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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
NSAIDs: Actions and Uses
NSAIDs: Actions and Uses
•
Exact mechanism of action unknown;
thought to work by inhibiting action of
enzyme cyclooxygenase responsible for
prostaglandin synthesis; NSAIDs inhibit two
related enzymes
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Inhibit activity of cyclooxygenase-1 (COX-1):
Enzyme helps to maintain the stomach lining
•
Inhibit activity of cyclooxygenase-2 (COX-2):
Enzyme triggers pain and inflammation

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
NSAIDs: Actions and Uses (cont.)
NSAIDs: Actions and Uses (cont.)
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Ibuprofen and naproxen: Block COX-2, produces
pain relief; inhibit COX-1, causes adverse reactions
including unwanted GI reactions such as stomach
irritation and ulcers
•
Celecoxib: Inhibits only COX-2; less potential for GI
adverse reactions
•
Used for osteoarthritis, rheumatoid arthritis, and
other musculoskeletal disorders; mild to moderate
pain; primary dysmenorrhea; fever reduction

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
NSAIDs: Adverse Reactions
NSAIDs: Adverse Reactions
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Gastrointestinal system reactions
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Nausea, vomiting, dyspepsia, diarrhea,
constipation, epigastric pain, indigestion,
abdominal distress or discomfort,
intestinal ulceration, stomatitis, jaundice,
bloating, anorexia, dry mouth

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
NSAIDs: Adverse Reactions (cont.)
NSAIDs: Adverse Reactions (cont.)
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Central nervous system reactions
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Anxiety, lightheadedness, vertigo,
headache, drowsiness, somnolence,
insomnia, confusion, depression, stroke,
psychic disturbances
•
Cardiovascular reactions
–
Congestive heart failure, decrease or
increase in blood pressure, cardiac
arrhythmias, myocardial infarction

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
NSAIDs: Adverse Reactions (cont.)
NSAIDs: Adverse Reactions (cont.)
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Renal reactions
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Hematuria, cystitis, elevated blood urea
nitrogen, polyuria, dysuria, oliguria, acute
renal failure in those with impaired renal
function
•
Sensory reactions
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Blurred or diminished vision, diplopia,
swollen or irritated eyes, photophobia,
reversible loss of color vision, tinnitus,
taste change, rhinitis

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
NSAIDs: Adverse Reactions (cont.)
NSAIDs: Adverse Reactions (cont.)
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Hematologic reactions
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Neutropenia, eosinophilia, leukopenia,
pancytopenia, thrombocytopenia,
agranulocytosis, aplastic anemia
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Skin reactions
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Rash, erythema, irritation, skin eruptions,
exfoliative dermatitis, Stevens-Johnson
syndrome, ecchymosis, purpura

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
NSAIDs: Adverse Reactions (cont.)
NSAIDs: Adverse Reactions (cont.)
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Metabolic/endocrine reactions
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Decreased appetite, weight increase or
decrease, hyperglycemia or
hypoglycemia, flushing, sweating,
menstrual disorders, vaginal bleeding
•
Other
–
Thirst, fever, chills, vaginitis

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
NSAIDs: Contraindications
NSAIDs: Contraindications
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Cross-sensitivity, if allergic to one NSAID,
there is increased risk of allergic reaction to
others; hypersensitivity to aspirin; during
third trimester of pregnancy and lactation
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Ibuprofen: Hypertension, peptic ulceration, or
GI bleeding
•
Celecoxib: Allergic to sulfonamides, or history
of cardiac disease or stroke