NSAIDS NCLEX Nursing Pharmacology Review
Nursing Pharmacology Study Guide on NSAIDs
Non-steroidal anti-inflammatory drugs or NSAIDs are a group of drugs that reduce inflammation and pain. They are mainly used for arthritic disorders and musculoskeletal pain.
Their effect on the cyclooxygenase pathways allows them to reverse the inflammatory process and the corresponding tissue damage that occurs with the chronicity of this cascade.
Nursing Stat Facts
Aside from their analgesic, antipyretic and anti-inflammatory effects, they also decrease platelet aggregation which is useful in preventing conditions caused by thromboembolism such as transient ischemic attacks, myocardial infarction, and stroke.
They are classified based on their chemical structures with each category having slightly different characteristics.
Indications of NSAIDs
NSAIDs have been around for quite some time and they were used to treat fever and pain. Recently, discoveries are made which extend their usefulness beyond symptomatic relief. The indications for the use of NSAIDs are the following:
- For analgesic and anti-inflammatory effects:
- For prevention due to antiplatelet effects:
Actions of NSAIDs
The inhibition of prostaglandin biosynthesis is the main mechanism for the anti-inflammatory and analgesic effect of NSAIDs.
They block the cyclooxygenase thus preventing arachidonic acid from synthesizing prostaglandins. Arachidonic acid is liberated when there is cell membrane damage during inflammation.
If there is no resolution of the underlying injury that prompted the inflammatory cascade, chronic inflammation sets in which in turn results in tissue damage to the host.
NSAIDs stop this cascade at this level. As a result, the signs of inflammation which include redness, swelling, pain, heat, and loss of function also known as the five cardinal signs of inflammation, subsides.
There are 2 types of cyclooxygenases, COX1 and COX2. COX1 is inherently and continuously produced by the body while COX2 is produced only during tissue injury at the site of damage.
Some drugs inhibit both cyclooxygenases while some selectively inhibit COX2.
The 2 types of cyclooxygenase inhibition:
- Non – selective COX inhibitors – These NSAIDs block both the cyclooxygenase 1 and 2 pathways resulting in two effects – arresting inflammation and preventing platelet aggregation.
- Selective COX2 inhibitors – This class of NSAIDs were developed mainly to inhibit inflammation without the side effects that arise from inhibition of COX-1 which include gastric and duodenal ulcers and bleeding. As such, these drugs can be used to treat inflammatory disorders but are not useful for the prevention of diseases that depend on COX-1 inhibition.
Side Effects and Adverse Effects of NSAIDs
As a class of drugs, NSAIDs have similar side effects. Most of them stem from the effects on prostaglandin inhibition and chemical components. More serious side effects are from the effect on the blood.
The most common side effects are as follows:
- allergic reactions like urticaria and wheals
- fluid retention and edema
- abdominal pain
- asthma attack
Less common side effects include:
- aplastic anemia
- abnormal liver function test results
- liver failure
- renal insufficiency
- renal failure
- congestive heart failure
- myocardial infarction
- gastric and duodenal ulcers
- gastrointestinal bleeding
Contraindications and cautions for NSAIDs
It should be remembered that NSAIDs affect platelet aggregation and inflammation. Any disease entity whose pathophysiology is affected by both processes will most likely be affected by the intake of NSAIDs.
Some conditions are prohibited from NSAID use while others may be allowed with proper caution and monitoring.
NSAIDs are contraindicated in patients with the following conditions:
- Patients with hemophilia – NSAIDs have anti-platelet effects that can exacerbate the bleeding tendencies and may be fatal for these patients.
- Previous NSAID or salicylate hypersensitivity – any previous hypersensitivity to medication is a contraindication for repeated use of the said medication.
- Asthma attack after ingestion of NSAIDS – such events should be noted as subsequent attacks may be severe and can be life-threatening.
- Patients who have recently undergone coronary artery bypass graft surgery – studies have shown an increased risk of myocardial infarction for some NSAIDs for these patients.
NSAIDs should be used with caution in patients with the following conditions:
- chronic kidney disease
- medication allergy
- diabetes mellitus
- bronchial asthma
- systemic lupus erythematosus
- gastric and duodenal ulcers
- History of gastrointestinal bleeding
- History of bleeding disorders other than hemophilia
- Concurrent condition that has bleeding tendencies like dengue and chikungunya fevers
- Recent viral infections like chickenpox and flu. Studies have associated NSAID use with the development of Reye syndrome, a condition that causes swelling in the liver and brain.
Drug Interactions with NSAIDs
NSAID metabolism is mainly through the liver by way of the cytochrome P450 system and eliminated through the kidneys. Therefore, all drugs that are metabolized by these similar enzymes and pathways will have interactions with NSAIDs to varying extents.
Their effect on the arachidonic acid – prostaglandin pathways of reducing inflammation and decreasing platelet aggregation crosses with the mechanisms of actions of several other drugs as well. The following drugs should be used with caution when taken with NSAIDs.
