Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Related Agents

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
Disease Spotlight: Primary Dysmenorrhea
Therapeutic Action
Indications
Pharmacokinetics
Contraindications and Cautions
Adverse Effects
Interactions
Nursing Considerations
Recommended Resources
See Also
References and Sources

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:

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Pharm Phlash! Pharmacology Flash Cards ^{#1 BEST SELLER!}
Test-yourself review cards put critical clinical information for nearly 400 of the top generic medications at your fingertips. And, you can count on them for accuracy, because each card is based on content from Davis’s Drug Guide for Nurses. Increase your test scores in pharmacology class.

Focus on Pharmacology (8th Edition)
Focus on Nursing Pharmacology makes challenging concepts more approachable. Engaging learning features cultivate your clinical application, critical thinking and patient education capabilities. This updated 8th edition builds on your knowledge of physiology, chemistry and nursing fundamentals to help you conceptualize need-to-know information about each group of drugs.

Pharmacology Made Incredibly Easy (Incredibly Easy! Series®)
Nursing pharmacology guide offers step-by-step guidance so you can grasp the fundamentals in enjoyable Incredibly Easy style. This is the perfect supplement to class materials, offering solid preparation for NCLEX® as well as a handy refresher for experienced nurses. Colorfully illustrated chapters offer clear, concise descriptions of crucial nursing pharmacology concepts and procedures.

Lehne’s Pharmacology for Nursing Care (11th Edition)
The Eleventh Edition of Lehne’s Pharmacology for Nursing Care provides a thorough understanding of key drugs and their implications for nursing care. This text, written by renowned nursing educators, helps you comprehend and apply pharmacology principles. A clear and engaging writing style simplifies complex concepts, making even the most challenging pharmacology content enjoyable. We recommend this book if you want a comprehensive nursing pharmacology guide.

Nursing Drug Handbook
Nursing2023 Drug Handbook delivers evidence-based, nursing-focused drug monographs for nearly 3700 generic, brand-name, and combination drugs. With a tabbed, alphabetical organization and a “New Drugs” section, NDH2023 makes it easy to check drug facts on the spot.

Pharmacology and the Nursing Process
The 10th edition of Pharmacology and the Nursing Process offers practical, user-friendly pharmacology information. The photo atlas contains over 100 unique illustrations and photographs depicting drug administration techniques. Updated drug content reflects the most recent FDA drug approvals, withdrawals, and therapeutic uses.

Mosby’s Pharmacology Memory NoteCards: Visual, Mnemonic, and Memory Aids for Nurses
The 6th edition of Mosby’s Pharmacology Memory NoteCards: Visual, Mnemonic, & Memory Aids for Nurses incorporates illustrations and humor to make studying easier and more enjoyable. This unique pharmacology review can be utilized as a spiral-bound notebook or as individual flashcards, making it ideal for mobile study.

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.