Pharmacologic Profile

General Use

NSAIDs are used to control mild to moderate pain, fever, and various inflammatory conditions, such as rheumatoid arthritis and osteoarthritis. Ophthalmic NSAIDs are used to ↓ postoperative ocular inflammation, to inhibit perioperative miosis, and to ↓ inflammation due to allergies.

General Action and Information

NSAIDs have analgesic, antipyretic, and anti-inflammatory properties. Analgesic and anti-inflammatory effects are due to inhibition of prostaglandin synthesis. Antipyretic action is due to vasodilation and inhibition of prostaglandin synthesis in the CNS. COX-2 inhibitors (celecoxib) may cause less GI bleeding.

Contraindications

Hypersensitivity to aspirin is a contraindication for the whole group of NSAIDs. Cross-sensitivity may occur.

Precautions

Use cautiously in patients with a history of bleeding disorders, GI bleeding, and severe hepatic, renal, or cardiovascular disease. Safe use in pregnancy is not established and, in general, should be avoided during the second half of pregnancy.

Interactions

NSAIDs prolong bleeding time and potentiate the effect of warfarin, thrombolytic agents, some cephalosporins, antiplatelet agents, and valproates. Prolonged use with aspirin may result in ↑ GI side effects and ↓ effectiveness. NSAIDs may also ↓ response to diuretics or antihypertensive therapy. COX-2 inhibitors do not negate the cardioprotective effect of low-dose aspirin.

Nursing Implications

Assessment

• Patients who have asthma, allergies, and nasal polyps or who are allergic to tartrazine are at an ↑ risk for developing hypersensitivity reactions.
• Assess pain and limitation of movement; note type, location, and intensity prior to and at the peak (see Time/Action Profile) following administration.
• Assess fever and note associated signs (diaphoresis, tachycardia, malaise, chills).
• Most NSAIDs prolong bleeding time due to suppressed platelet aggregation and, in large doses, may cause prolonged PT. Monitor periodically in prolonged high-dose therapy to assess for GI blood loss.

Potential Nursing Diagnoses

• Acute pain (Indications)
• Risk for imbalanced body temperature (Indications)
• Deficient knowledge related to disease processes and medication regimen (Patient/Family Teaching)

Implementation

• Administer NSAIDs after meals or with food to minimize gastric irritation.

Patient/Family Teaching

• Instruct patient to take NSAIDs with a full glass of water and to remain in an upright position for 15–30 min after administration.
• Caution patient to avoid concurrent use of alcohol with this medication to minimize possible gastric irritation; 3 or more glasses of alcohol per day may ↑ the risk of GI bleeding with salicylates or NSAIDs. Caution patient to avoid taking acetaminophen, salicylates, or NSAIDs concurrently for more than a few days, unless directed by health care professional to prevent analgesic nephropathy.
• Advise patient on long-term therapy to inform health care professional of medication regimen prior to surgery. NSAIDs may need to be withheld prior to surgery.

Evaluation/Desired Outcomes

• Relief of mild to moderate discomfort
• Reduction of fever.