NSAIDs

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton  

Introduction

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a drug class used as antipyretic, anti-inflammatory, and analgesic agents. These effects make NSAIDs useful for treating muscle pain, dysmenorrhea, arthritic conditions, pyrexia, gout, and migraines. However:

• NSAIDs can cause serious side effects, some of which may be life-threatening.
• NSAIDs may interact with other medicines and cause unwanted effects.
• NSAIDs should always be used cautiously, for the shortest time possible and at the lowest effective dose.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most well recognized drugs worldwide for the treatment of pain, inflammation, and fever .

Image 1: Ibuprofen, a common NSAID.

Mechanism of Action

NSAIDs work like corticosteroids, without many of the side effects of steroids. Corticosteroids are man-made drugs that are similar to cortisone, a naturally-occurring hormone. Like cortisone, NSAIDs reduce pain and inflammation that often come with joint and muscle diseases and injuries.

NSAIDs prevent our bodies from making prostaglandins. Prostaglandins are hormone-like chemicals in the body that contribute to inflammation, pain and fever by raising temperature and dilating blood vessels, which causes redness and swelling in the place they are released.

• NSAIDs block a specific enzymes called cyclooxygenase (or COX) used by the body to make thromboxanes and prostaglandins.
• Specifically: thromboxanes play a role in platelet adhesion; prostaglandins cause vasodilation, increase the temperature set-point in the hypothalamus, and play a role in anti-nociception.

By reducing production of prostaglandins, NSAIDs help relieve the discomfort of fever and reduce inflammation and the associated pain.

Common NSAIDs

Some commonly used NSAIDs include:

• aspirin (such as Disprin)
• ibuprofen (such as Nurofen)
• naproxen (such as Naprosyn)
• diclofenac (such as Voltaren)
• celecoxib (such as Celebrex).

Uses

NSAIDs are used to treat:

• Pain of rheumatoid arthritis (RA), osteoarthritis and tendonitis. See NSAIDs in the Management of Rheumatoid Arthritis
• Muscle aches.
• Backaches.
• Dental pain.
• Pain caused by gout.
• Bursitis.
• Menstrual cramps.

They can also be used to reduce fever or relieve minor aches caused by the common cold.

Adverse Effects

NSAIDs have well-known adverse effects affecting the gastric mucosa, renal system, cardiovascular system, hepatic system, and hematologic system. They include:

1. Gastric adverse effects see NSAIDs Gastropathy
2. Renal adverse effects that can occur include acute renal dysfunction, fluid and electrolyte disorders, renal papillary necrosis, and nephrotic syndrome/ interstitial nephritis.
3. Cardiovascular adverse effects can also be increased with NSAID use; these include MI, thromboembolic events, and atrial fibrillation.
4. Hematologic adverse effects are possible, particularly with nonselective NSAIDs due to their antiplatelet activity. This antiplatelet effect typically only poses a problem if the patient has a history of GI ulcers, diseases that impair platelet activity ( eg hemophilia, von Willebrand), and in some perioperative cases.
5. See also The Influence of NSAIDs on Physiologic Processes and Exercise