NSAIDs – Classification, Action, Side Effects, and Nursing 5.
Dysmenorrhea (menstrual cramps)
Responsibilities
Introduction 4. Side Effects
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) are medicines that A. Gastrointestinal:
reduce pain, inflammation, and fever. Gastric irritation, nausea, vomiting
They do not contain steroids (unlike corticosteroids). Peptic ulcer, bleeding
B. Renal (kidney):
1. Classification of NSAIDs Reduced urine output, kidney damage (with long use)
A. Based on chemical nature: C. Cardiovascular:
1. Salicylates – Aspirin (Acetylsalicylic acid) Increased blood pressure, fluid retention
2. Propionic acid derivatives – Ibuprofen, Naproxen D. Hematological:
3. Acetic acid derivatives – Diclofenac, Indomethacin Prolonged bleeding time (especially with aspirin)
4. Enolic acid (Oxicam) derivatives – Piroxicam, Meloxicam E. Hypersensitivity:
5. Fenamates – Mefenamic acid Skin rash, asthma attack in allergic persons
6. Selective COX-2 inhibitors – Celecoxib, Etoricoxib F. CNS:
B. Based on duration of action: Dizziness, headache
Short-acting: Ibuprofen, Diclofenac
Long-acting: Piroxicam, Naproxen 5. Nursing Responsibilities
1. Assess pain, inflammation, and temperature before and after
2. Mechanism of Action giving the drug.
NSAIDs inhibit the enzyme Cyclooxygenase (COX) which helps 2. Give NSAIDs after food or with milk to reduce gastric irritation.
form prostaglandins. 3. Check for history of ulcers, asthma, or kidney disease.
Prostaglandins cause pain, fever, and inflammation. 4. Monitor for signs of GI bleeding – black stool, vomiting blood.
By blocking COX, NSAIDs reduce prostaglandin production, 5. Encourage fluid intake (if not contraindicated).
leading to: 6. Avoid giving with alcohol → increases stomach irritation.
o ↓ Pain (analgesic effect) 7. Avoid giving with anticoagulants (risk of bleeding).
o ↓ Fever (antipyretic effect) 8. Educate the patient about:
o ↓ Inflammation (anti-inflammatory effect) o Taking medicine with meals
There are two COX enzymes: o Reporting any stomach pain or rash
COX-1: Protects stomach lining, helps platelets clot o Avoiding self-medication for long periods
COX-2: Causes inflammation and pain 9. Observe for allergic reactions.
→ Non-selective NSAIDs (like aspirin, ibuprofen) block both COX-1 and 10. Record response and side effects in the patient’s chart.
COX-2.
→ Selective NSAIDs (like celecoxib) block only COX-2 → fewer gastric
side effects.
DIURETICS
3. Therapeutic Uses Introduction
1. Pain relief – headache, toothache, muscle pain, arthritis Diuretics are drugs that increase urine output by the kidneys.
2. Fever reduction They help the body remove excess water, sodium, and salts.
3. Inflammation – rheumatoid arthritis, osteoarthritis Mainly used in edema, hypertension, and heart failure.
4. Post-operative pain
1. Classification of Diuretics System / Type Side Effects
Site of Key Features / Dehydration, low sodium (hyponatremia), low
Type Example Drugs Fluid & Electrolyte
Action Uses potassium (hypokalemia) except in K⁺-sparing
imbalance
Distal diuretics
1. Thiazide Hydrochlorothiazide, Mild diuretic, used
convoluted Cardiovascular Hypotension, dizziness
diuretics Bendroflumethiazide in hypertension
tubule
Increased blood sugar (thiazides), increased uric
Strong diuretic, Metabolic
2. Loop acid → gout
Furosemide, Loop of used in pulmonary
diuretics CNS Weakness, headache
Bumetanide Henle edema, heart
(High-ceiling) Hearing loss (with loop diuretics like furosemide if
failure Others
given fast IV)
Prevent K⁺ loss,
3. Potassium- Distal tubule,
Spironolactone, weak diuretic,
sparing Collecting 5. Nursing Responsibilities
Amiloride, Triamterene used with other
diuretics duct 1. Assess vital signs – especially blood pressure and pulse before
diuretics
giving.
