Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking cyclooxygenase (COX) enzymes, which reduces prostaglandin production and consequently decreases inflammation, pain, and fever. NSAIDs are used to treat conditions like arthritis, gout, and postoperative pain but can cause side effects like gastrointestinal ulceration and bleeding by inhibiting protective prostaglandins in the stomach. They may also increase risks of cardiovascular and renal issues. Care must be taken with NSAID combinations or when used with other drugs that impact renal function.

1. NonsteroidalNonsteroidal
Antiinflammatory DrugsAntiinflammatory Drugs
(NSAIDs)(NSAIDs)
Under The Guidance Of – Presented By -Under The Guidance Of – Presented By -
Mr. Sudhakar Singh Mohd Asad FarooquiMr. Sudhakar Singh Mohd Asad Farooqui
(ASST.PROFESSOR ) B.Pharm 3(ASST.PROFESSOR ) B.Pharm 3rdrd
yearyear
CHANDRA SHEKHAR SINGH COLLEGE OF PHARMACYCHANDRA SHEKHAR SINGH COLLEGE OF PHARMACY
ALLAHABADALLAHABAD

2. What are NSAIDs and how do theyWhat are NSAIDs and how do they
work?work?
 Drug with analgesic( without impairingDrug with analgesic( without impairing
consciousness ), antipyretic, and anti-consciousness ), antipyretic, and anti-
inflamammatory effectsinflamammatory effects
 weak acids, PH 3-5, well absorbedweak acids, PH 3-5, well absorbed
from stomach and intestinal mucosafrom stomach and intestinal mucosa
 protein-bound in plasma ( albumin),protein-bound in plasma ( albumin),
 metabolised in the livermetabolised in the liver

3. ProstaglandinsProstaglandins
 Prostaglandins : produced by the cells,Prostaglandins : produced by the cells,
promote inflammation, pain, and fever; bloodpromote inflammation, pain, and fever; blood
clotting function of platelets; protect the liningclotting function of platelets; protect the lining
of the stomach from damaging effects of acid.of the stomach from damaging effects of acid.
 two COX enzymes, COX-1 and COX-2.two COX enzymes, COX-1 and COX-2.
produce prostaglandins that promoteproduce prostaglandins that promote
inflammation, pain, and feverinflammation, pain, and fever

4. What are NSAIDs and how do theyWhat are NSAIDs and how do they
workwork ??
 NSAIDs block the COX enzymes , reduceNSAIDs block the COX enzymes , reduce
prostaglandins, inflammation, pain, and fever areprostaglandins, inflammation, pain, and fever are
reduced.reduced.
 COX-1 produced prostaglandins that support plateletsCOX-1 produced prostaglandins that support platelets
and protect the stomach.and protect the stomach.
 Reduced prostaglandins that protect the stomach andReduced prostaglandins that protect the stomach and
support blood clotting, so NSAIDs can cause ulcerssupport blood clotting, so NSAIDs can cause ulcers
in the stomach and promote bleeding.in the stomach and promote bleeding.

6. For what conditions are NSAIDsFor what conditions are NSAIDs
used?used?
 Infalmmatory arthritis,Infalmmatory arthritis,
AS, psoriatic arthritis,AS, psoriatic arthritis,
ReterReter’’s syndromes syndrome
 Acute goutAcute gout
 Metastatic bone painMetastatic bone pain
 Headache, migrainHeadache, migrain
 Postoperative painPostoperative pain
 Pyrexia ( fever)Pyrexia ( fever)
 Renal colicRenal colic

7. For what conditions are NSAIDsFor what conditions are NSAIDs
used?used?
 AspirinAspirin (also an NSAID) : inhibit the clotting(also an NSAID) : inhibit the clotting
of blood( platelet aggregation ) ,preventof blood( platelet aggregation ) ,prevent
strokes and cardiovascular attacksstrokes and cardiovascular attacks

8. Classification of NSAIDClassification of NSAID

10. Mode of action of NSAIDMode of action of NSAID

11. COXCOX
Cyclooxygenase (COX) is found bound to the
endoplasmatic reticulum. It exists in 3 isoforms:
• COX-1 (constitutive) acts in physiological
conditions.
• COX-2 (inducible) is induced in inflammatory
cells by pathological stimulus.
• COX-3 (in brain).

