NSAIDs and salicylates

NSAIDs and salicylates

Drug monograph · NCLEX study reference
Therapeutic class	Analgesic, anti-inflammatory, antipyretic; aspirin also antiplatelet
Pharmacologic class	NSAIDs (COX inhibitors); aspirin is a salicylate
Onset / peak / duration	PO onset 30 to 60 minutes; varying durations (naproxen longer).
Half-life / level	Varies; aspirin antiplatelet effect lasts the platelet lifespan (about 7 to 10 days).
Routes	PO (oral), IV, IM
High-alert (ISMP)	No
Black box warning	Yes (see Safety)
Antidote / reversal	Supportive care; for aspirin toxicity, alkalinize urine and provide supportive care.
Pregnancy / lactation	Avoid in the third trimester.

Nursing pharmacology study reference (NCLEX-style monograph). Numeric values are standard teaching ranges for study and must be verified against current manufacturer labeling before clinical use. This is educational content, not prescribing guidance.

NSAIDs and salicylates — Analgesic, anti-inflammatory, antipyretic; aspirin also antiplatelet; NSAIDs (COX inhibitors); aspirin is a salicylate.

Identification

• Therapeutic class: Analgesic, anti-inflammatory, antipyretic; aspirin also antiplatelet.
• Pharmacologic class: NSAIDs (COX inhibitors); aspirin is a salicylate.

Pharmacology

• Mechanism of action: Inhibit cyclooxygenase to reduce prostaglandins, lowering pain, inflammation, and fever; celecoxib is COX-2 selective (less GI effect); aspirin irreversibly inhibits platelet COX-1.
• Onset / peak / duration: PO onset 30 to 60 minutes; varying durations (naproxen longer).
• Half-life / therapeutic level: Varies; aspirin antiplatelet effect lasts the platelet lifespan (about 7 to 10 days).

Clinical use

• Indications: Pain, inflammation, fever; aspirin for cardiovascular antiplatelet protection; ketorolac for short-term moderate to severe pain.
• Usual dose, route, frequency: Ibuprofen PO every 6 to 8 hours; ketorolac IV, IM, or PO; aspirin daily low dose for cardiac protection.
• Maximum dose / adjustments: Lowest effective dose for the shortest time; ketorolac limited to 5 days total; reduce or avoid in renal impairment and the elderly.

Safety

• Contraindications: Active GI bleeding or ulcer, severe renal impairment, third-trimester pregnancy, aspirin in children with viral illness (Reye syndrome), coronary bypass surgery period (NSAIDs), aspirin or NSAID allergy.
• Black box warning: NSAIDs increase the risk of serious cardiovascular thrombotic events (heart attack, stroke) and serious GI bleeding, ulceration, and perforation; ketorolac carries additional boxed limits (short-term use only, contraindicated in labor and delivery and with neuraxial anesthesia).
• Interactions: Anticoagulants and antiplatelets (bleeding), ACE inhibitors and ARBs and diuretics (reduced effect and renal risk), lithium and methotrexate (raised levels), corticosteroids (GI bleeding), alcohol (food/drink).
• Pregnancy / lactation: Avoid in the third trimester.
• High-alert: No.

Adverse effects

• Common side effects: GI upset, heartburn, fluid retention, dizziness.
• Serious effects to report: GI bleeding (black or bloody stools), cardiovascular events, renal impairment, severe allergic reaction, tinnitus (aspirin toxicity).
• Antidote / reversal: Supportive care; for aspirin toxicity, alkalinize urine and provide supportive care.

Nursing process

• Assessment before administration: GI and cardiovascular and renal history, bleeding risk, pain assessment.
• Interventions during therapy: Give with food; monitor for bleeding and edema; limit duration.
• Monitor: GI symptoms, renal function, blood pressure, signs of bleeding.
• Evaluation / expected outcome: Reduced pain and inflammation.

Patient teaching

• Patient teaching: Take with food; report black stools or stomach pain; do not give aspirin to children with fever.
• Notify provider if: Black or bloody stools, severe stomach pain, ringing in the ears, swelling, chest pain.
• Administration tips: With food or milk; lowest effective dose; ketorolac short courses only.