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 includes 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 which has antipyretic and analgesic properties but does not have the anti-inflammatory effects of the salicylates or the NSAIDs.
Table of Common Drugs and Generic Names
Here is a table of commonly encountered NSAIDs and related agents, their generic names, and brand names:
|Classification||Generic Name||Brand Name|
|NSAIDs and Related Agents|
|Acetic Acids||diclofenac||Voltaren, Cataflam|
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, PGF2a. This stimulates uterine contractions, ischemia, and sensitization of nerve endings.
- Prevalence rate is as high as 90 percent and is common among younger women. Some cases are adequately provided relief by OTC NSAIDs.
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 release of heat. The mechanism related to analgesic effects has not been identified.
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 often used in place of the 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 treatment of influenza, for prophylaxis of children receiving diphtheria-pertussis-tetanus (DPT) immunizations, and for relief of musculoskeletal pain associated with arthritis.
Here are the characteristic interactions of NSAIDs and the body in terms of absorption, distribution, metabolism, and excretion:
|Oral||30 min||1-2 h||4-6 h|
|IV||Start of infusion||Minutes||4-6 h|
|T1/2: -1.8 – 2.5 hrs.|
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.
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
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 in patients taking NSAIDs are the same as that of patients taking anti-inflammatory agents.
Practice Quiz: NSAIDs
Here are some practice questions for this study guide:
In Exam Mode: All questions are shown but the results, answers, and rationales (if any) will only be given after you’ve finished the quiz.
Practice Quiz: NSAIDs
Practice Mode: This is an interactive version of the Text Mode. All questions are given in a single page and correct answers, rationales or explanations (if any) are immediately shown after you have selected an answer. No time limit for this exam.
Practice Quiz: NSAIDs
Text Mode: All questions and answers are given on a single page for reading and answering at your own pace. Be sure to grab a pen and paper to write down your answers.
1. Nurse Kate is taking care of patients taking ibuprofen. Which of the following should be included in her assessment and monitoring?
1. Answer: A. Blood pressure and bowel sounds
NSAIDs are associated with CV (hypertension) and GI (constipation, diarrhea, etc.) adverse effects. All other options are not related.
2. Upon checking the medication chart, Nurse Mike found out that his patient is taking both acetaminophen and furosemide. Which of the following interventions is an appropriate nursing action for these two drugs?
A. Administer medications as they are because they enhance drug actions.
B. Measure patient’s intake and output closely.
C. Arrange for SGPT monitoring.
D. Assess for signs and symptoms of bleeding.
2. Answer: B. Measure patient’s intake and output closely.
Acetaminophen can decrease the diuretic effect of loop diuretics so it is important to monitor patient for fluid retention.
3. Which of the following patient manifests acetaminophen toxicity?
A. Marie, 26, with new-onset jaundice while on drug therapy
B. Eva, 54, with difficulty of breathing while on drug therapy
C. Steven, 37, with joint stiffness while on drug therapy
D. Robert, 29, with new-onset glaucoma while on drug therapy
3. Answer: A. Marie, 26, with new-onset jaundice while on drug therapy
Acetaminophen toxicity manifests as severe hepatotoxicity.
4. Which enzyme is found in active sites of trauma or injury?
4. Answer: D. COX-2
The presence of this enzyme in active sites of trauma prompts increase in prostaglandins. NSAIDs block COX-2 before signs and symptoms of inflammation can develop.
5. The patient asked the nurse of how soon pain relief will be achieved after a dose of intravenous NSAIDs. The nurse would be correct by answering:
A. 5-10 minutes depending on the site involved
B. at the start of infusion
C. 30 minutes since pain is usually extensive
D. at the first hour of infusion
5. Answer: B. at the start of infusion
Onset of action of IV NSAIDs is immediately after infusion. In oral form, onset is 30 minutes after administration.
6. Which of the following NSAID pairing is correct?
A. propionic acid: indomethacin
B. acetic acid: ibuprofen
C. oxicam derivatives: naproxen
D. fenamates: mefenamic acid
6. Answer: D. fenamates: mefenamic acid
Ibuprofen is a propionic acid and indomethacin is an acetic acid.