chapter 12 anti-inflammatory agents. copyright 2007 thomson delmar learning, a division of thomson...
TRANSCRIPT
Chapter 12
Anti-inflammatory Agents
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
12 - 2
Nonsteroidal Anti-inflammatory Drugs
Group of frequently prescribed drugs Treat pain Common drug
Acetylsalicylic acid (ASA) Hermann Kolbe
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Uses for NSAIDs
Analgesic (mild to moderate) Antigout Anti-inflammatory Antipyretic Relief of vascular headaches Platelet inhibition
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How NSAIDs Work
Stop the activation of the arachidonic acid pathway
Reduce: Pain Headache Fever Inflammation
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Analgesics
Reduce pain by blocking prostaglandins
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Antipyretics
Inhibit prostaglandin E2 in the brain
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Inflammation Relief
Inhibit either the: Leukotriene pathway Prostaglandin pathway Or both pathways
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Pain Relief
Relief of mild to moderate pain Bone, joint, and muscle pain Osteoarthritis Rheumatoid arthritis Juvenile rheumatoid arthritis Dysmenorrhea
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Common NSAIDs
Common drugs that are used: Ibuprofen (Motrin, Advil) Ketoprofen (Orudis) Ketorolac (Toradol) Naproxen (Naprosyn)
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
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Gastrointestinal Side Effects
First-generation NSAIDs Dyspepsia, heartburn, epigastric distress,
nausea Gastrointestinal bleeding Mucosal lesions (erosions or ulcerations)
(continues)
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
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Gastrointestinal Side Effects
Second-generation NSAIDs Called COX-2 inhibitors
More specific in their action Reduce gastrointestinal distress
(continued)
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
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Cardiovascular Side Effects
Second-generation NSAIDs Serious side effects:
Cardiac arrhythmias Heart attack Stroke
Celecoxib (Celebrex) may be removed Rofecoxib (Vioxx) removed from market by
the FDA
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Precautions
First and second generation Do not take if you:
Have or had stomach ulcers and bleeding Have had asthma Have had an allergic response to aspirin or sulfa Have severe kidney problems Have severe liver problems Are pregnant
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Renal Side Effects
Creatinine clearance reduced Renal failure
Acute tubular necrosis
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Nursing Assessment
Before beginning therapy, perform thorough assessment for:
Gastrointestinal lesions or peptic ulcer disease
Bleeding disorders Heart disorders Perform lab studies
CBC, platelet count, cardiac, renal, and liver
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Medical History
Medication history Serious drug interactions
Alcohol Heparin and warfarin (Coumadin) Phenytoin Steroids Sulfonamides
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Salicylates
Do not give salicylates to children under age 12.
Reye’s syndrome Give with food and milk.
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Client Education
Educate clients about precautions. Watch for:
Unusual bleeding, abdominal pain, and cardiac problems
Enteric-coated tablets should not be crushed or chewed.
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Therapeutic Effects
Monitor for: Decrease in swelling Decrease in pain Decrease in joint tenderness