COX-2 inhibitors: pharmacological data and adverse effects.

Abstract:

:The nonsteroidal anti-inflammatory drugs (NSAIDs) cover a wide range of selectivity, from the nonselective cyclooxygenase (COX) inhibitors to the preferential COX-2, and the newest coxibs, selective COX-2, with 1000-fold selectivities for COX-2. Coxibs belong to the distinct classes of sulphonamides, methylsulphones, and phenylacetic acid derivatives. The affinity of an inhibitor for COX-1 and COX-2 determinates its relative selectivity. Minor changes in the amino acid structure between the 2 enzymes results in different forms of their active sites. However, the primitive hypothesis of a dualism between an isoform totally inducible (COX-2) and the other isoform constitutive (COX-1) was not completely true. Thus, also selective COX-2 inhibitors have been shown to interact with gastrointestinal, renal, and cardiovascular systems. New insights into pharmacological data and side effect profile of coxibs have been reported in this review. They may reduce gastrointestinal-related risks, but when administered with low-dose aspirin, they could create an ulcerogenic dual-COX inhibitor. Moreover, by inhibiting COX-2, they could delay ulcer healing. Similarly to traditional NSAIDs, coxibs compromise the glomerular filtration rate in patients at increased risk, and may cause peripheral oedema and hypertension. According to the traditional ''COX-2 hypothesis'', they should not impair efficacy of coagulation. However, in combination with an oral anticoagulant they increase the International Normalized Ratio (INR) and, in some cases, cause bleeding. The altered balance between prostacyclin and thromboxane, due to selective inhibition of COX-2 without reducing COX-1, could promote a prothrombotic state and explain the observed increased cardiovascular risk. Finally, the role of COX-2 expression in the ischemic preconditioning mechanism and the recent discovery of a pro-oxidant activity of sulphones has been analysed.

journal_name

Minerva Anestesiol

journal_title

Minerva anestesiologica

authors

Mattia C,Coluzzi F

keywords:

subject

Has Abstract

pub_date

2005-07-01 00:00:00

pages

461-70

issue

7-8

eissn

0375-9393

issn

1827-1596

journal_volume

71

pub_type

杂志文章,评审
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    authors: Azzolini M,Ragagni M,Pfaender M,Dallape L,Gasperotti G

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    authors: Chillemi S,Sinardi D,Marino A,Mantarro G,Campisi R

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    authors: Cavaliere F,Antonelli M

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  • Esmolol for septic shock: more than just heart rate control?

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    pub_type: 评论,杂志文章

    doi:

    authors: Orbegozo Cortes D,Njimi H,Dell'Anna AM,Taccone FS

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  • [Muscular enzyme level disorders and a malignant hyperthermia susceptability test: postoperative study of a patient with elevated CPK].

    abstract::The preoperative evaluation of the enzymatic level concerning the functioning of the neuromuscular system, is of particular importance. The diseases of these regions may lead to Malignant Hyperthermia (MH) in the course of general anaesthesia. The authors illustrate the case of a young asymptomatic patient with consta...

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    doi:

    authors: Perugini M,Montironi C,Rocchi S

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  • [Comparison of 2 low molecular weight heparins in patients undergoing major abdominal surgery].

    abstract:INTRODUCTION AND AIMS:Thromboembolic disease can, in a large number of cases, be prevented in patients undergoing major surgery by using low molecular weight heparin (LMWH). These molecules extracted from standard heparin using a variety of cleavage methods possess different physical and chemical characteristics. The a...

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    doi:

    authors: Mabilia MA,Minicucci S,Pettiti G,Tamponi G,Bogli F

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  • Prone positioning during veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adults.

    abstract:BACKGROUND:Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an effective rescue therapy for improving oxygenation in selected severe acute respiratory distress syndrome (ARDS). Prone position (PP) is usually considered before vvECMO and few data are available on the association of PP during VV-ECMO. Thus, w...

    journal_title:Minerva anestesiologica

    pub_type: 杂志文章

    doi:

    authors: Guervilly C,Hraiech S,Gariboldi V,Xeridat F,Dizier S,Toesca R,Forel JM,Adda M,Grisoli D,Collart F,Roch A,Papazian L

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  • [The laryngeal mask in pediatric anesthesia].

    abstract::AIM. To evaluate the validity of general anesthesia using the laryngeal mask airway (LMA) in pediatrics in a series of 163 patients. MONITORING. ETCO2 and SpO2 were evaluated five minutes after the insertion of LMA and then at five minute intervals. SpO2 was evaluated every two minutes after the removal of LMA. Use of...

