Nonsteroidal anti-inflammatory drugs

Nursing administration actions:

- Ketorolac is only for short-term treatment of moderate to severe pain. - It should not be used for more than 5 days because of the risk of kidney damage.

First-generation NSAIDs include:

Aspirin Ibuprofen (Advil, Motrin) Naproxen (Aleve) Indomethacin (Indocin) Diclofenac (Voltaren) Ketorolac (Toradol) Meloxicam (Mobic)

Second-generation NSAIDs include:

Celecoxib (Celebrex) tip: To help you remember that this drug is a second-generation NSAID look back at want second-generation NAIDs look back at what it does it is a selective COX-2 inhibitor. So cele (select) cox (COX) ib (inhibitor). Again, I have a simple mind and have to keep it simple. If I know this one is a second-generation, then I know all the others are first generation.

Common drugs in this class include first-generation NSIAIDs which

inhibit both COX-1 and COX-2

Complications with NSAIDS is

is GI issues like dyspepsia, abdominal pain, heartburn, and nausea. - Patients who smoke, have a history of peptic ulcers, or drink alcohol have an increased risk for GI irritability. - Patient's should take the medication with food or a full glass of water or milk and avoid alcohol. - NSAIDs can impair kidney function. Which means they should be used cautiously in patients with heart failure of impaired kidney function. - Non-aspirin NSAIDs can also increase the risk for heart attack or stroke, so always use the smallest dose possible.

Thromboxane

is a hormone that induces platelet aggregation and arterial constriction and prostaglandins are a group of lipids that control processes such as inflammation, blood flow, the formation of blood clots, and the induction of labor.

second-generation NSAIDs which are

selective COX-2 inhibitors.

Nonsteroidal anti-inflammatory drugs Pharmacological Action:

Inhibition of cyclooxygenase-1 (COX- 1) can result in decreased platelet aggregation and kidney damage while inhibition of cyclooxygenase-2 (COX-2) results in decreased inflammation, fever, and pain and does not decrease platelet aggregation.

Cyclooxygenase

Is an enzyme that is responsible for the formation of thromboxane and prostaglandins

Contraindications/precautions:

(1) Think about what cyclooxygenase does. (2) It is responsible for the formation of thromboxane and prostaglandins. (3)If thromboxane causes platelet aggregation and arterial constriction and prostaglandins form blood clots, and NSADs block COX-1 and 2, what potential issues would you anticipate? ****If you guessed bleeding disorders, you would be correct. ****Which means you should uses these drugs cautiously in people with active peptic ulcer disease, and bleeding disorders. ****Also because prostaglandin is part of the process that induces labor, you should not use in pregnant patients. ****It is considered a Pregnancy Risk Category D which means there is positive evidence of human fetal risk but potential benefits might warrant use of the drug despite the potential risk.

Interactions

(1) concurrent use of NSAIDs and anticoagulants, glucocorticoids, or alcohol can all increase the risk of bleeding. (2) Ibuprofen actually DECREASES the antiplatelet effectiveness of aspirin, so avoid concurrent use. (3) And using Ketorolac and NSAIDs concurrently because it can increase the risk of known adverse effects.