Lesson 20: NSAIDs

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

• NSAIDs inhibit cyclooxygenase (COX) enzymes reducing prostaglandin production.
• COX-1:
  • Always present; maintains normal physiological function.
  • Inhibition leads to impaired platelet function, gastric irritation, and reduced renal blood flow.
• COX-2:
  • Inducible, expressed during inflammation.
  • Inhibition results in analgesic, anti-inflammatory, and antipyretic effects with a ceiling effect on analgesia.
• Aspirin:
  • Irreversibly inhibits COX-1 and COX-2; platelet inhibition lasts for the life of the platelet.
  • Toxicity can cause gap metabolic acidosis.
  • Associated with Samter's triad: asthma, allergic rhinitis, nasal polyps.
• Ketorolac:
  • 30 mg IV is equianalgesic to 10 mg IV morphine; limited to 5 days treatment.
• Acetaminophen:
  • NOT an NSAID; an analgesic and antipyretic but lacks anti-inflammatory properties.
  • Commonly causes acute liver failure in the US; max dose is 4 g/day.