{"id":16643,"date":"2018-05-28T18:04:29","date_gmt":"2018-05-28T18:04:29","guid":{"rendered":"http:\/\/www.mometrix.com\/academy?page_id=16643"},"modified":"2026-03-26T09:28:53","modified_gmt":"2026-03-26T14:28:53","slug":"nsaid-effects","status":"publish","type":"page","link":"https:\/\/www.mometrix.com\/academy\/nsaid-effects\/","title":{"rendered":"NSAID Side Effects"},"content":{"rendered":"\n\t\t\t<div id=\"mmDeferVideoEncompass_bLh6ZrRJIV0\" style=\"position: relative;\">\n\t\t\t<picture>\n\t\t\t\t<source srcset=\"https:\/\/www.mometrix.com\/academy\/wp-content\/uploads\/2023\/01\/circle-play-duotone.webp\" type=\"image\/webp\">\n\t\t\t\t<source srcset=\"https:\/\/www.mometrix.com\/academy\/wp-content\/uploads\/2023\/01\/circle-play-duotone.png\" type=\"image\/jpeg\"> \n\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" loading=\"eager\" id=\"videoThumbnailImage_bLh6ZrRJIV0\" data-source-videoID=\"bLh6ZrRJIV0\" src=\"https:\/\/www.mometrix.com\/academy\/wp-content\/uploads\/2023\/01\/circle-play-duotone.png\" alt=\"NSAID Side Effects Video\" height=\"464\" width=\"825\" class=\"size-full\" data-matomo-title = \"NSAID Side Effects\">\n\t\t\t<\/picture>\n\t\t\t<\/div>\n\t\t\t<style>img#videoThumbnailImage_bLh6ZrRJIV0:hover {cursor:pointer;} img#videoThumbnailImage_bLh6ZrRJIV0 {background-size:contain;background-image:url(\"https:\/\/www.mometrix.com\/academy\/wp-content\/uploads\/2023\/02\/607-thumb-final-2.webp\");}<\/style>\n\t\t\t<script defer>\n\t\t\t  jQuery(\"img#videoThumbnailImage_bLh6ZrRJIV0\").click(function() {\n\t\t\t\tlet videoId = jQuery(this).attr(\"data-source-videoID\");\n\t\t\t\tlet helpTag = '<div id=\"mmDeferVideoYTMessage_bLh6ZrRJIV0\" style=\"display: none;position: absolute;top: -24px;width: 100%;text-align: center;\"><span style=\"font-style: italic;font-size: small;border-top: 1px solid #fc0;\">Having trouble? <a href=\"https:\/\/www.youtube.com\/watch?v='+videoId+'\" target=\"_blank\">Click here to watch on YouTube.<\/a><\/span><\/div>';\n\t\t\t\tlet tag = document.createElement(\"iframe\");\n\t\t\t\ttag.id = \"yt\" + videoId;\n\t\t\t\ttag.src = \"https:\/\/www.youtube-nocookie.com\/embed\/\" + videoId + \"?autoplay=1&controls=1&wmode=opaque&rel=0&egm=0&iv_load_policy=3&hd=0&enablejsapi=1\";\n\t\t\t\ttag.frameborder = 0;\n\t\t\t\ttag.allow = \"autoplay; fullscreen\";\n\t\t\t\ttag.width = this.width;\n\t\t\t\ttag.height = this.height;\n\t\t\t\ttag.setAttribute(\"data-matomo-title\",\"NSAID Side Effects\");\n\t\t\t\tjQuery(\"div#mmDeferVideoEncompass_bLh6ZrRJIV0\").html(tag);\n\t\t\t\tjQuery(\"div#mmDeferVideoEncompass_bLh6ZrRJIV0\").prepend(helpTag);\n\t\t\t\tsetTimeout(function(){jQuery(\"div#mmDeferVideoYTMessage_bLh6ZrRJIV0\").css(\"display\", \"block\");}, 2000);\n\t\t\t  });\n\t\t\t  \n\t\t\t<\/script>\n\t\t\n<p><script>\nfunction zkF_Function() {\n  var x = document.getElementById(\"zkF\");\n  if (x.style.display === \"none\") {\n    x.style.display = \"block\";\n  } else {\n    x.style.display = \"none\";\n  }\n}\n<\/script><\/p>\n<div class=\"moc-toc hide-on-desktop hide-on-tablet\">\n<div><button onclick=\"zkF_Function()\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.mometrix.com\/academy\/wp-content\/uploads\/2024\/12\/toc2.svg\" width=\"16\" height=\"16\" alt=\"show