NSAIDs Pharmacology: An Analgesics Review

Non-steroidal anti-inflammatory drugs (NSAIDs) are analgesic pain medications that bring down any inflammation inside the body without affecting the adrenal glands. In this post, we’ll go through the following:

• How inflammation is formed
• The common types of NSAIDs
• How NSAIDs work
• The antipyretic property of NSAIDs

What are NSAID Drugs? Pathophysiology

When the body experiences stress, sickness, or any unusual disruption, inflammatory factors are released as a defense mechanism. Usually, inflammatory factors are apparent when people work out or participate in extreme physical sports. These activities will eventually lead to increased stress on the body and may prompt prostaglandin release.

After going through rigorous training, it is expected that people will complain of pain. And the moment people experience pain and inflammation, either localized or generalized, the next thing that’s supposed to happen is the ingestion of pain medication, primarily to eliminate the problem.

Mechanism of Action for NSAIDs

NSAIDs primarily work by inhibiting the enzyme cyclooxygenase (COX), which is responsible for converting arachidonic acid into various eicosanoids such as thromboxanes, prostaglandins, and prostacyclins. By blocking the COX enzyme, the production of these eicosanoids is suppressed, resulting in therapeutic effects.

Studying for the NCLEX? Read more about analgesics here.

Types of NSAIDs

Technically, tons of NSAIDs are approved for use in the US. However, Ibuprofen is the most popular generic type of NSAID, while Motrin is the most popular brand of Ibuprofen. The main mechanism of Ibuprofen is to cease inflammatory agents released by the body, which causes tenderness and fever.

NSAIDs List

• Naproxen
• Salicylate acid (Aspirin)
• Acetylsalicylic acid (Aspirin)
• Ibuprofen & Indomethacin
• Ketorolac (brand: Toradol)

Inflammatory Factors

What are the inflammatory factors that are released as a form of defense mechanism?

• Substance P
• COX-1
• COX-2
• COX-3

COX-1 and COX-2 are the ones that produce prostaglandins. Prostaglandins are known to have several functions, namely:

• Promote inflammation that leads to pain
• Aid in the blood clotting activity of the platelets
• Prevent harmful effects of acid in the stomach

NSAIDs and Pediatric Patients

One important detail about non-steroidal medications is their antipyretic properties, which is why they are also given to pediatric patients.

Scenario:

A child is admitted in the emergency room due to a fever of 103 Fahrenheit that is not resolved by Tylenol, which has been given every three hours.

Question:

Is it appropriate to give an NSAID?

Answer:

Yes, you can. NSAIDs have the same antipyretic or anti-fever properties. Double doses of NSAIDs can also be given because they do not have toxic effects on the liver, whether it’s an adult or a pediatric patient.

NSAIDs and the Central Nervous System

How does NSAID act on the central nervous system regarding its antipyretic properties?

NSAIDs act on the hypothalamus, the thermo-regulator of the brain. You can remember the hypothalamus by calling it the “hypothermostat” because one of its primary functions is controlling the body’s temperature.

If a patient is feverish, NSAIDs will immediately act on the hypothalamus to persuade it to decrease the body’s temperature. NSAIDs cause dilation of the blood vessels, which will result in the release of heat from the body.

For this reason, NSAIDs are usually given to patients who are either suffering from inflammation or fever, or both.

Side Effects of NSAIDs

• Dizziness
• Stomach aches
• Diarrhea
• Stomach ulcers
• Indigestion
• Headaches
• Drowsiness

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