NSAIDs Adverse Effects and Contraindications Quiz

Drugs Affecting the Nervous System and Anesthesia

• Analgesics are pain-relieving drugs.
• Analgesics are divided into two groups: non-narcotic and narcotic/opioid.
• Non-narcotic analgesics are for mild to moderate pain, and some also have antipyretic actions.
  • Salicylates include aspirin, magnesium salicylate, and sodium salicylate.
  • Non-salicylates include paracetamol.
  • NSAIDs include ibuprofen.
• Narcotic/opioid analgesics are for severe pain and may cause dependence.
  • Examples include morphine and pethidine.
• Antipyretics lower temperature by acting on the hypothalamus.
  • Paracetamol, aspirin, and ibuprofen have similar antipyretic effects.
• Anti-inflammatory agents reduce inflammation symptoms.
  • NSAIDs like ibuprofen, diclofenac, indomethacin, and piroxicam are examples.

Comparison of Analgesics

• Opioids have strong efficacy and pain relief, acting centrally via specific receptors.
  • Morphine is a strong opioid.
  • They also have tolerance and dependence.
• Non-opioids have weaker efficacy and pain relief, acting peripherally via prostaglandin synthesis.
  • Aspirin is a weak non-opioid.

Acetylsalicylic Acid (Aspirin)

• Acetylsalicylic Acid (ASA) is a salicylate that relieves headaches, muscular and joint pains, and reduces inflammation.
• ASA's anti-inflammatory action is noticeable only at high doses (3-4g/day).
• Mechanism of action: inactivates cyclooxygenase irreversibly, inhibits prostaglandin synthesis, and inhibits platelet aggregation.
• Indications: relief from mild to moderate pain, fever, inflammatory conditions like rheumatic fever, rheumatoid arthritis, osteoarthritis and dysmenorrhea, and to lower risk of ischaemic attacks (TIA/stroke), or Myocardial Infarctions (MI).
• Dosage Forms: tablets
• Recommended Dosage (Adult): 350-650 mg every 4 hours for minor pain. 500-1000 mg every 4-6 hours for moderate to severe pain. 75-325 mg/day in chronic pain management.
• Adverse Effects: Dizziness, tinnitus (ringing in the ears), skin eruptions, epigastric discomfort, heartburn, peptic ulceration and bleeding, increased bleeding tendency, nausea, vomiting, anorexia, hypersensitivity reactions.
• Contraindications: Hypersensitivity, asthma, peptic ulcer/dyspepsia, those with bleeding disorders, late pregnancy, and children (risk of Reye's syndrome).
• Drug Interactions: anticoagulants, NSAIDs, oral hypoglycemics (ASA increases hypoglycemia effect of sulfonylureas).

Paracetamol (Acetaminophen)

• Paracetamol (APAP) is a non-salicylate, non-narcotic, CNS agent.
• It relieves pain (analgesic) and reduces fever (antipyretic).
• Has no anti-inflammatory action.
• Reduces fever by direct action on the hypothalamus, leading to peripheral vasodilation, sweating, and heat dissipation.
• Indications: pain and fever relief, good substitute for aspirin (where aspirin is not tolerated).
• Contraindications: severe liver or kidney damage, hypersensitivity.
• Dosage Forms: tablets, capsules, suspension, suppositories, intravenous
• Recommended Dosage (Adult): 325-650 mg every 4-6 hours as needed; maximum 4 g/24 hours. (Child: 10-15 mg/kg/dose. Detailed age-specific doses provided).
• Adverse effects: If used as directed, rarely causes side effects. Heavy alcoholics and smokers are more susceptible to liver toxicity. Skin rashes and neutropenia are rare.
• Drug Interactions: alcohol, barbiturates, carbamazepine, rifampicin—potential for increased hepatotoxicity with high doses or prolonged use.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

• NSAIDs are another type of non-narcotic analgesic with antipyretic, analgesic, and anti-inflammatory activities.
• They are effective against low-to-moderate pain.
• They lack the unwanted CNS effects of opioids.
• Act by inhibiting prostaglandin synthesis through cyclooxygenase (COX). Newer NSAIDs specifically inhibit COX-2 enzyme.
• Common NSAIDS are:
  • Salicylic acid derivatives (aspirin)
  • Para aminophenol derivatives (paracetamol)
  • Pyrazolone derivatives (Sphenylbutazone)
  • Indole acetic derivative (sulidac)
  • Arylacetic acid derivative (diclofenac)
  • Proprionic acid derivatives (Ibuprofen)
  • Anthralinic acid derivatives (Flufenamic acid)
  • Oxicams (piroxicam)
  • Alkanones (nabumetone)
• Common indications: relief of osteoarthritis, rheumatoid arthritis, mild-moderate pain, fever