13. COX-2
inhibitors
• Selective (coxibs)
• Preferential
COX-3
inhibitors
•Antipyretic
analgesics
Nonselective
COX-1/COX-2
inhibitors
NSAIDsNSAIDs
COX inhibitOrs

15. MODE OF ACTION OF PARACETAMOL

16. Mode Of Action Of Aspirin

17. Prostaglandin synthesis-

19. SIDE EFFECTSSIDE EFFECTS

20. Side effects of NSAIDsSide effects of NSAIDs
GastrointestinalGastrointestinal
 Direct irritation : acidic moleculesDirect irritation : acidic molecules
 Indirect irritation: inhibit COX-1, reduceIndirect irritation: inhibit COX-1, reduce
protective prostaglandinsprotective prostaglandins
 nausea, vomiting, dyspepsia, gastricnausea, vomiting, dyspepsia, gastric
ulcer/bleeding, diarrheaulcer/bleeding, diarrhea
 Duration of therapy, doseDuration of therapy, dose

21. Side effects of NSAIDsSide effects of NSAIDs
CardiovascularCardiovascular
 80% increase risk with newer COX-2 and high80% increase risk with newer COX-2 and high
dose traditional NSAIDdose traditional NSAID
 Heart failure riskHeart failure risk

22. Side effects of NSAIDsSide effects of NSAIDs
RenalRenal
 Decrease prostaglandinsDecrease prostaglandins→→ constriction ofconstriction of
afferent arterioleafferent arteriole →→ decreased renal perfusiondecreased renal perfusion
→→alter renal functionalter renal function
 : salt and fluid retension, hypertension: salt and fluid retension, hypertension
 Caution: NSAID with ACE inhibitor, diureticCaution: NSAID with ACE inhibitor, diuretic
 Rare: ARF, ATN, nephrotic syn.Rare: ARF, ATN, nephrotic syn.

23. Side effects of NSAIDsSide effects of NSAIDs
OthersOthers
 Allergy: shortness of breathAllergy: shortness of breath
 Asthma : a higher risk for serious allergicAsthma : a higher risk for serious allergic
reactionreaction
 with a serious allergy to one NSAID are likelywith a serious allergy to one NSAID are likely
to have similar reaction to a different NSAIDto have similar reaction to a different NSAID
 photosensitivityphotosensitivity

24. Combinational RiskCombinational Risk
 If COX-2 inhibitor taken, should not use aIf COX-2 inhibitor taken, should not use a
traditional NSAID concomitantlytraditional NSAID concomitantly
 With daily aspirin therapy, should use otherWith daily aspirin therapy, should use other
NSAID carefully, they may block theNSAID carefully, they may block the
cardioprotective effect of aspirincardioprotective effect of aspirin

25. During pregnancyDuring pregnancy
 Not recommended during pregnancy,Not recommended during pregnancy,
particular 3rd trimesterparticular 3rd trimester
 Cause early closure of fetal ductus arteriosus,Cause early closure of fetal ductus arteriosus,
and fetal renal toxicity, premature birthand fetal renal toxicity, premature birth
 Acetaminophen ia more safe during pregnancyAcetaminophen ia more safe during pregnancy
 In France, NSAID and aspirin is contra-In France, NSAID and aspirin is contra-
indicated after 6 months of pregnancyindicated after 6 months of pregnancy

27. REFERENCEREFERENCE
https://www.google.com/https://www.google.com/
https://en.wikipedia.org/wiki/Arachidonic_acidhttps://en.wikipedia.org/wiki/Arachidonic_acid