Anti-Inflammatory Drugs Flashcards
NSAIDs
Meds:
- ASA
- Ibuprofen
- Naproxen
- Ketorolac
MOA:
- Prostaglandin production inhibitor (inhibits COX)
- Anti-inflammatory
- Analgesic
- Antipyretic
Indications: Indications:
- Mild pain (analgesic) –> joint or bone injuries (sprains, strains), muscle pain, toothache, HA
- Fever (antipyretic)
- Inflammation (anti-inflammatory; OA, RA, gouty arthritis, Lupus, dysmenorrhea)
Contraindications:
- Pregnancy(D)
- PUD
- RF
- Bleeding disorders
- Concurrently with alcohol
Caution with:
- ACs
- Glucocorticoid
- ACE/ARB –> also damage your kidneys
- Hx of ischemic CVA & MI
Parenteral NSAID:
- much higher risk of RF due to the route of administration
- Ibuprofen IV gtt. Never IV push or IM
- Ketorolac IV,IM
- *NSAID Black Box Warning**
- High risk for serious thrombotic events: sudden death, MI, unstable angina, ischemic CVA, TIA, & peripheral thromboses
Nursing:
Educate/monitor High risk for ACS & CVA
- Never take more than one type of NSAID, take the smallest dose, limit the length of NSAID use
- Call 911 with any new chest pain or neurological deficits
Educate/monitor RF:
- Monitor for worsening fluid retention => HF symptoms, - I/O imbalance
- Avoid with Hx. of RF, HTN, HF
Monitor for GI bleed/PUD
- Always take with food
- Avoid other gastric irritants (alcohol or taking multiple NSAIDs)
- Monitor for bleeding, caution with AC (see code phrases)
- High risk in elderly (PUD four times more common in older adults)
Aspirin (ASA)
MOA:
- Antiplatelet: small scheduled dose (MI, CVA prophylaxis)
- NSAID (1899): not included in 2005 and 2015 FDA black box warning for NSAIDs
Contraindication:
- Younger than 19 years of age –> potential for fatal Reye’s syndrome (swelling of liver and brain)
To Avoid GI bleed:
- Take with food
If Hx. of PUD, GERD, GI bleed:
- Enteric coated (EC) aspirin, don’t break or crush
- Buffered aspirin (aspirin + calcium carbonate) or other antacids
Nursing
- Stop taking for 7 days to clear from body after consulting with provider
- May be taken with clopidogrel (for further antiplatelet effect)
- Emergency medicine for acute MI, must chew
Prednisone & Methylprednisolone
- Corticosteroids
- Routes: PO, IM, IV, topical, aerosol, intra-articular injections
Indications:
- Inflammatory disorders
Contraindications:
- Fungal/viral infections, live attenuated virus vaccine (intranasal influenza, small pox)
Side Effects:
- Hyperglycemia (in diabetic patients)
- Leukocytosis
- Immunosuppressant anti-inflammatory mechanism
- Water/Na retention (worsening of HF, edema, HTN) => hypokalemia (dysrhythmia)
- Water/Na retention => increased IOP (worsening of glaucoma)
- SubQ tissue loss with chronic use => “paper-skin” or “steroid skin”
- Adrenal suppression (never stop abruptly to avoid adrenal crisis) requires weaning
- Osteoporosis (take Vitamin D, Ca++ & exercise)
Methotrexate
- DMARD
MOA:
- Immunomodulator
- Cytotoxic agent
Side Effects:
- High risk of infection
- Hepatotoxicity
- Ulcerative stomatitis –> inspect gums, mouth & throat
- Bone marrow suppression –> monitor CBC trend
Contraindications:
- Pregnancy/lactation (class X teratogenic)
- Pediatrics
- Never during acute infection*
Education:
- Take on empty stomach
- Avoid sunlight
Think of a meth head in a meth house
Hydroxychloroquine
- DMARD
MOA:
- Antimalarial
- Anthelmintic
- Off label use for RA & SLE
Side Effects:
- Retinal damage –> monitor vision & eye exams, stop if blurry vision
- Think of Trump –> he is offensive to look at
Azathioprine, Cyclosporine & Tacrolimus
- DMARD
MOA:
- Immunosuppressants
Side effects:
- Renal failure
- Hepatotoxicity
- Blood dyscrasia & bleeding
- Hirsutism (male pattern hair growth) –> reversible with discontinuing the medication
- Gingival hyperplasia –> good dental hygiene and routine check-ups
Ron, Harry & Hermione Beat Bad Guys
Allopurinol
- Anti-gout; PO/IV
MOA:
- Lowers serum uric acid biosynthesis
Contraindication:
- Pregnancy (C)
Side effects
- Hepatotoxicity –> higher risk of nephrolithiasis
Nursing:
- Increase fluid (2-3 L/day) & monitor I/Os –> to increase uric acid excretion => to avoid risk of nephrolithiasis
- Avoid foods high in purine (red meat, organ meat, scallops, aged cheese)
- Alcohol & caffeine can increases uric acid
- Monitor labs & I/O balance
- For acute attacks:
- NSAIDs
- Glucocorticoids
Nursing for Anti-gout Drugs
Nursing:
Increase fluid (2-3 L/day) & monitor I/Os
to increase uric acid excretion => to avoid risk of nephrolithiasis
Avoid foods high in purine
red meat, organ meat, scallops, aged cheese
alcohol & caffeine can increases uric acid
Contraindication
Pregnancy (C)
for acute attacks
NSAIDs
glucocorticoids
Montelukast
- Leukotriene modifier
- PO
- MOA: suppress the effect of LT => ↓ inflammation, edema, mucus => bronchodilation
- Indication: maintenance therapy (not for acute SOB)
- For 1-year & up
- Side effects:depression, suicidal ideation, liver failure, drug interactions
- Causes liver failure → causes drug toxicity
- first pass is not as effective
- do liver function tests
- don’t do hepatotoxic agents (acetaminophen, alcohol)
Colchicine
- PO
MOA:
- Anti-inflammatory only for gout
Side effects:
- GI distress –> take with food, avoid grapefruit juice
- Suppressed bone marrow –> monitor CBC
- Rhabdomyolysis –> monitor for muscle pain and RF
Nursing:
- Increase fluid (2-3 L/day) & monitor I/Os –> to increase uric acid excretion => to avoid risk of nephrolithiasis
- Avoid foods high in purine (red meat, organ meat, scallops, aged cheese)
- Alcohol & caffeine can increases uric acid
- Monitor labs & I/O balance
- For acute attacks:
- NSAIDs
- Glucocorticoids