Proximal Used in cerebral 2. Monitor intake and output (I/O) and daily weight to check fluid
4. Osmotic
Mannitol tubule, Loop edema, acute loss.
diuretics
of Henle renal failure 3. Observe for dehydration – dry mouth, low urine, thirst, poor skin
5. Carbonic turgor.
Proximal Used in glaucoma,
anhydrase Acetazolamide 4. Check electrolytes (Na⁺, K⁺) regularly.
tubule metabolic alkalosis
inhibitors o Report signs of low potassium: muscle weakness, irregular
pulse.
2. Mechanism of Action 5. Administer in the morning – to prevent sleep disturbance due to
Diuretics act on different parts of the kidney tubules to increase urination.
excretion of sodium and water. 6. Encourage potassium-rich diet (bananas, oranges) if non–K⁺-
When sodium is not reabsorbed, water follows it → more urine is sparing diuretic is used.
produced. 7. Educate patient:
↓ Blood volume → ↓ Blood pressure → ↓ Workload on the heart. o Take medicine at the same time daily.
o Avoid sudden position change (risk of dizziness).
3. Therapeutic Uses o Do not take extra doses.
1. Hypertension – reduces blood pressure. 8. Monitor blood glucose in diabetic patients (especially with
2. Congestive heart failure (CHF) – removes excess fluid. thiazides).
3. Edema – due to kidney, liver, or heart disease. 9. Avoid giving with ototoxic drugs (risk of hearing loss with loop
4. Renal disorders – to maintain urine flow. diuretics).
5. Cerebral edema – Mannitol reduces brain swelling. 10. Record patient response and report side effects.
6. Glaucoma – Acetazolamide reduces intraocular pressure.
6. Common Examples
4. Side Effects Loop diuretic: Furosemide (Lasix)
Thiazide: Hydrochlorothiazide
K⁺ sparing: Spironolactone
Osmotic: Mannitol Condition Type of Analgesic Used
Carbonic anhydrase inhibitor: Acetazolamide Neuropathic pain Adjuvant analgesics
ANALGESICS
Introduction
Analgesics are drugs that relieve pain without causing loss of
4. Side Effects
consciousness. Drug Type Common Side Effects
They act on the central or peripheral nervous system to reduce Non-opioid Gastric irritation, nausea, vomiting, ulcers, kidney
pain sensation. (NSAIDs) damage
Analgesics are among the most commonly used medicines in Paracetamol Liver damage (in overdose)
nursing practice.
Constipation, nausea, vomiting, drowsiness, respiratory
Opioids
depression, dependence/addiction
1. Classification of Analgesics
Adjuvants Drowsiness, dizziness
Type Examples Action Site / Notes
A. Non-opioid Paracetamol, Aspirin, Act mainly at the site of
5. Nursing Responsibilities
(Non-narcotic) NSAIDs (Ibuprofen, pain; also reduce fever &
1. Assess pain using a pain scale (0–10) before and after drug
analgesics Diclofenac) inflammation
administration.
B. Opioid Act on the brain & spinal 2. Check for allergies or history of drug reaction.
Morphine, Codeine,
(Narcotic) cord (CNS) to relieve 3. Monitor vital signs, especially respiration (for opioids).
Pethidine, Fentanyl
analgesics severe pain 4. Give drugs after food or with milk (for NSAIDs) to prevent
C. Adjuvant stomach upset.
Antidepressants, Used in chronic pain,
(supportive) 5. Observe for side effects:
Anticonvulsants neuropathic pain
analgesics o Constipation (opioids)
o Drowsiness or confusion
2. Mechanism of Action o Signs of liver or kidney damage
A. Non-opioid analgesics: 6. Avoid alcohol use with analgesics.
Inhibit prostaglandin synthesis (chemicals causing pain and 7. Monitor for dependence or misuse (especially opioids).
inflammation). 8. Encourage non-drug methods for pain relief (relaxation,
Act peripherally at the site of injury and centrally in the brain to positioning, cold/heat application).
reduce pain and fever. 9. Educate the patient about:
B. Opioid analgesics: o Correct dosage and timing
Bind to opioid receptors in the brain and spinal cord. o Not exceeding prescribed dose (especially paracetamol)
Block pain signal transmission and change the perception of pain. o Reporting unusual symptoms
Produce analgesia, sedation, and sometimes euphoria. 10. Record pain relief, side effects, and nursing actions accurately.
