NSAIDS (Non-steroidal Anti-Inflammatory Drugs)

Inhibition of COX-2

results in decreased inflammation, fever, and pain.

Contraindications:

First generation: • pregnancy • peptic ulcer disease • bleeding disorders (hemophilia, vitamin K deficiency) • Hypersensitivity to aspirin and other NSAIDs • Children and adolescents who have chickenpox/influenza (aspirin) • Older adults • Clients who smoke cigarettes • H.pylor infection • Hypovolemia • Asthma • Urticaria • Hx of alcoholism • Celecoxib contraindicated in clients who have an allergy to sulfonamides • Keterolac is contraindicated in clients who have advanced renal dysfunction (use no longer than 5 days because of the risk for kidney damage) • Second generation NSAIDs should be used cautiously in clients who have known cardiovascular disease

Mechanism of Action:

Inhibition of COX-1 can result in decreased platelet aggregation and kidney damage. Inhibition of COX-2 results in decreased inflammation, fever, and pain.

Nursing Interventions

• Advise clients to take with food or full glass of milk • Teach to avoid alcohol • Observe for dark colored stools, severe abdominal pain, N/V, • Administer a proton pump to decrease risk of ulcer formation • Monitor I&O • Advise clients to stop taking aspirin one week before surgery or expected date of childbirth • Do not crush or chew enteric-coated or sustained release aspirin tablets • Notify provider if salicylism occurs • Administer IV ibuprofen over 30 mins and keep patient hydrated

Interactions

• Anticoagulants increase risk of bleeding • Glucocorticoids increase risk of gastric bleeding • Alcohol increases risk of bleeding • Ibuprofen decreases the antiplatelet effects of low dose aspirin used to prevent MI • Ketorolac and concurrent use of other NSAIDs increase the risk of known adverse effects

Evaluation of Effectiveness:

• Reduced inflammation • Reduced fever • Relief from mild to moderate pain • Absence of injury

Side Effects:

•GI discomfort- dyspepsia, abdominal pain, heartburn, nausea) •Damage to gastric mucosa may lead to GI bleeding and perforation, especially with long-term use •Risk is increased in older adults, clients who have smoke or abuse alcohol, and those who have a history of peptic ulcers or previous inability to tolerate NSAIDs •Renal dysfunction (decreased urine output, weight gain from fluid retention, increased BUN and creatinine levels) •Increased risk of heart attack and stroke •Salicylism may occur with aspirin (tinnitus, sweating, headache, and dizziness, and respiratory alkalosis)

Indications:

•Inflammation suppression, analgesia for mild-moderate pain (e.g. osteoarthritis, rheumatoid arthritis), •fever reduction •dysmenorrhea •inhibition of platelet aggregation (protects against ischemic stroke and MI).

Adverse effects

•Reye syndrome- aspirin in fever in children •Aspirin toxicity (sweating, high fever, acidosis, dehydration, electrolyte imbalances, coma, respiratory depression)

First Class:

: aspirin, ibuprofen (Motrin/Advil), Naproxen, Ketorolac Second-generation NSAIDs: Celecoxib (Celebrex)

Inhibition COX-1 can result

decreased platelet aggregation and kidney damage.