- Drugs that act on the hematopoietic system such as anti-thrombotic and other anti-platelets increase the risk of bleeding. Examples of these drugs are warfarin, heparin, novel anti-coagulants, and other anti-platelets.
- NSAIDs attenuate the effect of most anti-hypertensive drugs. Taking NSAIDs with these drugs may decrease their effectiveness and cause increased blood pressure. Such drugs include ace-inhibitors, angiotensin receptor blockers, thiazide diuretics and loop diuretics.
- NSAIDs may affect the kidney through the regulation of the renal artery’s blood flow. Drugs that act on the kidneys may precipitate damage when used with NSAIDs. Drugs that are eliminated through the kidneys may show decreased renal clearance and increased toxicity. These drugs include the mood disorder drugs, anti-cancer drugs, cardiac drugs, and nephrotoxic anti-bacterial drugs like aminoglycosides.
- Some drugs interact with NSAIDs through their metabolism in the liver. Anti-epileptic drugs may show decreased hepatic clearance and displacement from protein binding since NSAIDs are also highly protein-bound.
- Oral anti-diabetic drugs may induce further hypoglycemia when taken with NSAIDs
- Drugs that affect the gastrointestinal tract like corticosteroids may increase the risk of ulceration and bleeding. Antacids may interfere with the absorption of NSAIDs.
Nursing Care Plan for Patients on NSAIDs
- Possible Nursing Diagnoses
- Nausea and Vomiting due to the gastrointestinal side effects of NSAIDs
- Acute Pain (gastric)
- Risk for Hypoglycemia related to drug interactions between NSAIDs and anti-diabetic agents
- Risk for Impaired Urinary Elimination related to the effects of NSAIDs on the kidneys
- Risk for Bleeding (Gastrointestinal) related to drug interactions between NSAIDs and antacids or corticosteroids
- Risk for Hyperkalemia
- Deficient Knowledge related to new drug prescription
|1.Verify the patient’s diagnosis and the need for administering NSAIDs.||To confirm the indication for administering NSAIDs.|
|2. Check the patient’s allergy status.||Previous allergic reaction to NSAIDs may render the patient unable to take them. Alternatives to NSAIDs should therefore be considered in case of allergy.|
|3. Assess if the patient is pregnant.||NSAIDs should not be prescribed to a pregnant woman who is at 20 weeks or above as these drugs can potentially harm the kidney function of the developing fetus.|
|4. Assess the patient’s mucous membranes and his/her ability to swallow. If giving intravenously, assess the suitability of the vein or the status of the central venous access device or CVAD.||To check for any potential problems with administration, hydration, and absorption.|
To ensure that the right form of NSAIDs is given through the right route.
|5. Check for current medication history.||Taking corticosteroids, anticoagulants, antacids, cholinergic agonists with NSAIDs may increase the risk for internal gastrointestinal upset or bleeding.|
|6. Check the patient’s serum blood sugar levels if taking anti-diabetics alongside NSAIDs.||Patients on NSAIDs and oral anti-diabetics may experience hypoglycemic episodes.|
|7. Ask the patient for any medical or family history of hemophilia, gastrointestinal ulcers, or bleeding disorders.||NSAIDs have anti-platelet effects that can exacerbate the bleeding tendencies and may be fatal for these patients.|
Nursing Planning and Intervention
|Administer NSAIDs with or after meals and on time as prescribed.||NSAIDs are best taken on full stomach to reduce the occurrence of stomach upset. NSAIDs should always be taken on time to prevent any delays and errors during treatment.|
|Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking NSAIDs. Instruct the patient on how to self-administer oral NSAIDs.||To inform the patient on the basics of NSAIDs, as well as to empower him/her to safely self-administer the medication.|
|Monitor the patient’s input and output.||NSAIDs may cause impaired urinary elimination.|
|Advise the pregnant woman to avoid any NSAIDs. Actively recommended a suitable medication that can mimic NSAIDs.||Pregnant women at 20 weeks or above are not allowed to take NSAIDs as they may harm the kidneys of the fetus.|
|Routinely check for the blood glucose level of the patient, especially if they are diabetic.||NSAIDs may reduce serum glucose levels.|
|Administer supportive medications as needed. These may include anti-nausea medications. Report these side effects to the doctor and stop the NSAIDs if adverse events occur.||Administer supportive medications to help the patient cope with taking NSAIDs.|
|1.Ask the patient to repeat the information about NSAIDs.||To evaluate the effectiveness of health teaching on NSAIDs.|
|2. Monitor the patient’s serum electrolyte levels and renal and hepatic function.||To ensure that the NSAIDs did not cause any electrolyte imbalance (specifically hyperkalemia) or renal and/or hepatic dysfunction.|
|3. Monitor the patient’s response to NSAIDs.||To check if the NSAIDs are effective or if the dose needs to be adjusted.|
|4. Check for any signs of gastrointestinal bleeding and discontinue NSAIDs if there is any evidence of such.||NSAIDs put a patient at risk for GI bleeding and must be immediately stopped if any signs of bleeding occur.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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