• Introduction 

• Illustrated mechanism of action 

• Examples of Medication Brand Names (with Images)

• Indication

• Side Effects 

• Precautions & Contraindications 

• Monographs

• Reference

                                                                     NSAIDS

 Illustrated mechanism of action

NSAIDs exert their therapeutic effects primarily by inhibiting cyclooxygenase (COX) enzymes, which play a central role in the biosynthesis of prostaglandins from arachidonic acid.

1. Arachidonic Acid Pathway:

 • When cells are damaged due to injury or infection, phospholipase A2 is activated and releases arachidonic acid from membrane phospholipids.

 • Arachidonic acid serves as the substrate for COX enzymes to produce prostaglandins, prostacyclins, and thromboxanes.

2. COX Enzymes:

 • There are two main isoforms of the COX enzyme:

 • COX-1: Constitutively expressed in most tissues; involved in maintaining gastric mucosal integrity, renal blood flow, and platelet aggregation.

 • COX-2: Inducible and primarily expressed at sites of inflammation; responsible for the synthesis of pro-inflammatory prostaglandins.

3. NSAID Action:

 • NSAIDs non-selectively inhibit COX-1 and COX-2 (e.g., ibuprofen, naproxen), or selectively inhibit COX-2 (e.g., celecoxib).

 • This inhibition results in:

 • Reduced prostaglandin synthesis, leading to:

 • Decreased inflammation

 • Reduced pain sensitivity (analgesic effect)

 • Lowered fever (antipyretic effect)

4. Clinical Benefits and Risks:

 • Therapeutic Effects: Anti-inflammatory, analgesic, and antipyretic.

 • Adverse Effects (mostly due to COX-1 inhibition):

 • Gastric ulcers and GI bleeding

 • Impaired renal function

 • Increased risk of cardiovascular events (especially with selective COX-2 inhibitors) 

Examples of Medication Brand Name 

Indication

Indications for NSAIDs (Non-Steroidal Anti-Inflammatory Drugs):

 1. Pain Relief (Analgesia):

 • Mild to moderate pain relief (headaches, toothaches, etc.)

 • Post-surgical pain

 • Musculoskeletal pain (e.g., back pain, strains, sprains)

 • Pain due to injury or trauma

 2. Inflammatory Conditions:

 • Osteoarthritis (degenerative joint disease)

 • Rheumatoid arthritis (autoimmune disorder affecting joints)

 • Gout (pain and inflammation caused by high uric acid levels)

 • Ankylosing spondylitis (inflammatory arthritis affecting the spine)

 3. Fever Reduction (Antipyretic):

 • Common cold, flu, or other febrile illnesses

 • Post-vaccination fever in children or adults

 4. Menstrual Pain (Dysmenorrhea):

 • Relief of primary dysmenorrhea (painful menstruation)

 5. Muscle and Joint Inflammation:

 • Conditions like bursitis (inflammation of the bursa) or tendinitis (inflammation of tendons)

 6. Post-traumatic and Post-surgical Inflammation:

 • Inflammation and swelling after surgery, trauma, or injury

 7. Acute Migraines:

 • Relief from acute migraine attacks (especially with medications like ibuprofen or naproxen)

 8. Dental Pain:

 • Pain management following dental procedures or toothaches

 9. Postpartum Pain Relief:

 • Relief from pain after childbirth.

Side Effect

1. Gastrointestinal (GI) Side Effects:

 • Nausea, vomiting

 • Dyspepsia (indigestion)

 • Gastric or duodenal ulcers

 • GI bleeding or perforation (can be life-threatening)

2. Renal (Kidney) Effects:

 • Reduced renal perfusion and glomerular filtration rate (GFR)

 • Acute kidney injury (especially in dehydrated or elderly patients)

 • Electrolyte imbalances (e.g., hyperkalemia, sodium retention)

3. Cardiovascular Risks:

 • Hypertension

 • Increased risk of myocardial infarction (heart attack)

 • Increased risk of stroke

 • Fluid retention and edema

4. Hematologic Effects:

 • Inhibition of platelet aggregation (especially with non-selective NSAIDs like aspirin)

 • Increased bleeding tendency

5. Hypersensitivity Reactions:

 • Rashes, urticaria (hives)

 • Anaphylaxis (rare)

 • NSAID-exacerbated respiratory disease (asthma flare-ups)

6. Hepatic (Liver) Effects:

 • Elevated liver enzymes

 • Rare cases of hepatitis or liver failure

7. Central Nervous System (Less Common):

 • Headache

 • Dizziness

 • Tinnitus (especially with high-dose aspirin) 

Precautions & Contraindications

Precautions for NSAIDs:

 1. Use cautiously in patients with gastrointestinal issues.

 2. Monitor kidney function in patients with renal impairment.

 3. Caution in patients with cardiovascular conditions.

 4. Use with caution in patients with liver disease.

 5. Asthmatic patients may experience worsened symptoms.

 6. Monitor blood pressure in patients with hypertension.

 7. Avoid in the third trimester of pregnancy.

 8. Use cautiously in elderly patients. 

Contraindications for NSAIDs:

 1. Contraindicated in active peptic ulcers.

 2. Contraindicated in severe renal impairment.

 3. Contraindicated in active bleeding.

 4. Contraindicated in patients with NSAID hypersensitivity.

 5. Contraindicated in severe heart failure.

 6. Contraindicated in the third trimester of pregnancy.

 7. Contraindicated in active liver disease. 

Monographs

https://www.nhs.uk/conditions/nsaids/

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/medications-non-steroidal-anti-inflammatory-drugs 

 https://www.healthline.com/health/side-effects-from-nsaids 

https://my.clevelandclinic.org/health/treatments/11086-non-steroidal-anti-inflammatory-medicines-nsaids 

https://www.nhs.uk/medicines/ibuprofen-for-adults/who-can-and-cannot-take-ibuprofen/ 

https://www.ncbi.nlm.nih.gov/books/NBK548614/?utm_source=chatgpt.com 

https://pmc.ncbi.nlm.nih.gov/articles/PMC7347500/?utm_source=chatgpt.com 

https://search.app/TNmcSoyNwhLvC9LZ8 

https://search.app/vdcS6HSc21gqKz5AA 

https://search.app/RB7b8LTSmFPnnta17 

https://search.app/KgibepcyLP7FReMG9