NSAIDs in elderly patients

Reposted from http://www.choosingwisely.org/clinician-lists/american-society-nephrology-nsaids-in-individuals-with-hypertension-heart-failure-or-chronic-kidney-disease/#.VjyyqRt0PN4.twitter

NO NSAIDs in

  • Hypertension
    – NSAIDs increases BP by decreasing synthesis of vasodilators eg prostaglandins)
  • CHF
    – NSAIDs decreases the synthesis of prostaglandins which vasodilate the afferent arterioles; vasoconstriction leads to reduced GFR and water retention (read this: http://renalfellow.blogspot.my/2009/04/prostaglandin-basics.html)
  • CKD
    – because as mentioned, it reduces GFR

Alternative to NSAID for pain control: paracetamol, tramadol or short-term use of narcotic analgesics.

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