3. Therapeutic Uses 6. Commonly Used Analgesics
Condition Type of Analgesic Used Drug Name Type Key Use
Headache, muscle pain, fever Non-opioid (Paracetamol, Ibuprofen) Paracetamol Non-opioid Mild pain, fever
Post-operative pain, cancer pain Opioid (Morphine, Pethidine) Ibuprofen NSAID Pain + inflammation
Arthritis, inflammation NSAIDs Aspirin NSAID Mild pain, antiplatelet
Drug Name Type Key Use 5. Antibiotics: Kill H. pylori → prevent recurrence of ulcers.
Morphine Opioid Severe pain, cancer pain
3. Therapeutic Uses
Pethidine Opioid Labour or post-op pain Peptic ulcer (gastric or duodenal)
Fentanyl Opioid Severe or chronic pain Gastroesophageal reflux disease (GERD)
Zollinger-Ellison syndrome (excess acid)
ANTI-PEPTIC ULCER DRUGS (APUD) Stress ulcers in hospitalized patients
Introduction H. pylori eradication therapy
Peptic ulcers are sores in the stomach or duodenum caused by
excess acid, H. pylori infection, or NSAID use. 4. Side Effects
Anti-peptic ulcer drugs are used to reduce gastric acid, protect Class Common Side Effects
the stomach lining, and promote healing. Headache, nausea, diarrhea, long-term → low
PPIs
magnesium, vitamin B12 deficiency
1. Classification of Anti-Peptic Ulcer Drugs
Headache, dizziness, diarrhea, rarely gynecomastia
Class Examples Action / Use H2 blockers
(Cimetidine)
Omeprazole, Block acid secretion at the Constipation (Aluminium), diarrhea (Magnesium), acid
A. Proton Pump Antacids
Pantoprazole, stomach’s proton pump → rebound
Inhibitors (PPIs)
Esomeprazole effective in healing ulcers
Cytoprotective Constipation (Sucralfate), diarrhea (Misoprostol),
Block histamine H2 agents abdominal cramps
B. H2 Receptor Ranitidine, Famotidine,
receptors → reduce
Antagonists Cimetidine Antibiotics Nausea, diarrhea, allergic reactions, yeast infections
gastric acid secretion
Aluminium hydroxide, Neutralize existing
C. Antacids Magnesium hydroxide, stomach acid → relieve 5. Nursing Responsibilities
1. Assess symptoms – pain, heartburn, vomiting, blood in stool.
Calcium carbonate pain/heartburn
2. Give drugs as prescribed:
D. Mucosal o PPIs 30–60 minutes before meals
Protect the stomach lining
Protectants / o Antacids 1–2 hours after meals
Sucralfate, Misoprostol by forming a protective
Cytoprotective 3. Monitor for side effects – diarrhea, constipation, electrolyte
barrier
agents imbalance.
Amoxicillin, 4. Check for drug interactions: H2 blockers and PPIs may interact
E. Antibiotics (for H. Kill H. pylori bacteria in
Clarithromycin, with other meds.
pylori eradication) combination therapy
Metronidazole 5. Encourage lifestyle modifications:
o Avoid spicy, oily foods, alcohol, smoking.
2. Mechanism of Action o Eat small frequent meals.
1. PPIs: Bind to proton pumps → inhibit acid secretion → reduce 6. Educate the patient:
irritation and allow healing. o Take complete course of antibiotics for H. pylori.
2. H2 Blockers: Block H2 receptors → reduce acid production. o Report black stools, vomiting blood, or severe abdominal
3. Antacids: Neutralize acid → provide symptomatic relief. pain.
4. Cytoprotective agents: Form a protective layer → prevent 7. Monitor lab values if on long-term therapy (electrolytes, liver
damage from acid and pepsin. function).
8. Record patient response – relief of pain, healing signs, absence 1. Enhancing GABA activity → increases neuronal inhibition (e.g.
of complications. Diazepam, Valproic acid).
2. Blocking sodium channels → prevents rapid firing of neurons
6. Common Examples (e.g. Phenytoin, Carbamazepine).
Drug Type Example Key Use 3. Blocking calcium channels → prevents spread of seizure activity
PPI Omeprazole Duodenal/gastric ulcer, GERD (e.g. Ethosuximide).
