NSAIDs Pharmacology Study Guide for Nurses

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:

ClassificationGeneric NameBrand Name
NSAIDs and Related Agents
Propionic AcidsfenoprofenNalfon
flurbiprofenAnsaid
ibuprofenMotrin, Advil
ketoprofenOrudis
naproxenNaprosyn
oxaprozinDaypro
Acetic AcidsdiclofenacVoltaren, Cataflam
etodolacLodine
indomethacinIndocin
ketorolacToradol
nabumetoneRelafen
sulindacClinoril
tolmetinTolectin
Fenamatesmeclofenamate
mefenamic acidPonstel
Oxicam DerivativesmeloxicamMobic
piroxicamFeldene

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.

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 release of heat. The mechanism related to analgesic effects has not been identified.

Indications


NSAIDs are indicated for the following medical conditions:

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  • 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.

Pharmacokinetics


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

RouteOnsetPeakDuration
Oral30 min1-2 h4-6 h
IVStart of infusionMinutes4-6 h
T1/2: -1.8 – 2.5 hrs.
Metabolism: liver
Excretion: 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:

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.

 

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Practice Quiz: NSAIDs


Here are some practice questions for this study guide:

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1. Nurse Kate is taking care of patients taking ibuprofen. Which of the following should be included in her assessment and monitoring?

A. Blood pressure and bowel sounds
B. Weight and appetite
C. Muscle strength and range of motion
D. Respiratory rate, depth, and rhythm

1. Answer: A. Blood pressure and bowel sounds

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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?

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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?

A. Streptokinase
B. COX-1
C. alpha-ketoglutarate
D. COX-2

4. Answer: D. COX-2

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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?

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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.

See Also


Here are other nursing pharmacology study guides:

Endocrine System Drugs

Autonomic Nervous System Drugs

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Immune System Drugs

Chemotherapeutic Agents

Reproductive System Drugs

Nervous System Drugs

Cardiovascular System Drugs

Further Reading and Resources


Recommended resources and books:

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  1. Focus on Nursing Pharmacology - Easy to follow guide for Pharmacology
  2. NCLEX-RN Drug Guide: 300 Medications You Need to Know for the Exam - Great if you're reviewing for the NCLEX
  3. Nursing 2017 Drug Handbook (Nursing Drug Handbook) - Reliable nursing drug handbook!
  4. Lehne's Pharmacology for Nursing Care - Provides key information on commonly used drugs in nursing
  5. Pharmacology and the Nursing Process - Learn how to administer drugs correctly and safely!
  6. Pharm Phlash Cards!: Pharmacology Flash Cards - Flash Cards for Nursing Pharmacology
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