PTCB Guide to NSAIDsDec 3rd, 2023
What are NSAIDs?
NSAIDs are non-steroidal anti-inflammatory drugs.
NSAIDs are among the most widely prescribed drugs for patients suffering from mild-to-moderate pain or inflammation and the pain associated with it, particularly of the musculoskeletal system. Aspirin is also used as an antiplatelet drug, reducing the risk of developing blood clots.
Many NSAIDs are also used to reduce fever (acting as antipyretic agents).
Examples of NSAIDs include:
For the PTCB exam, technicians are expected to have a rounded knowledge of NSAIDs but are not expected to have a detailed understanding of each of these drugs. Instead, technicians should be able to recognise an NSAID drug, how the drug class works, and what major side effects and drug interactions NSAIDs are associated with.
NSAID Mechanism of Action
NSAIDs work by inhibiting COX enzymes.
COX = Cyclooxygenase
There are two main forms of the COX enzyme: COX-1 and COX-2.
COX-2 is responsible for pro-inflammatory effects, whereas COX-1 is responsible for inhibiting clot formation and protecting the gastric lining.
Therefore, inhibiting both enzymes will cause predictable adverse effects, which we list below. For now, though, it’s sufficient to know that NSAIDs inhibit both COX-1 and COX-2 enzymes, but it’s through COX-2 inhibition that NSAIDs exert their therapeutic effects (note: aspirin is an exception to this rule, as it is the only NSAID to irreversibly inhibit COX-1).
Remember, these therapeutic effects include:
- Reducing pain.
- Reducing fever.
- Reducing inflammation.
- Reducing pain associated with inflammation.
Adverse Effects / Contraindications
Adverse effects of NSAIDs include:
- Increased risk of gastric ulcers or bleeding
- Kidney impairment
- Increased risk of heart attack and stroke
- Fluid retention
- NSAID-associated hypersensitivity reactions
For this reason, NSAIDs should ideally be avoided in severe kidney damage, heart failure, liver failure; and in patients who have previously suffered a heart attack (myocardial infarction) or stroke (cerebrovascular accident / brain accident).
NSAIDs should be taken with food to minimize gastrointestinal-related side effects.
NSAIDs should be avoided in the third trimester of pregnancy due to the risk of premature closure of the ductus arteriosus. The ductus arteriosus is the blood vessel that connects the pulmonary artery (main vessel supplying blood to the lungs) to the aorta (main vessel supplying blood to the rest of the body).
Notable drug interactions with NSAIDs include:
- Increased risk of gastric bleeding when NSAIDs are taken with SSRI antidepressants or anticoagulant drugs, including warfarin.
- Increased risk of gastric ulceration when NSAIDs are taken with corticosteroids.
- ACE inhibitors increase the risk of kidney damage.
- NSAIDs reduce the blood pressure-lowering effects of antihypertensive drugs, including diuretics.
That about wraps up our PTCB guide to NSAIDs; an important and must-know drug class to learn about for the pharmacy technician exam.
We reviewed the essential details about NSAIDs that you are expected to know – covering major examples, what they are used to treat, how they work, and what major side effects, drug interactions, and contraindications the NSAID class is associated with.
Let’s take a minute to quickly revise any key points:
- NSAIDs are drugs that reduce pain, fever, and inflammation. Aspirin is also used as an antiplatelet drug.
- Examples of NSAIDs include aspirin, celecoxib, diclofenac, ibuprofen, piroxicam, and indomethacin.
- NSAIDs work by inhibiting COX enzymes. It’s through inhibition of COX-2 that NSAIDs exert their anti-inflammatory effects.
- NSAIDs cause gastric-related side effects, such as bleeding and ulcers; as well as increasing the risk of heart attack and stroke.
- NSAIDs are avoided in the third trimester of pregnancy due to the risk of premature closure of the ductus arteriosus.
- Risk of bleeding / gastric ulcers increases if NSAIDs are taken with anticoagulants, SSRIs, or corticosteroids.
- NSAIDs oppose the blood-pressure lowering effects of antihypertensive drugs.
PTCB Exam-Style Questions
Below, we put together some practice PTCB exam questions on the topic of NSAIDs; testing the material covered in this article. At the very bottom of this article, you can find the answer to each question. Go through each of these questions and make a note of your answers.
Q1. All these drugs are examples of NSAIDs, except which?
Q2. The therapeutic effects of NSAIDs are mediated through which of these mechanisms?
a) COX-1 inhibition
b) COX-2 inhibition
c) Both COX-1 and COX-2 inhibition
d) None of the above
Q3. NSAIDs reduce pain associated with inflammation, but they do not reduce inflammation itself.
Q4. All the following side effects are associated with NSAIDs, except which?
a) Renal impairment
b) Gastric bleeding
d) Fluid loss
Q5. NSAIDs oppose the antihypertensive effects of drugs, such as thiazide diuretics.
These five questions are representative of the style and difficulty of PTCB exam questions that cover the NSAID drug class. If you scored high on those five, you can be sure that you already have a strong grasp of this drug class.
Question 1: Amiloride
Amiloride is a potassium-sparing diuretic.
Question 2: COX-2 inhibition
Whilst most NSAIDs inhibit both COX-1 and COX-2 enzymes, it’s through COX-2 inhibition that NSAIDs exert their therapeutic effects.
Question 3: False
NSAIDs reduce both inflammation and pain associated with inflammation.
Question 4: Fluid loss
Instead, NSAIDs cause fluid retention (edema), which increases blood pressure.
Question 5: True
NSAIDs are pro-hypertensive drugs. They therefore oppose the actions of antihypertensive drugs, including thiazide diuretics.
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