Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Related Agents

Updated on

May 4, 2024

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Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Related Agents

Contents

Nonsteroidal anti-inflammatory drugs (NSAIDs) provide strong anti-inflammatory and analgesic effects without the adverse effects associated with corticosteroids. These drugs have associated cardiovascular and gastrointestinal risks when taking them.

NSAIDs include propionic acids, acetic acids, fenamates, oxicam derivatives, and cyclooxygenase-2 (COX-2) inhibitors. They differ in chemical structures but NSAIDs are clinically all-inclusive.

Acetaminophen is a related drug that has antipyretic and analgesic properties but does not have the anti-inflammatory effects of salicylates or the NSAIDs.

NSAIDs: Generic and Brand Names

Here is a table of commonly encountered NSAIDs and related agents, their generic names, and brand names:

Propionic Acids
- fenoprofen (Nalfon)
- flurbiprofen (Ansaid)
- ibuprofen (Motrin, Advil)
- ketoprofen (Orudis)
- naproxen (Naprosyn)
- oxaprozin (Daypro)
Acetic Acids
- diclofenac (Voltaren, Cataflam)
- etodolac (Lodine)
- indomethacin (Indocin)
- ketorolac (Toradol)
- nabumetone (Relafen)
- sulindac (Clinoril)
- tolmetin (Tolectin)
Fenamates
- meclofenamate
- mefenamic acid (Ponstel)
Oxicam Derivatives
- meloxicam (Mobic)
- piroxicam (Feldene)

Disease Spotlight: Primary Dysmenorrhea

Primary dysmenorrhea is defined as cramping pain in the lower abdomen just before or during menstruation, in the absence of other diseases such as endometriosis. (AAFP, 1999)
Etiology is not precisely understood but most symptoms can be attributed to the action of uterine prostaglandin, PGF_2a. This stimulates uterine contractions, ischemia, and sensitization of nerve endings.
The prevalence rate is as high as 90 percent and is common among younger women. Some cases are adequately provided relief by OTC NSAIDs.

Therapeutic Action

The desired and beneficial action of NSAIDs is:

Inhibition of prostaglandin synthesis thereby exerting its anti-inflammatory, analgesic, and antipyretic effects.
It blocks two enzymes, namely cyclooxygenase (COX) 1 and 2 present in all tissues and seems to be involved in many body functions, like blood clotting, stomach lining, and sodium-water balance in the kidney. COX-1 turns arachidonic acid into prostaglandins as needed. COX-2 is active at sites of trauma or injury when more prostaglandins are needed. Therefore, NSAIDs block inflammation before all of the signs and symptoms can develop.
Acetaminophen, a related agent, acts directly on the thermoregulatory cells in the hypothalamus to cause sweating and vasodilation causing the release of heat. The mechanism related to analgesic effects has not been identified.

Indications

NSAIDs are indicated for the following medical conditions:

Relief of signs and symptoms of rheumatoid arthritis and osteoarthritis
Relief of mild to moderate pain
Treatment of primary dysmenorrhea
Fever reduction
Acetaminophen, a related agent, is used to treat moderate to mild pain and fever in children and is often used in place of NSAIDs or salicylates. It is found in many combination products and can cause severe liver toxicity that can lead to death when taken in high doses.
Acetaminophen is also used in the treatment of influenza, for prophylaxis of children receiving diphtheria-pertussis-tetanus (DPT) immunizations, and for relief of musculoskeletal pain associated with arthritis.

Pharmacokinetics

Here are the characteristic interactions of NSAIDs and the body in terms of absorption, distribution, metabolism, and excretion:

Route	Onset	Peak	Duration
Oral	30 min	1-2 h	4-6 h
IV	Start of infusion	Minutes	4-6 h

Half-life (T1/2)	Metabolism	Excretion
1.8 – 2.5 hrs.	Liver	Urine

Contraindications and Cautions

Contraindications and cautions for the use of NSAIDs include:

Allergy to NSAIDs or salicylate. Prevent adverse effects.
Allergy to sulfonamides. Contraindication with celecoxib.
CV dysfunction or hypertension. Varying effects of prostaglandins
Peptic ulcer or known GI bleeding. Potential to exacerbate GI bleeding.
Pregnancy or lactation. Potential adverse effects on the neonate or mother.
Renal or hepatic dysfunction. Can alter metabolism and excretion of the drug.
Any other known allergies. Indicate increased sensitivity.

Adverse Effects

Use of NSAIDs may result to these adverse effects:

CNS: headache, dizziness, somnolence, fatigue
CV: hypertension
GI: nausea, dyspepsia, GI pain, constipation, diarrhea, flatulence
Hema: bleeding, platelet inhibition, bone marrow depression

Interactions

The following are drug-drug interactions involved in the use of NSAIDs:

Loop diuretics: decreased diuretic effect
Beta-blockers: decreased antihypertensive effect
Ibuprofen: potential for lithium toxicity
Oral anticoagulants: increased bleeding with acetaminophen
Chronic ethanol ingestion: risk of toxicity with acetaminophen

Nursing Considerations

Nursing considerations in patients taking NSAIDs are the same as that of patients taking anti-inflammatory agents.

Recommended Resources

Our recommended nursing pharmacology resources and books:

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase which will help support us. Thank you! For more information, check out our privacy policy.

Pharm Phlash! Pharmacology Flash Cards
Pocket-size flash cards covering drug classes, actions, side effects, and nursing considerations. The 2023 edition is handy for quick review between classes and clinicals.

Karch’s Focus on Nursing Pharmacology
The 2026 edition of this easy-to-follow nursing pharmacology text, organized by body system with a focus on safe medication administration and client teaching.

Pharmacology Made Incredibly Easy!
The 2026 edition of the Incredibly Easy! series breaks down drug classes with cartoons, memory aids, and quick-review checkpoints.

Lehne’s Pharmacology for Nursing Care
A comprehensive pharmacology text (2024 edition) that explains how drugs work and connects each drug class to nursing implications and client safety.

Nursing2027-2028 Drug Handbook
The newest edition of the Nursing Drug Handbook, with up-to-date monographs on dosing, adverse reactions, and nursing considerations for thousands of drugs.

Davis’s Drug Guide for Nurses
The 2026 edition of this trusted drug reference, with clear monographs, high-alert warnings, and client teaching points for each medication.

Mosby’s Pharmacology Memory NoteCards
Visual, mnemonic, and memory aids for nursing pharmacology (2024 edition). Great for remembering drug classes and key side effects for exams and the NCLEX.

References and Sources

References and sources for this pharmacology guide for NSAIDs:

Karch, A. M., & Karch. (2011). Focus on nursing pharmacology. Wolters Kluwer Health/Lippincott Williams & Wilkins. [Link]
Katzung, B. G. (2017). Basic and clinical pharmacology. McGraw-Hill Education.
Lehne, R. A., Moore, L. A., Crosby, L. J., & Hamilton, D. B. (2004). Pharmacology for nursing care.
Smeltzer, S. C., & Bare, B. G. (1992). Brunner & Suddarth’s textbook of medical-surgical nursing. Philadelphia: JB Lippincott.

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About the Author

Iris Dawn Tabangcora, RN

Iris Dawn is a nurse writer in her 20s who is on the constant lookout for latest stories about Science. Her interests include Research and Medical-Surgical Nursing. She is currently furthering her studies and is seriously considering being a student as her profession. Life is spoiling her with spaghetti, acoustic playlists, libraries, and the beach.