratament l i c anticoag lante c marinice+cre!te ri&c l de 6emoragii/ !i c liti l+m"re!te litemia# ri&c to0ic &porit/% Substan activ: CELECOF8?% Forma farmaceutic: cap& le conin:nd '00 !i (00mg celeco0i$% Aciune terapeutic: Antiinflamator# antipiretic !i analge.ic% Indicaii: Tratament l &imptomatic al $olii artro.ice !i poliartritei re matoide# Mod de administrare: 8ntern: $oala artro.ic": (00mg de '-( ori1.i% Poliartrita re matoid": (00-,00mg1.i -n ( pri.e% La pacienii c in& ficien" 6epatic" moderat" tratament l tre$ ie iniiat c E m"tate din do.a recomandat"% Reacii adverse: Cenerale: edem periferic1retenie 6idro&alin"% Ca&trointe&tinale: d reri a$dominale# diaree# di&pep&ie# flat len" melen"% 7epatice: di&f ncie 6epatic"# 6epatit"# icter# cre!terea TCO !i TCP% 4i&tem nervo&: ameeli# in&omnie# 6ipertonie# para&te.ie# ata0ie% Organe de &im: t l$ r"ri de vedere# alterarea g &t l i% P&i6iatrice: an0ietate# depre&ie# conf .ie % Re&piratorii: faringit"# rinit"# &in .it"# t &e# di&pnee# $ron6o&pa&m% C tanate: ra&6# rticarie# alopecie# foto&en&i$ilitate# eritem m ltiform% 4ang ine: anemie# le copenie# trom$ocitopenie# pancitopenie% Cardiova&c lare: 7TA# palpitaii# in& ficien" cardiac"% T l$ r"ri renale !i rinare: di&f ncie renal"# 8RA% Reacii alergice: !oc anafilactic# angioedem# va&c lit"# mio.it"% Altele: crampe ale mem$relor inferioare# tinit &# o$o&eal"# infecie rinar"% Contraindicaii: 7iper&en&i$ilitate la celeco0i$ &a la oricare din componentele prod & l i; 6iper&en&i$ilitate la & lfonamide; pacienii c a&tm $ron!ic; rinit" ac t" polipo." na.al"# edem angione rotic# rticarie &a alte reacii alergice# d p" admini&trarea de acid acetil&alicilic &a A894# lcer ga&trod odenal; in& ficien" 6epatic" &ever"; in& ficien" renal";&arcin"; al"ptarea; femei aflate la v:r&ta fertil"# -n lip&a nei metode contraceptive eficace%