1. Nonsteroidal Anti-Inflammatory Drugs(NSAIDs)
Drugs in this class have analgesic,antipyretic and antiinflammatory actions in different measures.

2. Outlines Mechanism of action Classification Brand names Side effects
Cautions & Contra-indications
Counseling Points

3. 4 signs of inflammation Redness - due to local vessel dilatation
Heat - due to local vessel dilatation
Swelling – due to influx of plasma proteins and phagocytic cells into the tissue spaces
Pain – due to local release of enzymes and increased tissue pressure

4. Mechanism of action

5. A. Nonselective Cox inhibitors(traditional NSAIDs)
1.Salicylates:- Acetyl salicylic acid
Brands:- Aspirin,Dispril
Aspirin protect,Jusprin etc- (antiplatelets)
2. Propionic acid derivatives:- Ibuprofen,
Ketoprofen,Naproxen,Flurbiprofen etc.

6. Drugs-brand names Ibuprofen:- Brufen,Advil,Dolgit,Profinal,
Sapofen,Irfen,Ibugesic etc.
Ketoprofen:- Profenid, Fastum,Oruvail etc.
Naproxen:- Miranax, Nopain etc.

7. 3.Anthranilic acid derivative
Drug:- Mephenamic acid
Brands:- Ponstan,Mafepain,Fendol,
Fenamforte,Alfoxan etc.
4.Aryl-acetic acid derivatives
Drugs:- Diclofenac,Aceclofenac etc.
Brands:-Voltaren,Clofen,Grofenac, Olfen,Voltic,
Rofenac,Diclogesic,Votrex etc.

8. 7.Indole derivatives 5.Oxicam derivatives
Drugs:- Piroxicam, Tenoxicam,Meloxicam
Brands:- Piroxicam:- Feldene
Meloxiacm:- Mobic
Tenoxicam:- Tilcotil
6.Pyrrolo-pyrrole derivatives
Drug:- Keterolac
7.Indole derivatives
Drugs:- Indomethacin, Sulindac
Brands:- Indorem,Indocid etc.

9. 8.Pyrazolone derivatives
Drugs:- Phenylbutazone, Oxyphenylbutazone etc
9.Sulphonanilides
Drug:- Nimesulide

10. B.Selective cox-2 inhibitors
Drugs:- Etoricoxib, Celecoxib,Parecoxib,
Rofecoxib etc.
Brands:- Etoricoxib:- Arcoxia
Celecoxib- Celebrex
C. 5-LOX-COX Inhibitor
Drug:- Licofelone

11. D.Analgesic-antipyretic with poor antiinflammatory action
Paraminophenol derivatives
Drug:- Paracetamol (acetaminophen)
Brands:- Panadol, Calpol,Enelfa,Adol,Omol
Tylenol,Fevadol,Pmol etc.
Other drugs are Metamizol, Propiphenazone, Nefopam etc.

12. Common side effects Gastrointestinal:-
Abdominal pain,Nausea,Diarrhea Peptic ulceration,Dyspepsia,Gastric erosion,GI bleeding, perforation,esophagitis etc.
Renal:- Sodium and water retention,
Interstitial nephritis,Chronic renal failure etc.

13. Common side effects Hepatic:- Raised transaminases
CNS:- Headache, mental confusion, behavioural disturbances, seizure precipitation etc.
Haematological :- Bleeding,thrompocytopenia, haemolytic anemia , agranuloctyosis etc.
Anaphylactoid reactios:- Asthma exacerbetion, Angioedema, skin rashes, nasal polyposisetc, rhinitis etc.

14. Cautions & Contra-indications
Geriatric patients : Renal functions are low
Pregnant women : Ductus arterios closure, avoid during last trimester,delay of labour
All NSAIDs are contraindicated in severe heart failure.
Selective COX2 inhibitors contraindicated with IHD, Cerebro vascular disease,peripheral arterial disease, moderate or severe heart failure(LVD,HTN) etc.

15. Counseling Points
To take the medication with 240ml of water 30 minutes before or 2hours after meals, or with food or milk if gastric irritation occurs.
Advise the patient on chronic NSAID therapy should monitor laboratory parameters especially bun, serum creatinine, LFT and CBC.
Use of alcoholic beverages may increase GI irritation and bleeding.

16. Philip K Mathew Clinical instructor School of pharmacy
Thanks
Philip K Mathew
Clinical instructor
School of pharmacy