Which of the following is not an example of non-steroidal anti-inflammatory drugs?

Appeared in: Raj. CHO - 2023

Explanation

Fentanyl is a synthetic opioid analgesic, a class of drugs distinct from NSAIDs.
Its primary mechanism of action is binding to and activating mu-opioid receptors in the central nervous system to produce strong analgesia.
Unlike NSAIDs, fentanyl does not inhibit cyclooxygenase (COX) enzymes and therefore lacks significant anti-inflammatory properties.
It is typically reserved for managing severe acute or chronic pain.

Option A: Ibuprofen is a classic example of a non-steroidal anti-inflammatory drug (NSAID).
Option C: Etoricoxib is a selective COX-2 inhibitor, which is a specific subclass of NSAIDs.
Option D: Aspirin (acetylsalicylic acid) is the prototypical NSAID and belongs to the salicylate class.

Visual 1: Diagram: Mechanism of Action - NSAIDs vs. Opioids. A visual showing NSAIDs blocking the COX enzyme in the arachidonic acid pathway, contrasted with opioids binding to receptors on a neuron to block the transmission of pain signals.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Classification of Analgesics: NSAIDs vs. Opioids as background academic context rather than a clinical decision trigger.
Nurses must clearly distinguish between NSAIDs and opioids due to their profoundly different side effect profiles, monitoring requirements, and legal/addiction considerations.
When administering NSAIDs, nurses should assess for history of peptic ulcers, monitor renal function, and watch for signs of GI bleeding (e.g., melena).
For opioids like fentanyl, the priority nursing assessment is respiratory rate and level of sedation to prevent life-threatening respiratory depression. Having naloxone (an opioid antagonist) available is a critical safety measure.

How to Approach the Question

Identify the core task: The question asks you to find the drug that is not an NSAID. This is a classification question requiring you to spot the exception.
Analyze the keyword 'NOT': This negative framing means three of the options will be NSAIDs, and only one will belong to a different drug class.
Systematically classify each option: Go through the list one by one and assign a drug class.
Classify Ibuprofen and Aspirin: Recognize these as very common, standard NSAIDs.
Classify Etoricoxib: Recall that drugs ending in '-coxib' are COX-2 inhibitors, a specific type of NSAID.
Classify Fentanyl: Identify this as a potent, controlled prescription painkiller, which places it in the opioid category.

Concept Tested & Keywords

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E6 Pharmacology KD Tripathi OneStop 9e p. 342-345

Practise the full Raj. CHO - 2023

Attempt every question from this paper in a timed mock, then review the full solution for each one.