Celecoxib

CLASS

  • COX-2 inhibitor

MECHANISM OF ACTION

  • blocks access of arachidonic acid to active site at apex of a hydrophobic channel on COX-2

PHARMACEUTICS

  • tablets

DOSE

  • PO 100 to 400mg BD

INDICATIONS

  • inflammatory pain

ADVERSE EFFECTS

  • hypertension
  • renal failure
  • dyspepsia

PHARMACOKINETICS

  • Absorption –
  • Distribution – 97% protein bound, Vd = 6L/kg
  • Metabolism – hepatic, 3 active metabolites
  • Elimination – t1/2 = 10 hrs

EVIDENCE

Summarized from ANZCA Evidence-based guide to Pain Management

  • COX 2 inhibitors and NSAIDs have similar effects on renal function
  • COX 2 inhibitors don’t produce bronchospasm in aspirin induced respiratory disease
  • COX 2 inhibitors -> no effect of platelet function
  • COX 2 inhibitors -> same peptic ulcer rate as placebo (decreased compared to NSAIDs)
  • COX 2 inhibitors -> don’t give in patients with lots of vascular risk factors
  • parocoxib & valdecoxib DO NOT increase risk of cardiovascular disease after non-cardiac surgery
  • COX 2 inhibitors and NSAIDs are associated with the same rates of adverse CVS effects (MI)
  • short-term use of COX 2 inhibitors do not affect bone healing after spinal fusion
  • VIGOR study looked @ rofecoxib vs naproxen and found significant increase in MI in rofecoxib group (patients on low-dose aspirin were excluded)

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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