Differences between Cox-1 and Cox-2

Table Comparison

Cox-1	Cox-2
Constitutively expressed	Inducible expression
Found in most tissues	Primarily found in inflamed tissues
Protects gastric mucosa	Associated with inflammation and pain
Involved in platelet aggregation	Involved in inflammation and fever
Inhibition leads to increased risk of gastric ulcers and bleeding	Inhibition leads to decreased inflammation and pain
Nonselective NSAIDs inhibit Cox-1	Selective Cox-2 inhibitors spare Cox-1

Mnemonics

Cox-1

Mnemonic: "Cox-1 keeps the blood from becoming number one (run)."

• Helps remember that Cox-1 is involved in platelet aggregation and helps in protecting the gut lining. Inhibition leads to increased bleeding and gastric ulcers.

Cox-2

Mnemonic: "Cox-2 brings the pain to you."

• Helps remember that Cox-2 is primarily involved in inflammation, pain, and fever. Inhibiting it results in pain relief.

NSAIDs RELATIVE RISKS OF GI ADVERSE EFFECTS (From low to high) Celecoxib Ibuprofen Aspirin Diclofenac Naproxen Indomethacin Piroxicam

The acronym formed is "CIADNIP". This can be read as "See, I Aid Nip", which could be visualized as these drugs helping to 'nip' pain and inflammation in the bud.

NSAID	Use Cases	Side Effects	Additional Information
Aspirin	Pain relief, fever reduction	Gastric irritation, bleeding, Reye's syndrome	Irreversibly inhibits COX-1 and COX-2 enzymes; used for antiplatelet effects, but caution in children due to the risk of Reye's syndrome
Ibuprofen	Pain relief, fever reduction	Gastric irritation, renal toxicity	Reversibly inhibits COX-1 and COX-2 enzymes; widely used over-the-counter NSAID
Naproxen	Pain relief, inflammation reduction	Gastric irritation, renal toxicity	Longer half-life compared to other NSAIDs; used for chronic conditions like arthritis
Indomethacin	Pain relief, inflammation reduction	Gastric irritation, renal toxicity	Particularly effective for gouty arthritis; can cause CNS side effects like headache and confusion
Meloxicam	Pain relief, inflammation reduction	Gastric irritation, renal toxicity	Selectively inhibits COX-2 enzyme; used for chronic conditions like osteoarthritis
Celecoxib	Pain relief, inflammation reduction	Increased cardiovascular risk, GI bleeding risk	Selectively inhibits COX-2 enzyme; used as an alternative for patients at high risk of GI side effects
Diclofenac	Pain relief, inflammation reduction	Gastric irritation, renal toxicity	Available in multiple formulations (oral, topical, ophthalmic); used for various musculoskeletal conditions
Ketorolac	Short-term pain relief	Gastric irritation, increased bleeding risk	Primarily used for short-term management of moderate to severe pain; limited to 5 days of use due to increased bleeding risk

Clinical Significance:

• Understanding the use cases, side effects, and additional information of NSAIDs is crucial for clinical decision-making, especially in managing pain, inflammation, and fever.
• Awareness of the potential side effects, such as gastric irritation and renal toxicity, helps in monitoring and minimizing adverse effects.
• Knowledge of the selective COX-2 inhibitors (celecoxib) and their cardiovascular risks is important for selecting appropriate NSAIDs for patients with a high risk of gastrointestinal side effects.