💊 NSAIDs

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are a class of medications that reduce pain, fever, and inflammation. They are distinct from corticosteroids, lacking their steroid structure.

NSAIDs primarily exert their effects by inhibiting cyclooxygenase (COX) enzymes, specifically COX-1 and COX-2. This inhibition reduces the synthesis of prostaglandins, thromboxanes, and prostacyclins, which are mediators of pain, inflammation, and fever.

NSAIDs are widely used for the symptomatic relief of mild to moderate pain, such as headaches, dental pain, and musculoskeletal pain. They are also indicated for inflammatory conditions like rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis, as well as for dysmenorrhoea and fever.

Absolute contraindications include active peptic ulcer disease, gastrointestinal bleeding, severe renal impairment, severe heart failure, and a history of hypersensitivity reactions (e.g., asthma, angioedema) to NSAIDs or aspirin. They should be avoided in the third trimester of pregnancy.

Common adverse effects include gastrointestinal upset (e.g., dyspepsia, nausea, abdominal pain), peptic ulcers, and GI bleeding. Renal impairment, hypertension, fluid retention, and exacerbation of asthma are also significant risks. Cardiovascular thrombotic events (e.g., MI, stroke) are a concern, especially with long-term use of selective COX-2 inhibitors.

For long-term use, regular monitoring of renal function (urea, creatinine, eGFR), blood pressure, and full blood count (for anaemia due to GI bleeding) is recommended. Patients should be advised to report any signs of gastrointestinal bleeding or fluid retention. Clinical assessment for cardiovascular risk should be ongoing.

Always check for allergies, especially to aspirin or other NSAIDs. Be vigilant for drug interactions, particularly with anticoagulants (increased bleeding risk), ACE inhibitors/ARBs (increased renal toxicity), and diuretics (reduced efficacy, increased renal toxicity). Counsel patients on taking with food, potential GI side effects, and the importance of reporting dark stools or severe abdominal pain.

NSAIDs are a cornerstone of pain and inflammation management. Remember their significant side effect profile, especially gastrointestinal and renal toxicity. Always consider co-prescribing a proton pump inhibitor (PPI) for patients at high risk of GI complications. Avoid in severe heart failure and late pregnancy. Be aware of the cardiovascular risks, particularly with COX-2 selective agents.

SBAs frequently test the contraindications of NSAIDs, particularly in patients with renal impairment, heart failure, or a history of GI bleeding. Questions may also focus on drug interactions, such as with warfarin or ACE inhibitors, and the counselling points regarding GI protection (e.g., PPI co-prescription). The distinction between non-selective and COX-2 selective NSAIDs and their respective risk profiles is also common.