NSAIDS

intended response

• reduce symptoms of inflammation

• increase function

• reduce fever

CV events

• Cause an increased risk for serious cardiovascular thrombotic events, myocardial infarction

• , and stroke, which can be fatal. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk.

• The risk for heart attack or stroke can occur as early as the first weeks of using an NSAID.

• The risk may increase with longer use of the NSAID and with higher doses.

GI events

• Cause an increased risk for serious gastrointestinal adverse events, including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal.

• These events can occur at any time during use and without warning symptoms.

• Older adult patients are at greater risk for serious gastrointestinal events.

contraindications

• known drug allergy that places pt at risk for bleeding

• aspirin allergy

• category C drugs for pregnancy in first two trimesters

• category D in third

• nursing mothers (excreted into breast milk)

CV adverse effects

• noncardiogenic pulmonary edema

• increased risk for MI

• stroke

GI adverse effects

• dyspepsia

• heartburb

• epigastric distress

• n/v

• anorexia

• abdominal pain

• GI bleeding

• mucosal lesions

hematologic adverse effects

• altered homeostasis through effects on platelet function

hepatic adverse effects

acute reversible hepatoxicity

renal adverse effects

• reduction in creatinine clearance

• acute tubular necrosis with renal failure

aspirin (salicylate)

• treatment is based on the manifesting symptoms

• s/s: increased HR, tinnitus, headache, dizziness, n/v, diarrhea, sweating, thirst, hyperventilation, hypo/hyperglycemia

common NSAIDS

• ibuprofen (contraindicated in setting of coronary artery bypass graft surgery and recent MI)

• naproxen

• ketorolac (only for short term because it is very hard on liver and kidneys)

Side effects

• GI upset

• fluid retention

• BP elevation

• kidney damage

• salicylate poisoning (ASA toxcity)

• tinnitus and hearing loss

administration considerations

• allergies

• GI history

• CV history

• kidney functioning

PT teaching

• Take with food

• Monitor for bleeding

• Take lowest effective dose for shortest amount of time

• Never take more than one NSAID

• May want to try acetaminophen first

• Drug Holiday

• Educate on S&S of heart attack or stroke and to seek immediate medical attention 

• Do not take with warfarin (an anticoagulant)

pediatrics

• only ibuprofen recommended

• Avoid aspirin (Reye’s syndrome - A liver disease that can lead to coma and mental retardation)

pregnancy and breastfeeding

• Aspirin not recommended while breastfeeding

• Consult provider for use during first 6 months

• Avoid NSAIDs during last 3 months due to increased risk of bleeding

elderly

• reduced rate of drug metabolism and elimination

• do not have to be ill for NSAIDS to affect them

• more likely to have GI problems

• more likely to have bleeding issues