4. Modulating neurotransmitter release → (e.g. Levetiracetam).
H2 Blocker Ranitidine Gastric acid reduction
🧩 Result: Stabilization of neuronal membranes → prevention of seizures.
Antacid Aluminium hydroxide Symptomatic relief of heartburn (Diagram of a neuron with sodium, calcium, and GABA pathways can be
Cytoprotective Sucralfate Protect mucosa, ulcer healing drawn here for extra marks.)
Antibiotic Clarithromycin H. pylori eradication
4. Pharmacokinetics (1 mark)
Mostly given orally; some IV for emergencies (e.g. Diazepam).
Antiepileptic Drugs (10 Marks)
Metabolized in the liver.
1. Introduction / Definition (1 mark) Excreted by kidneys.
Antiepileptic drugs (AEDs) are medications that prevent or control
seizures by stabilizing abnormal electrical activity in the brain. 5. Therapeutic Uses (2 marks)
They are also known as anticonvulsants. Epilepsy (all types of seizures)
Status epilepticus (emergency)
2. Classification (2 marks) Trigeminal neuralgia (Carbamazepine)
I. Based on type of seizure: Bipolar disorder (Valproic acid, Carbamazepine)
Neuropathic pain (Gabapentin, Pregabalin)
Type of Seizure Drugs
Generalized tonic–clonic (grand Phenytoin, Carbamazepine, Valproic 6. Adverse Effects (1 mark)
mal) acid Drowsiness, dizziness, ataxia
Absence (petit mal) Ethosuximide, Valproic acid Nausea, vomiting
Myoclonic / Atonic Valproic acid, Clonazepam Gingival hyperplasia (Phenytoin)
Hepatotoxicity (Valproic acid)
Carbamazepine, Phenytoin,
Partial (focal) seizures Skin rashes / allergic reactions
Gabapentin
Withdrawal seizures if stopped suddenly
Status epilepticus (emergency) Diazepam, Lorazepam, Phenytoin
II. Based on mechanism: 7. Nursing Considerations (1 mark)
Na⁺ channel blockers: Phenytoin, Carbamazepine Monitor serum drug levels (Phenytoin therapeutic range: 10–20
Ca²⁺ channel blockers: Ethosuximide µg/mL).
GABA enhancers: Valproic acid, Phenobarbital, Benzodiazepines Educate patient: take drug regularly, do not stop abruptly.
Newer agents: Gabapentin, Lamotrigine, Levetiracetam Avoid alcohol and driving until response known.
Maintain seizure chart for observation.
3. Mechanism of Action (2 marks) Provide oral care to prevent gingival hyperplasia.
Antiepileptic drugs act by reducing abnormal electrical activity in the Monitor for signs of toxicity and liver function.
brain through one or more of the following mechanisms: Classification of Anti-Parkinson Drugs
1. Introduction A – Amantadine
Parkinson’s disease is a neurodegenerative disorder caused by a C – Cholinergic blockers (Anticholinergics)
deficiency of dopamine in the basal ganglia of the brain. A/B – Adjuncts and balancing agents
Anti-Parkinson drugs aim to restore the balance between dopamine and
acetylcholine.
2. Classification of Anti-Parkinson Drugs
Main Class Examples Mechanism / Action
A. Drugs that
increase dopamine
activity
Converted to dopamine in
1⃣ Dopamine Levodopa (usually
brain → ↑ dopamine
precursor given with Carbidopa)
levels
Bromocriptine,
2⃣ Dopamine receptor Pramipexole, Directly stimulate
agonists dopamine receptors
Ropinirole
Inhibit breakdown of
3⃣ MAO-B inhibitors Selegiline, Rasagiline dopamine by MAO-B
enzyme
Prevent breakdown of
Entacapone,
4⃣ COMT inhibitors levodopa → prolong its
Tolcapone
action
B. Drugs that reduce
cholinergic activity
Block acetylcholine →
1⃣ Anticholinergic Trihexyphenidyl,
restore dopamine-
drugs Benztropine, Biperiden
acetylcholine balance
C. Drugs that Increases dopamine
promote dopamine Amantadine release and decreases
release reuptake
3. Mnemonic (for easy recall):
👉 “L-DOPA CAB”
L – Levodopa
D – Dopamine agonists
O – (MAO-B inhibitors)
P – (COMT inhibitors)