Selective NSAIDS (COX-2)

hi darling. its friday and ive got hte AMH here next to me.
something at work today has forced my hand into SELECTIVE NSAIDS (COX-2 INHIBITORS). we've already learnt about them in pharmacology, but lets be honest, my brain is a clean slate. Ready to be thoroughly confused in the year 2013!!
so selective nsaids.
There's 4 in the book but here's two im familiar with:
Celecoxib (Celebrex)
Meloxicam (Mobic)
NSAIDS have anti-inflammatory, antipyretic and analgesic activities through inhibition of prostaglandin synthesis by blocking COX. blocking COX-1 affects gastric secretions and platelet aggregation. COX-2 is the one that has the analgesic etc properties.
NSAIDS are used for arthritis, osteoarthritis, acute gout and pain/fever.
PRECAUTIONS for NSAIDS
Ashtma - bronchospasm possible due to COX-1 inhibition
Coaggulation disorders - with non selective cause it has antiplatelet effects = bleeding risk
selective nsaids and even diclofonic (no, not the diclofenac!) can increase risk of thrombosis, which is blood clotting in vessel or heart
Avoid with Hx of GI bleeding
oh - NSAIDS may affect fertility so if you're planning a pregnancy, reconsider.
increased risk of adverse effects in the elderly (esp. heart failure, GI ulcers and renal impairment)

COMPARE THE PAIRR
enteric coats do not reduce the risk of GI ulcers :S so why have them? LOL
topical NSAIDS = high conc in the tissue where it is applied and very little is absorbed
selective NSAIDS have increased risk of worsening heart conditions particularly without some low dose aspirin. WHYY? WHY? i should probably make an effort to remmeber the things i dont understand so i can ask a pharmacist, but if i dont understand it how do i remmeber it :( (no im not writing it down)

COUNSELLING
swollen ankles, difficulty breathing (bronchospasm from COX-1 inhibition?), black stool (im assuming thats blood in stool), dark colour coffe vomit (lol im assuming thats blood in bile from GI ulceration) = STOP AND TELL YOUR DR . god how do you tell someone that without alarming hte shit out of them? (but at least then you can inspect their shit and rule out one of the indicators)
dont take aspirin as pain relief because that will increase your risk of side effects.

for use in osteoarthritis, it will usually take 2 weeks to see therapeutic effects. if condition not better in three, consider using something else.
NSAIDS can be used with paracetamol or an opioid for severe pain. LOL the lone example listed here for severe pain is tumour metastases in bone. i dont even know why im laughing. i think its because the example is so barbaric and blatently severe that its funny they would even list it there. 'YOU'RE NOT TO USE AN OPIOID WITH THIS UNLESS YOURE DYING' thats basically what it implies right?

if someone is taking low dose aspirin for its anti-thrombotic effects, they should not stop because the antiplatelet effect of NSAIDS are not reliable.
blood test at least once a year if taking regularly
use lowest effective dose for shortest time possible and use paracetamol to lower NSAID dose where possible
for patients with high risk of GI effects, take with a proton pump inhibitor or misoprostol. why is that you ask? i dont know either. but allow me to find out.
proton pump inhibitors suppress acid secretion by inactivating H+/K+ ATPase enzyme system which is apparently a proton pump.
misoprostol is a protaglandin E1 analogue that increases mucus secretions in stomach.

coming back to the non selective nsaids gig, as a precaution, allergies to sulphonamides may indicate allergy risk to celecoxib.
Meloxicam is also not for pain unrelated to arthritis. so that means Meloxicam is used just for arthritis only.

and im going to stop there.