Ibuprofen

• Ibuprofen (IBP) is a propionic acid derivative with similar analgesic effects to aspirin (ASA) but generally less GI discomfort at equi-effective doses.
• It inhibits platelet aggregation and prolongs bleeding time.
• Indications: rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and other conditions.
• Common adverse effects: gastrointestinal disturbances (e.g., heartburn, dyspepsia, abdominal distress, gastritis, and ulceration), dizziness, drowsiness, jaundice, and fatigue.
• Contraindications: hypersensitivity where urticaria, severe rhinitis, bronchospasm or angioedema precipitated by ASA or other NSAIDs. Active peptic ulcer or bleeding abnormalities.
• Dosage Forms: tablets, suspension, IM, IV, gel 5%
• Recommended dosages: adult (200-400 mg PO every 4-6 hours, max 1800mg/day), specific child dosages,

Diclofenac

• Diclofenac is an acetic acid derivative with analgesic, antipyretic, and anti-inflammatory properties.
• At therapeutic doses, it has little effect on platelet aggregation, suitable for patients not responding to ibuprofen.
• Indications: Rheumatoid arthritis (RA), Osteoarthritis (OA), Ankylosing spondylitis. Ophthalmic agent for cataract surgery
• Contraindications: similar to ibuprofen, hypersensitivity
• Dosage Forms: Tablets, sustained-release tablets, suppositories, emulgel, ampoules.
• Recommended dosage forms and ranges: different administration forms and routes depending on the condition and requirements.

Narcotic/Opioid Analgesics

• Opioid analgesics are obtained from the opium plant.
• They are categorized as raw narcotics, semisynthetic narcotics, and synthetic narcotics.
• Morphine, codeine, and heroin are examples.
• Act by binding to opioid receptors (mu, kappa, delta).
• Indications: Moderate to severe acute and chronic pain, anxiety reduction prior to surgery, anesthesia support, obstetric analgesia, anxiety relief.
• Adverse effects: Respiratory depression is a major hazard. Others include light-headedness, dizziness, sedation, constipation, anorexia, nausea, vomiting, sweating.
• Contraindications: hypersensitivity to the drugs, acute bronchial asthma, emphysema, upper airway obstruction, head injury, increased intracranial pressure, convulsive disorders, severe renal or hepatic dysfunction, acute ulcerative colitis, pregnancy.

Sedative/Hypnotics

• Sedatives promote a relaxing, calming effect, not sleep.
• Hypnotics induce sleep.
• Divided into barbiturates and miscellaneous.
• Barbiturates: ultrashort-acting, short-acting, intermediate-acting, and long-acting, depending on their duration of action.
• Miscellaneous: non-benzodiazepines (e.g., ethchlorvynol [Placidyl], zaleplon [Sonata], zolpidem [Ambien]) and benzodiazepines (e.g., estazolam [ProSom], flurazepam [Dalmane], quazepam [Doral]).
• Adverse effects: CNS depression, drowsiness, dizziness, headache, nausea.
• Contraindications: hypersensitivity, coma, severe respiratory problems, history of drug/alcohol abuse, pregnancy or lactation
• Drug interactions: Alcohol, antidepressants, narcotics, antihistamines, phenothiazines

Anesthesia

• Anesthesia is a loss of feeling or sensation.
• Types:
  • Local anesthesia: loss of feeling in a specific area, person is awake or partially sedated.
  • General anesthesia: loss of feeling and consciousness for the whole body.

Preanesthesia

• A preanesthetic drug is given before anesthesia administration to prepare the patient and reduce anxiety.
• Purpose: to relax, decrease anxiety, decrease secretions, and lessen nausea/vomiting.

General Anesthesia

• General anesthesia uses drugs that induce a loss of consciousness and pain in the whole body.
• Types of drugs: Inhalation drugs (e.g., halothane, desflurane, enflurane) and intravenous drugs.
• Stages of anesthesia: I-analgesia, II-delirium, III-surgical analgesia, and IV-respiratory paralysis.

Postanesthesia

• Postanesthesia care in the recovery room involves: admitting the patient, checking airway, assessing respiratory status, positioning the patient, and monitoring blood pressure, pulse, and respiratory rate until discharge.
• Nurses need to monitor for respiratory depression, exercise caution with narcotics, and check for complications (e.g., bleeding, nausea).

Test your knowledge on the adverse reactions and contraindications associated with NSAID use. This quiz covers various aspects of NSAIDs, including their effects on the gastrointestinal tract, cardiovascular system, and potential drug interactions. Assess your understanding of the risks linked to long-term NSAID consumption and how Ibuprofen affects platelet aggregation.