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Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Related Agents

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By Iris Dawn Tabangcora, RN

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.

Table of Contents

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, PGF2a. 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.


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 diphtheriapertussis-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:

Oral30 min1-2 h4-6 h
IVStart of infusionMinutes4-6 h
Half-life (T1/2)MetabolismExcretion
1.8 – 2.5 hrs.LiverUrine

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:


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

Nursing Considerations

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

Our recommended nursing pharmacology resources and books:

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Focus on Pharmacology (8th Edition)
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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)
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Nursing Drug Handbook
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Pharmacology and the Nursing Process
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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.

See Also

Here are other nursing pharmacology study guides:

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Drug Guides NEW!

Individual drug guides and nursing considerations for the most common medications used in nursing pharmacology:

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.
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.

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