Step I explain this NSAID

[Fungi121]

Can someone help me explain why NSAIDs are bad to give to people in congestive heart failure or the really elderly? This question I did told me this in the answer but aside from guesswork knowledge, I couldn't explain it too well....

I understand why no NSAIDs for renal failure and for GI issues but I can't explain CHF or elderly...!

 

[D3sidud3]

NSAIDs block PG production in kidney --> less dilation of afferent arteriole --> less RBF --> activation of renin/AT system --> increased BP

That's my understanding

 

[Fungi121]

NSAIDs block PG production in kidney --> less dilation of afferent arteriole --> less RBF --> activation of renin/AT system --> increased BP

That's my understanding

Hm....the RAAS would increase afterload making it more difficult for the failing heart, perhaps?

 

[pacman2018]

NSAIDs block PG production in kidney --> less dilation of afferent arteriole --> less RBF --> activation of renin/AT system --> increased BP

That's my understanding

continuing on this, this also leads to increased fluid retention which is obviously bad in heart failure.

as far as the elderly, I think there was a trial that showed NSAIDS in the elderly used chronically almost doubled CV mortality (and not just COX2 selective). I also think that the rates of GI bleed and ulcers are much higher in the elderly. not sure the exact mechanism for these though, but I think NSAIDS still carry a black box warning for both of these