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AĞRI VE NON-STEROİD ANTİİNFLAMATUAR İLAÇLAR

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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  1. AĞRI VE NON-STEROİD ANTİİNFLAMATUAR İLAÇLAR Prof. DR. IŞIK AYDINLI

  2. AĞRI % 80 Başvurnun en sık nedeni

  3. NONOPİOİD SİSTEMİK FARMAKOLOJİK TEDAVİ OPİOİD ADJUVAN BAŞARI % 85

  4. 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

  5. ? Asetilsalisilik asid SALİSİLİK ASİD GLİKOSİD SALİSİN Sodyum salisilat Romotizmada N:50 Ateş tedavisinde STONE, 1763 1827 HOFFMAN,1899 DESCARTES’ 1664 Wallace, 1997

  6. 2005 COX-1 COX-2 COX-3 Asetilsalisilik asid NSAİİ COX 1971 De Witt 1993, Botting 2003, Bela 2003

  7. 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

  8. 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

  9. 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

  10. 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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