Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Related Agents Nursing Considerations & Management

Notes

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
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.
  • 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:

  • 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:

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

  • 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.

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