or hide table of contents\"><\/button><\/p>\n<p>On this page<\/p>\n<\/div>\n<nav id=\"zkF\" style=\"display:none;\">\n<ul>\n<li class=\"toc-h2\"><a href=\"#Indications\" class=\"smooth-scroll\">Indications<\/a><\/li>\n<li class=\"toc-h2\"><a href=\"#Mechanism_of_Action\" class=\"smooth-scroll\">Mechanism of Action<\/a><\/li>\n<li class=\"toc-h2\"><a href=\"#Adverse_Effects_and_Safety_Guidelines\" class=\"smooth-scroll\">Adverse Effects and Safety Guidelines<\/a><\/li>\n<\/ul>\n<\/nav>\n<\/div>\n<div class=\"accordion\"><input id=\"transcript\" type=\"checkbox\" class=\"spoiler_button\" \/><label for=\"transcript\">Transcript<\/label>\n<div class=\"spoiler\" id=\"transcript-spoiler\">\n<p>Welcome to this video on non-steroidal anti-inflammatory drugs and their effects!<\/p>\n<h2><span id=\"Indications\" class=\"m-toc-anchor\"><\/span>Indications<\/h2>\n<p>\nNonsteroidal anti-inflammatory drugs are most often referred to as NSAIDs. NSAIDs have anti-inflammatory effects that are similar to those of steroids but without some of the serious adverse effects.<\/p>\n<p>Indications for NSAIDS include:<\/p>\n<ul>\n<li>Mild to moderate pain<\/li>\n<li>Fever<\/li>\n<li>Various ophthalmic uses<\/li>\n<li>Primary dysmenorrhea<\/li>\n<li>Tendinitis and bursitis<\/li>\n<li>Ankylosing spondylitis<\/li>\n<li>Rheumatoid arthritis<\/li>\n<li>Juvenile rheumatoid arthritis<\/li>\n<li>Osteoarthritis<\/li>\n<li>Gout, specifically acute gouty arthritis<\/li>\n<\/ul>\n<h2><span id=\"Mechanism_of_Action\" class=\"m-toc-anchor\"><\/span>Mechanism of Action<\/h2>\n<p>\nNSAIDs act by inhibiting the enzyme cyclooxygenase (COX).<\/p>\n<p><strong>Cyclooxygenase enzymes<\/strong> include two isoenzymes: <\/p>\n<ul>\n<li>Cyclooxygenase 1 (COX-1) and<\/li>\n<li>Cyclooxygenase 2 (COX-2)<\/li>\n<\/ul>\n<p>NSAIDs inhibit both COX-1 and COX-2, or COX-2 alone.<\/p>\n<p>Cyclooxygenase acts by converting arachidonic acid (which is released from phospholipids in cell membranes) to prostaglandins and related compounds, which are necessary to carry out many bodily processes. <\/p>\n<p>COX-1 is found in tissues throughout the body where it has primarily beneficial functions, such as:<\/p>\n<ul>\n<li>Protecting gastric mucosa<\/li>\n<li>Supporting renal function<\/li>\n<li>Promoting platelet aggregation<\/li>\n<li>Promoting macrophage differentiation<\/li>\n<\/ul>\n<p>Thus, inhibiting COX-1 does not relieve pain or inflammation.<\/p>\n<p>COX-2, however, has primarily inflammatory functions. COX-2 is active primarily at the site of injuries, where it mediates the inflammatory response, and in the brain, where it responds to injuries by:<\/p>\n<ul>\n<li>Promoting vasodilation (in inflammation)<\/li>\n<li>Sensitizing receptors to painful stimuli<\/li>\n<li>Mediating the fever response<\/li>\n<li>Mediating the perception of pain<\/li>\n<\/ul>\n<p>Thus, inhibiting COX-2 relieves pain and inflammation. However, in addition to the harmful processes, COX-2 also has some beneficial processes:<\/p>\n<ul>\n<li>Promoting renal function and perfusion<\/li>\n<li>Promoting vasodilation (preventing vasoconstriction)<\/li>\n<\/ul>\n<p>Most first-generation NSAIDs are non-selective cyclooxygenase inhibitors, meaning that they inhibit both COX-1 and COX-2.