USMLE

NSAIDs

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Musculoskeletal Drugs
  1. Azathioprine
  2. Corticosteroids
  3. Sulfasalazine
  4. TNF Inhibitors
  5. Immunosuppressants (Cyclosporine, Mycophenolate, Tacrolimus)
  6. Acetaminophen
  7. NSAIDs
  8. Colchicine
  9. Allopurinol
  10. Rasburicase
  11. Dantrolene
  12. Muscle Relaxants
  13. Bisphosphonates: Alendronate, Risedronate

Summary

NSAIDs, short for nonsteroidal anti-inflammatory drugs, are a class of medications that include the drug names ibuprofen, naproxen, ketorolac, indomethacin, and celecoxib. Clinically, NSAIDs are used to treat mild to moderate pain, reduce inflammation to treat diseases like arthritis, as well as to reduce fevers. Side effects of NSAIDs include GI ulcer formation and an increased risk of bleeding. NSAIDs can cause bronchospasm to exacerbate asthma. NSAIDs can cause kidney damage or nephrotoxicity, as well as fluid retention. And finally, NSAIDs are teratogenic and should be avoided in pregnant women, especially during the third trimester.

Key Points

  • Key Drugs
    • Ibuprofen (Advil, Motrin, Caldolor)
    • Naproxen (Aleve)
    • Ketorolac (Toradol)
    • Indomethacin (Tivorbex)
    • Celecoxib (Celebrex)
    • Meloxicam
    • Diclofenac
    • Mechanism
      • Inhibits COX-1 and/or COX-2 enzymes, which are needed for the synthesis of prostaglandins
        • Analgesic
        • Anti-Inflammatory
        • Antipyretic
    • Clinical Use
      • Reduces pain and inflammation (anti-inflammatory)
        • Usually used to treat arthritis (e.g. osteoarthritis, rheumatoid arthritis, ankylosing spondylitis)
      • Treats fever
    • Side Effects and Adverse Reactions
      • Gastrointestinal ulcers
        • Peptic ulcers caused by reduced mucus production that protects GI tract from stomach acid-mediated damage
        • May manifest as nausea, vomiting, anorexia, diarrhea and bloody stools
        • Take with food and plenty of water to minimize GI discomfort
        • Avoid alcohol, which may aggravate the GI distress
        • Celecoxib only inhibits COX-2, meaning it is not as likely to cause gastrointestinal side effects
        • Misoprostol is given to patients experiencing gastric distress.
      • Bleeding
        • Generally not recommended during pregnancy, as excess bleeding may occur during delivery
        • Inform dentist or surgeon of NSAID use before invasive procedures
        • Celecoxib only inhibits COX-2, meaning it is not as likely to cause bleeding side effects
      • Bronchospasm
        • Can exacerbate asthma
      • Nephrotoxic
        • NSAIDs can reduce renal blood flow
        • Should be avoided in patients with chronic kidney disease or patients taking other nephrotoxic drugs (e.g. lithium)
      • Fluid retention
        • Contraindicated with heart failure
      • Teratogenic
        • Avoid in 3rd trimester of pregnancy
        • NSAIDS can prematurely close the ductus arteriosus of the fetus, leading to vascular deformities in the infant
        • May cause excessive bleeding during delivery
        • Acetaminophen is generally a better alternative during pregnancy