22.03 NSAIDs

Non-steroidal anti-inflammatory drugs, often known as NSAIDs. In this one, in this video, we will look at the mechanism of action, in which disease process, what are the indication to use this medication, side effects, nursing consideration and some examples.

So, let’s talk about the mechanism of action. So we have a Arachidonic acid in the body which is often converted into cytoprotective prostaglandins in our body by COX-1. Now, what is COX-1? COX is cyclooxygenase enzyme. Now, what is the function of this cytoprotective prostaglandin? The first, gastric protection. This prostaglandin protects the stomach by producing the mucus that protects stomach against its own acids. The second one, it increases platelet aggression. So, blood clot formation happens really fast and it stops the bleeding anywhere from the body which is kinda protective mechanism from this cytoprotective prostaglandin does have. It also protects the kidneys as well. It causes the vasodilation and also the bronchodilation. Now, whenever there is a tissue injury in our body, anywhere, tissue injury, this arachidonic acid will be converted into the inflammatory prostaglandins by COX-2 which is cyclooxygenase enzyme 2. Now, what does this inflammatory prostaglandin does? it causes the inflammation, pain, it regulates hypothalamic temperature. So, what it does, it increases the temperature of the body whenever there’s a tissue injury, either at the site or generalized body temperature. So, those are the inflammatory prostaglandin works is. Now, this non-steroidal anti-inflammatory drugs blocks these COX-1 and COX-2 both. So, these drugs which blocks COX-1 and COX-2 called as non-selective NSAIDs. Now, there is only one drug available in the market which only blocks COX-2 called as selective NSAIDs. And we’ll take a look at some of the examples of non-selective and selective NSAIDs in the following slides. So, this is the basic mechanism of action of Non-steroidal anti-inflammatory drug that blocks cyclooxygenase enzyme 1 and 2, that’s why it’s often called cyclooxygenase inhibitors as well. And by blocking cyclooxygenase 2, it blocks the inflammation, it decreases the pain, and it decreases the temperature of the body.

So, as you know now that it decreases inflammation, pain and temperature, what is the use of this medication? It is use as a mild to moderate pain, it is also used as a anti inflammation to decrease the inflammation, and also used as antipyretic to decrease the body temperature. Now, these drugs are often used for the pain which is associated with inflammation. Not any other kind of pain, because it works better if the pain is due to the inflammation. So, these are the 3 main reason these medications are used for. However, you may have seen patient on aspirin after myocardial infarction or stroke. So, there’s a drug, Aspirin, and this non-steroidal anti-inflammatory drugs. Now, if you take a look at back here, it blocks the cycooxygenase 1, so, it’s gonna, instead of increase it, it’s gonna decrease the platelet aggression, so, it’s gonna make blood thin. So, because of that, this aspirin is used after myocardial infarction to prevent the further formation of the clot and stroke, and also myocardial infarction and stroke, to prevent the further M.I. and stroke. However, if the patient is on Aspirin, they still can have M.I. and stroke but this one actually decreases the significant chance of happening M.I. and stroke. So, it’s not guaranteed that if the patient is on aspirin after myocardial infarction or stroke, that they not gonna have myocardial infarction or stroke. But, this decreases the chances of happening those in future, these drugs, Aspirin.

Now, what are the side effects and what, as a nurse, what do you have to look for, what are the contraindication? So, this is the main one often asked on NCLEX as well, Salicylism, often happens with the aspirin. It doesn’t happen with any of the NSAIDs usually and often happens with the aspirin only. In salicylism, you feel tinnitus, dizziness, headache, and excessive sweating. So, when a patient goes on aspirin at home, you wanna teach them about like if you see any like a ringing in ears, like tinnitus, any dizziness, consistent headaches, or any kind of excessive sweating, call your doctor as soon as possible. Now, since we understood the mechanism of action, now, if we block the COX-1, cyclooxygenase 1 enzyme, it’s not gonna protect the stomach anymore, so it can cause the gastric bleeding and as well as the peptic ulcer. Now, since it’s gonna decrease the platelet aggression, it can cause the prolonged bleeding. So, after like a cut or some kind of trauma, there will be blood will take longer to clot than usual time. This drug can cause nausea, vomiting, diarrhea, dizziness and rash as well. Since one of the main function of cyclooxygenase 1 enzyme that converts into this cytoprotective prostaglandin that protects the kidney. Now, it’s not gonna be protected anymore since this non-selective anti-inflammatory drugs gonna block that COX-1, so, it can cause a kidney failure especially ibuprofen. Ibuprofen. And, this medication can cause the retention of fluid and edema as well.

The next slide is covering the some examples of non-steroidal non-inflammatory drugs. Now, we talked, there are some anti-inflammatory drugs that’s non-steroidal are non-selective and some of them, there’s only one which is selective. So, these examples are all non-selective NSAIDs. So, these drugs blocks COX-1 and COX-2, both. While this Celecoxib, it only blocks COX-2. So, Celecoxib doesn’t have the side effects like stomach bleeding, kidney failure, prolonged bleeding, those kinds of. Because it only, it decreases, it only blocks COX-2 enzyme, not the COX-1. There were many drugs in the market that only inhibits COX-2 which is often called as a selective NSAIDs because it selectively blocks COX enzymes, cycooxygenase 2, so, COX-2. However, there was a data coming from the users that it can cause the cardiac, went like edema, there were high risk of a heart failure, like so forth, so, most company took those drugs out of the market. There’s only one drug in the market right now which is a selective NSAID is Celecoxib. So, that’s the only difference between these non-selective and selective. And often they, on NCLEX they either use the Aspirin, the Ibuprofen, Diclofenac, Fenoprofen, Ketoprofen, Naproxen. Those are the most often tested drugs in NCLEX.

So, that was it about the NSAIDs. If you have any questions, you can contact us or put a comment.