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COX-2 selective inhibitors Celecoxib Etoricoxib Indications Pain (musculoskeletal, dental, postoperative) Inflammatory conditions (arthritis) Dysmenorrhea Fever Gout (acute attacks) Migraine Rheumatoid and osteoarthritis Adverse Effects Gastrointestinal Gastritis Peptic ulcer disease GI bleeding Renal Acute kidney injury Sodium and water retention Worsening heart failure Cardiovascular Hypertension Risk of MI and stroke (especially COX-2 inhibitors) Others Bronchospasm (aspirin-induced asthma) Delayed wound healing Skin rashes Contraindications Active peptic ulcer disease Chronic kidney disease Heart failure (moderate to severe) Aspirin-sensitive asthma Third trimester of pregnancy Take after food to reduce gastric irritation Use lowest effective dose for shortest duration Consider PPI co-prescription in high-risk patients Avoid combining multiple NSAIDs NSAIDs in Pregnancy Avoid in 3rd trimester Risk of premature closure of ductus arteriosus Paracetamol is preferred NSAIDs cause gastric injury via COX-1 inhibition COX-2 inhibitors less GI toxicity but CV risk NSAIDs worsen renal function in dehydration Do not combine NSAIDs with anticoagulants without caution To view or add a comment, sign in Gabapentin Drug Class Anticonvulsant / Neuropathic pain agent Structurally related to GABA but does not act directly on GABA receptors Mechanism of Action Binds to the 2 subunit of voltage-gated calcium channels in the CNS Reduces excitatory neurotransmitter release decreases neuronal hyperexcitability Exact mechanism in neuropathic pain not fully understood Indications 1

doi: 10.1038/ng.2356

Receptor Binding and Downstream Signaling IGF-1 LR3 binds IGF1R with affinity similar to native IGF-1, preserving the receptor-level pharmacology while altering the pharmacokinetics