piroxicam

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piroxicam

 [pēr-ok´sĭ-kam]
a nonsteroidal antiinflammatory drug with a long plasma half-life; used in treatment of arthritis and related conditions, gout, calcium pyrophosphate deposition disease, and dysmenorrhea.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

piroxicam

Apo-Piroxicam (CA), Brexidol (UK), Dom-Piroxicam (CA), Feldene, Gen-Piroxicam (CA), Novo-Pirocam (CA), Nu-Pirox (CA) PMS-Piroxicam (CA), PRO-Piroxicam (CA)

Pharmacologic class: Oxicam derivative, nonsteroidal anti-inflammatory drug (NSAID)

Therapeutic class: Analgesic, anti-inflammatory, antipyretic

Pregnancy risk category C (first and second trimesters), D (third trimester)

FDA Box Warning

• Drug may increase risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke (which can be fatal). Risk may increase with duration of use. Patients with cardiovascular disease or risk factors for it may be at greater risk.

• Drug increases risk of serious GI adverse events, including bleeding, ulcers, and stomach or intestinal perforation (which can be fatal). These events can occur at any time during use and without warning. Elderly patients are at greater risk.

• Drug is contraindicated for treatment of perioperative pain in setting of coronary artery bypass graft surgery.

Action

Inhibits cyclooxygenase (an enzyme needed for prostaglandin synthesis), stimulating anti-inflammatory response and blocking pain impulses

Availability

Capsules: 10 mg, 20 mg

Indications and dosages

Inflammatory disorders (such as arthritis)

Adults: 20 mg P.O. daily as a single dose or in two divided doses

Dosage adjustment

• Hepatic or renal impairment

• Elderly patients

Off-label uses

• Dysmenorrhea

• Ankylosing spondylitis

• Gout

Contraindications

• Hypersensitivity to drug or other NSAIDs (including aspirin)

• Active GI bleeding or ulcer disease

• Third trimester of pregnancy

Precautions

Use cautiously in:

• renal impairment, severe cardiovascular or hepatic disease

• history of ulcer disease

• pregnant patients in first or second trimester

• breastfeeding patients (not recommended)

• children (safety not established).

Administration

• Give with milk, antacids, or food to minimize GI upset.

Adverse reactions

CNS: headache, drowsiness, dizziness

CV: edema, hypertension, vasculitis, tachycardia, arrhythmias

EENT: blurred vision, tinnitus

GI: nausea, vomiting, diarrhea, constipation, abdominal pain, flatulence, dyspepsia, anorexia, severe GI bleeding

GU: proteinuria, renal failure

Hematologic: anemia, blood dyscrasias

Hepatic: jaundice, hepatitis

Skin: rash

Other: allergic reactions including anaphylaxis

Interactions

Drug-drug. Acetaminophen (chronic use), cyclosporine, gold compounds: increased risk of adverse renal reactions Anticoagulants, cefamandole, cefoperazone, cefotetan, clopidogrel, eptifibatide, heparin, plicamycin, thrombolytics, ticlopidine, tirofiban, valproic acid, vitamin A: increased risk of bleeding

Antineoplastics: increased risk of hematologic toxicity

Aspirin: decreased piroxicam blood level and efficacy

Corticosteroids, other NSAIDs: additive adverse GI reactions

Diuretics, other antihypertensives: decreased response to these drugs Insulin, oral hypoglycemics: increased risk of hypoglycemia

Lithium: increased lithium blood level and risk of toxicity

Probenecid: increased piroxicam blood level and risk of toxicity

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, blood urea nitrogen, creatinine, electrolytes, lactate dehydrogenase: increased levels

Bleeding time: prolonged Hematocrit, hemoglobin, platelets, white blood cells: decreased levels

Liver function tests: abnormal results

Drug-herbs. Alfalfa, anise, arnica, astragalus, bilberry, black currant seed oil, bladderwrack, bogbean, boldo, borage oil, buchu, capsaicin, cat's claw, celery, chaparral, cinchona bark, clove oil, coenzyme Q10, dandelion, danshen, dong quai, evening primrose oil, fenugreek, feverfew, garlic, ginger, ginkgo, guggul, papaya extract, red clover, rhubarb, safflower oil, skullcap, St. John's wort: increased anticoagulant effect, greater bleeding risk

Patient monitoring

• Monitor vital signs and cardiovascular status. Stay alert for hypertension and arrhythmias.