<\/p>\n<p>Some later generations are selective for COX-2 only.<\/p>\n<p>The most commonly used NSAIDs are non-specific, especially the older drugs, such as:<\/p>\n<ul>\n<li>Ibuprofen<\/li>\n<li>Naproxen<\/li>\n<li>Indomethacin<\/li>\n<\/ul>\n<p>Specific COX-2 inhibitors include:<\/p>\n<ul>\n<li>Celecoxib (Celebrex\u00ae)<\/li>\n<li>Meloxicam<\/li>\n<li>Diclofenac (a topical preparation)<\/li>\n<\/ul>\n<p>Most NSAIDs are available by prescription, but some, such as ibuprofen and naproxen, are available in lesser doses over-the-counter.<\/p>\n<p>So, what happens when COX-1 and COX-2 are inhibited? Let\u2019s look first at the effects of an NSAID on COX-1.<\/p>\n<ul>\n<li>Instead of protecting the gastric mucosa, ulceration and bleeding occurs<\/li>\n<li>Instead of supporting renal function, renal impairment occurs<\/li>\n<li>Instead of promoting platelet aggregation, anti-platelet action occurs<\/li>\n<li>Instead of promoting macrophage differentiation, macrophages develop a more inflammatory state<\/li>\n<\/ul>\n<p>While most of the changes resulting from COX-1 inhibition are harmful, the anti-platelet action may be beneficial because it can reduce the risk of myocardial infarction and stroke. <\/p>\n<p>This is the reason that <strong>aspirin<\/strong> (a first-generation NSAID) is usually avoided for control of pain and inflammation but used in low doses for its antiplatelet action.<\/p>\n<h2><span id=\"Adverse_Effects_and_Safety_Guidelines\" class=\"m-toc-anchor\"><\/span>Adverse Effects and Safety Guidelines<\/h2>\n<p>\nNow, let\u2019s take a look at the effects of an NSAID on COX-2:<\/p>\n<ul>\n<li>Instead of promoting vasodilation, it causes vasoconstriction, which reduces swelling but also increases the risk of myocardial infarction and stroke<\/li>\n<li>Instead of sensitizing receptors to painful stimuli and mediating the perception of pain, it reduces pain<\/li>\n<li>Instead of promoting renal function and perfusion, it impairs renal function<\/li>\n<\/ul>\n<p>Most of the <em>adverse<\/em> effects associated with NSAIDs result from COX-1 inhibition, especially their effects on the GI system. While most therapeutic effects result from COX-2 inhibition, selective COX-2 inhibitors also pose risks. <\/p>\n<p>Some of the early COX-2 inhibitors, such as rofecoxib (Vioxx\u00ae) were taken off of the market because they doubled the risk of heart attack and stroke.<\/p>\n<p>Adverse effects of NSAIDs may include:<\/p>\n<ul>\n<li>Gas, stomach pain, nausea, vomiting, gastric ulcers, GI bleeding, hemorrhage, or diarrhea<\/li>\n<li>Tinnitus and possible hearing loss<\/li>\n<li>Headache and dizziness<\/li>\n<li>Allergic reactions, sometimes as serious as anaphylaxis<\/li>\n<li>Acute renal failure<\/li>\n<li>Hepatic toxicity<\/li>\n<li>Heart failure, myocardial infarction, or stroke<\/li>\n<li>Altered hemostasis (that is associated with platelets)<\/li>\n<\/ul>\n<p>A range of NSAIDs is now available in both nonspecific and COX-2-specific formulations. So, while one may be ineffective, another may be effective.