NSAIDs (Non-steroidal Anti-inflammatory Drugs)

NSAIDs are a widely used class of medication for the treatment of pain and fever.  NSAIDs work by inhibiting cyclooxygenase enzymes, which are essential in the production of prostaglandins.  Prostaglandins increase the sensitivity of nerves to pain and have a variety of other effects including promotion of uterine contractions.  NSAIDS reduce prostaglandin levels, which reduces inflammation and painful stimuli.  

Prostaglandin E2 is a prostaglandin that raises the "set temperature" in the anterior hypothalamus. Reducing prostaglandin E2 levels by NSAID administration, lowers the "set temperature," which can aid in the treatment of fevers.

NSAIDs cause multiple side effects including stomach ulcers (prostaglandins reduce stomach acid production and promote mucus production), renal injury (prostaglandins promote blood flow to kidneys), increased risk of stroke and myocardial infarction, and increased bleeding risk.

Class Drugs

• Diclofenac

• Fenoprofen

• Ibuprofen

• Indomethacin

• Ketorolac

• Naproxen

• Sulindac

Class Mechanism of Action

Inhibits cyclooxygenase enzymes for prostaglandin synthesis

Class Applications

Anti-inflammatory

Analgesic

• NSAIDS decrease prostaglandins. Prostaglandins increase sensitivity of nerves to inflammatory mediators such as bradykinin, histamine, etc.

Antipyretic

• Prostaglandin E2 raises the set temperature in the anterior hypothalamus and is released in setting of pyrogens. NSAIDS decrease synthesis of Prostaglandin E2.

 

Class Adverse Effects

GI

• Increased risk for GI irritation and bleeding due to increased gastric acid secretion, decreased mucus production

Bleeding risk

• Inhibition of production of TXA2.

• TXA2 is key for the process of platelet aggregation

Renal Effects

• Decreased blood flow to kidneys caused by inhibition of production of PGE2 and PGI2, which maintain renal blood flow

Cardiac Effects

• Increased risk of MI and stroke

May increase risk of asthma exacerbation

• Inhibition of prostaglandin production may shift body to produce more leukotrienes, which contributes to asthma exacerbation

Avoid in pregnancy

• Third trimester use increases risk of premature closure of ductus arteriosus in the fetus.

Drug Table

Drug Name	Application	Comments	Image
Diclofenac			"Dick" " Low Fence"
Fenoprofen			"Fence" "Pro" "Fin"
Ibuprofen			"Advil Bottle"
Indomethacin			"India" "Meth"
Ketorolac			"Keto Diet Book" "Lacky"
Naproxen			"Nap" "Rocks"
Sulindac			"Sulk" "Deck