Antiinflammatory Agents

and Nonsteroidal
Antiinflammatory Drugs
(NSAIDs)

Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs
Large and chemically diverse group of drugs
with the following properties:
Analgesic
Antiinflammatory
Antipyretic

Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Mechanism of Action

Activation of the arachidonic acid
pathway causes:
pain
headache
fever
inflammation

Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

Instructors may wish to use

EIC Image #107:
Arachidonic Acid Pathway

Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Mechanism of Action

Analgesiatreatment of headaches and pain
Block the undesirable effects of prostaglandins,
which cause headaches

Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Mechanism of Action

Antipyretic: reduce fever
Inhibit prostaglandin E2 within the area of the brain
that controls temperature

Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Mechanism of Action

Relief of inflammation
Inhibit the leukotriene pathway, the prostaglandin
pathway, or both

Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs
Six structurally related groups:
Acetic acids
Carboxylic acids
Propionic acids
Enolic acids
Fenamic acids
Nonacidic compounds

Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Acetic Acid

diclofenac sodium (Voltaren)
diclofenac potassium (Cataflam)
etodolac (Lodine)
indomethacin (Indocin)
sulindac (Clinoril)
tolmetin (Tolectin)
Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Carboxylic Acids

Acetylated
aspirin (ASA)
choline magnesium salicylate (Trilisate)
diflunisal (Dolobid)

Nonacetylated
salicylamide
salsalate (Disalcid)
sodium salicylate
Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Propionic Acids

fenoprofen (Nalfon)
flurbiprofen (Ansaid)
ibuprofen (Motrin, others)
ketoprofen (Orudis)
ketorolac (Toradol)
naproxen (Naprosyn)
oxaprozin (Daypro)
Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Other Agents

Enolic acids
phenylbutazone (Butazolidin)
piroxicam (Feldene)

Fenamic acids
meclofenamic acid (Meclomen)
mefenamic acid (Ponstel)

Nonacidic compounds
nabumetone (Relafen)
Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Other Agents

COX-2 Inhibitors
celecoxib (Celebrex)
rofecoxib (Vioxx)

Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Drug Effects

Analgesic (mild to moderate)
Antigout
Antiinflammatory
Antipyretic
Relief of vascular headaches
Platelet inhibition (ASA)
Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Therapeutic Uses

Relief of mild to moderate pain
Acute gout
Various bone, joint, and muscle pain
Osteoarthritis
Rheumatoid arthritis
Juvenile rheumatoid arthritis
Dysmenorrhea
Fever
Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Specific Agents

salicylates (aspirin)
More potent effect on platelet aggregation and
thermal regulatory center in the brain
analgesic
antipyretic
antiinflammatory
Antithrombotic effect: used in the treatment of MI
and other thromboembolic disorders
Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Specific Agents

phenylbutazone (Butazolidin)
Greater effects on uric acid production and
excretion, in addition to antiinflammatory effects
More commonly used for treatment of gout

Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Side Effects

Gastrointestinal
dyspepsia, heartburn, epigastric distress, nausea
**GI bleeding
**mucosal lesions (erosions or ulcerations)
Misoprostol (Cytotec) can be used to reduce these
dangerous effects.

Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Side Effects

Renal
reductions in creatinine clearance
acute tubular necrosis with renal failure

Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Side Effects

Cardiovascular
noncardiogenic pulmonary edema

Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Salicylate Toxicity

Adults: tinnitus and hearing loss
Children: hyperventilation and CNS effects
Effects arise when serum levels exceed
300g/mL.
Metabolic acidosis and respiratory alkalosis
may be present.

Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Nursing Implications

Before beginning therapy, assess for
conditions that may be contraindications to
therapy, especially:
GI lesions or peptic ulcer disease
Bleeding disorders

Assess also for conditions that require

cautious use.
Perform lab studies as indicated (cardiac,
renal, liver studies, CDC, platelet count).
Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Nursing Implications

Perform a medication history to assess for
potential drug interactions.
Several serious drug interactions exist:
alcohol
heparin
phenytoin
oral anticoagulants
steroids
sulfonamides
Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Nursing Implications

Salicylates are NOT to be given to children
under age 12 because of the risk of Reyes
syndrome.
Because these agents generally cause GI
distress, they are often better tolerated if
taken with food, milk or an antacid to avoid
GI irritation.
Explain to patients that therapeutic effects
may not be seen for 3 to 4 weeks.
Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Nursing Implications

Educate patients about the various side
effects of NSAIDs, and to notify their
physician if these effects become severe
or if bleeding or GI pain occur.
Patients should watch closely for the
occurrence of any unusual bleeding,
such as in the stool.
Enteric-coated tablets should not be
crushed or chewed.
Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Nursing Implications

Monitor for therapeutic effects, which vary
according to the condition being treated:
decrease in swelling, pain, stiffness,
and tenderness of a joint or muscle area

Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.