<\/p>\n<p>While aspirin is an NSAID, it differs from other NSAIDS in that its effects on COX-1 and COX-2 are irreversible. In other words, COX-1 and COX-2 remain inhibited until new COX-1 and COX-2 are synthesized.<\/p>\n<p>The effects of other NSAIDs on COX-1 and COX-2 are reversible and decrease along with the blood titre.<\/p>\n<p>Contraindications to the use of NSAIDs include:<\/p>\n<ul>\n<li>Pregnancy at 20 weeks or later (risk of low amniotic fluid)<\/li>\n<li>Breastfeeding<\/li>\n<li>Anticoagulant therapy<\/li>\n<li>Inflammatory bowel disease<\/li>\n<li>Uncontrolled hypertension<\/li>\n<li>Sensitivity to specific ingredients within the drug<\/li>\n<li>The preoperative period: generally NSAIDs should be avoided for one week prior to surgery to reduce the risk of bleeding<\/li>\n<\/ul>\n<p>Additional contraindications include:<\/p>\n<ul>\n<li>A history of coronary artery bypass, transient ischemic attack, stroke, and heart disease<\/li>\n<li>A history of cirrhotic liver disease, heart disease, and renal disease<\/li>\n<\/ul>\n<p>NSAIDs are the most commonly prescribed medications for pain and inflammation, accounting for up to 10% of all prescriptions.  However, every year thousands of people die from adverse effects, most often GI bleeding, <\/p>\n<p>Because some NSAIDs are inexpensive and available over-the-counter, people often view them as safer than they actually are.<\/p>\n<p>It\u2019s critical to stress the importance of following directions and limiting use to no more than 3 days for fever or 10 days for pain unless monitored by a physician.<\/p>\n<p>Thanks for watching and happy studying!<\/p>\n<ul class=\"citelist\">\n<li><a href=\"https:\/\/www.medicalnewstoday.com\/articles\/179211\"target=\"_blank\">\u201cNSAIDs: Examples, Side Effects, and Uses.\u201d n.d.<\/a><\/li>\n<li><a href=\"https:\/\/my.clevelandclinic.org\/health\/drugs\/11086-non-steroidal-anti-inflammatory-medicines-nsaids\"target=\"_blank\">\u201cNSAIDs: What You Need to Know | Cleveland Clinic.\u201d<\/a><\/li>\n<li><a href=\"https:\/\/www.fda.gov\/drugs\/postmarket-drug-safety-information-patients-and-providers\/nonsteroidal-anti-inflammatory-drugs-nsaids\"target=\"_blank\">Research, Center for Drug Evaluation and. 2019. \u201cNonsteroidal Anti-Inflammatory Drugs (NSAIDs).\u201d<\/a><\/li>\n<\/ul>\n<\/div>\n<\/div>\n\n<div class=\"home-buttons\">\n<p><a href=\"https:\/\/www.mometrix.com\/academy\/\">Mometrix Academy &#8211; Home<\/a><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Mometrix Academy &#8211; Home<\/p>\n","protected":false},"author":1,"featured_media":105981,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":{"0":"post-16643","1":"page","2":"type-page","3":"status-publish","4":"has-post-thumbnail","6":"page_category-patient-care-videos","7":"page_category-pharmacology-videos","8":"page_category-video-pages-for-study-course-sidebar-ad","9":"page_type-video","10":"subject_matter-nursing"},"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO Pro 4.9.9 - aioseo.com -->\n\t<meta name=\"description\" content=\"NSAIDs are available as prescriptions or over-the-counter pain medication, like aspirin. 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