• Monitor kidney and liver function tests, hearing, and CBC.

Watch for signs and symptoms of drug-induced hepatitis and GI toxicity, including ulcers and bleeding.

• Monitor for signs and symptoms of infection, which drug may mask.

Patient teaching

• Advise patient to take with milk, antacids, or food to minimize GI upset.

• Tell patient drug may mask signs and symptoms of infection. Instruct him to contact prescriber if he suspects he has an infection.

Teach patient to recognize and immediately report signs and symptoms of allergic reaction or GI bleeding.

• Inform patient that many herbs increase the risk of GI bleeding. Caution him not to use herbs without prescriber's approval.

• Instruct patient to drink plenty of fluids and to report decreased urination.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.

• Tell female patient to inform prescriber if she is pregnant or breastfeeding.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved

piroxicam

(pĭ-rŏk′sĭ-kăm′)
n.
A nonsteroidal anti-inflammatory drug, C15H13N3O4S, used primarily to treat arthritis.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.

piroxicam

Feldene®Therapeutics An NSAID tightly bound to plasma proteins T1/2 30 hrs; hepatic biotransformation; metabolites excreted in kidneys. See NSAIDs.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

piroxicam

A non-steroidal anti-inflammatory drug (NSAID) used mainly to control symptoms in the various forms of ARTHRITIS. A brand name is Feldene.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005
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Ainda, com relacao a sonolencia diurna excessiva, Felden e colaboradores (2015) verificaram que 53,0% de academicos ingressantes em cursos de ensino superior, foram classificados com sonolencia diurna excessiva.
This is because the XBRL taxonomy needs to reflect the accounting standard as taxonomy development is crucial in every discussion (Piechocki and Felden, 2007 and Piechocki, Felden, Graning and Debreceny, 2009).
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For the application of the method, 10 Felden Flash (each containing 20 mg PIR) tablets were weighed to calculate the average weight of a tablet.
The last bad beat jackpot was awarded in December 2011 when Joseph Carlis of Erie, PA, won $26,836.75 and Edward Felden of Eastlake, Ohio, won $13,418.88 in a 1-3 No Limit Hold'em Game.
Newport County: J Perry, D Pipe, A Sandell (M Cooper 46), A Hughes, T James (M Porter 46), L Minshull, M Flynn (J Thompson 46), L Evans (B Swallow 61), R Charles (K Felden 61), J Louis, A O''Connor (J Harris 46).
[2.] Roussy, G., and Felden, M.: A Sensitive Method for Measuring Complex Permittivity with a Microwave Resonator.
Their science research skills may also improve if teaching inquiry labs affects them in the same way that it does GTAs (French & Russell, 2002; Felden et al., 2011).
Whilst awaiting call up to the RAF, he joined the Bristol Engine Company, working closely with Sir Roy Felden. Post-war he joined the family company and worked closely with Alec Issigonis to develop the Hydrolastic suspension system for a number of motor cars, notably the Austin Mini.
Peak Muscle activity Rectus abdominus External Oblique Average Normalized Average Normalized Scissors Mean 0.041 9.586 0.056 10.473 Felden Mean 0.053 12.290 0.041 7.494 kneeling Mean 0.101 20.263 0.074 13.374 push ups Mean 0.035 7.956 0.046 8.659 plank Mean 0.060 13.950 0.092 15.302 side Mean 0.039 9.603 0.070 12.629 towel Mean 0.033 7.247 0.049 9.083 crunch Mean 0.076 18.603 0.082 13.688 Peak Muscle activity Erector Spinae Latissimus Dorsi Average Normalized Average Normalized Scissors 0.007 2.111 0.064 6.476 Felden 0.007 1.888 0.083 10.799 kneeling 0.009 2.564 0.071 7.852 push ups 0.006 1.792 0.108 11.382 plank 0.008 2.587 0.056 6.909 side 0.018 5.513 0.057 7.019 towel 0.020 6.032 0.204 21.182 crunch 0.005 1.654 0.035 5.076