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 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.

• NSAIDs: Generic and Brand Names

• Disease Spotlight: Primary Dysmenorrhea
• Therapeutic Action
• Indications
• Pharmacokinetics
• Contraindications and Cautions
• Adverse Effects
• Interactions
• Nursing Considerations
NSAIDs: Generic and Brand 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

fenoprofen Nalfon

flurbiprofen Ansaid

ibuprofen Motrin, Advil

Propionic Acids
ketoprofen Orudis

naproxen Naprosyn

oxaprozin Daypro

diclofenac Voltaren, Cataflam

etodolac Lodine

indomethacin Indocin

Acetic Acids ketorolac Toradol

nabumetone Relafen

sulindac Clinoril

tolmetin Tolectin
 meclofenamate
Fenamates
mefenamic acid Ponstel

meloxicam Mobic
Oxicam Derivatives
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.