NSAIDS work by inhibiting the cyclooxygenase enzymes (COX-1 and COX-2). Cyclooxygenase-1 (COX-1)

contributes to the maintenance of the gastric protective mucosal layer. Cyclooxygenase-2 (COX-2) contributes

to the inflammatory response, pain transmission, and renal blood flow. The use of NSAIDS leads to decreased

prostaglandin synthesis. Decreased prostaglandins can cause GI bleeds, decreased renal perfusion, and CV side

effects. The serious cardiovascular events with COX-2 inhibitors had lead to the withdrawl of rofecoxib and

valdecoxib by the FDA. Celecoxib is still available for use in osteoarthritis, RA, and pain. NSAIDS do not alter

the disease process and joint destruction; its primary use is for symptom control.




N Nursing: Do not use when breast feeding, pregnant, NSAIDS pass across placenta.
S Serious bleeding (GI bleeding)
A Asthma, Angioedema
I Intestinal bleeding: PUD; Can interfere with efficacy of HTN drugs because it blocks prostaglandins (ACE/ARBS)
D Drugs that can effect coagulation (Plavix, Lovenox, Coumadin, ASA). It will inhibit platelets and increase chance of bleeding