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    pub_type: 杂志文章

    doi:

    authors: Piana R,Bruno G,Meo MT,Tamanti P,Zuccaro G

    更新日期:1996-01-01 00:00:00

  • Mechanotransduction in the lungs.

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    pub_type: 杂志文章,评审

    doi:

    authors: Spieth PM,Bluth T,Gama De Abreu M,Bacelis A,Goetz AE,Kiefmann R

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  • [Variations of esophageal temperature during general anesthesia with a low-flow circuit].

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    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors: Di Filippo A,Minoni C,Bonetti L,Rizzo L,Novelli GP

    更新日期:1995-09-01 00:00:00

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    更新日期:1992-12-01 00:00:00

  • [Antithrombin III in burned children].

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    authors: Del Principe D

    更新日期:2003-05-01 00:00:00

  • [Antibiotic therapy in Italy. Current data and proposals for the future].

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    authors: Malacarne P,Rossi C

    更新日期:2001-04-01 00:00:00

  • [Loco-regional block in ophthalmic surgery: single drug or drug combination with hyaluronidase? Randomized prospective study].

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    pub_type: 临床试验,杂志文章,随机对照试验

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    authors: Costa P,Papurel Begin G,Coaloa M,Villa C,Ravera E,Hellmann F,Di Giovanni M,Bono D

    更新日期:1999-11-01 00:00:00

  • Advances in neuraxial blocks for labor analgesia: new techniques, new systems.

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    pub_type: 杂志文章,评审

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    authors: Fun W,Lew E,Sia AT

    更新日期:2008-03-01 00:00:00

  • [Post-operative analgesia with sub-arachnoid fentanyl: ventilatory effects in elderly patients].

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    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors: Celleno D,Muratori F,Capogna G,Cipriani G,Emanuelli M,Sebastiani M,Costantino P,Varrassi G

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  • [A new ventilation method: the laryngeal mask].

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    doi:

    authors: Festa M,Ballaris MA,Cerutti E,Morolli G

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    doi:

    authors: Saillard C,Mokart D,Lemiale V,Azoulay E

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    pub_type: 杂志文章

    doi:

    authors: Zamperetti N,Mazzon D,Orsi L,Barneschi MG,Marsili M,Rossi C,Primadei M,Ethics Commission of the Italian Society of Anaesthesia, Analgesia, Resuscitation and Intensive Care.

    更新日期:2007-03-01 00:00:00

  • [Anesthesia, awareness and wakefulness].

    abstract::Drugs used in anesthesia do not always produce the expected neurophysiological results. By studying those cases in which the reappearance of intraoperative awareness is most common, an attempt was made to estimate how many and which levels of cerebral function could be identified. Four levels were recognised: awarenes...

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    pub_type: 杂志文章

    doi:

    authors: Cogliolo P,Tufano R,Romano V,Villani R,Duvall M,Laurino S,Del Franco G,Coppola T

    更新日期:1990-05-01 00:00:00

  • [Randomized study on the use of propofol for anesthesia in intracranial tumors. Comparison with balanced anesthesia].

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    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

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  • Patient blood management: a fresh look at a fresh approach to blood transfusion.

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    pub_type: 杂志文章,评审

    doi:

    authors: Liumbruno GM,Vaglio S,Grazzini G,Spahn DR,Biancofiore G

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  • [Use of neuroleptoanesthesia for carrying out a Harrington intervention in a patient probably susceptible to malignant hyperthermia].

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    pub_type: 杂志文章

    doi:

    authors: Lauri A,Corbari M,Galli C,Marri M

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    abstract:: ...

    journal_title:Minerva anestesiologica

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    pub_type: 杂志文章,meta分析,评审

    doi:

    authors: Qi DY,Wang K,Zhang H,Du BX,Xu FY,Wang L,Zou Z,Shi XY

    更新日期:2013-12-01 00:00:00