Antiinflammatory Flashcards
1
Q
Nonsteroidal Antiinflammatory Drugs (NSAIDs)
A
- analgesic, anti-inflammatory, antipyretic
- reduce the amount of prostaglandins your body makes
2
Q
NSAIDs (indications)
A
- used for HA, myalgia, neuralgia, arthralgia, alleviation of postoperative pain
- pain associated with arthritic disorders, RA, juvenile arthritis, ankylosing spondylitis, and osteoarthritis
- gout and hyperuricemia
3
Q
NSAIDs (Mech. of Action)
A
- inhibition of the leukotriene pathway, the prostaglandin pathway, or both
- blocking the chemical activity of the enzyme COX (an enzyme involved in prostaglandin synthesis)
COX-1: has a role in maintaining the GI mucosa, prostaglandin beneficial body effects
COX-2: prostaglandins involved in inflammation
4
Q
NSAIDs (Contraindications)
A
- known drug allergy (with known aspirin allergy must not receive NSAIDs
- conditions that place the patient at risk for bleeding
- vitamin K deficiency
- peptic ulcer disease
5
Q
NSAIDs (adverse effects)
A
- GI: heartburn to severe GI bleeding (most deaths associated with NSAID use are from GI bleeding)
- acute renal failure
- noncardiogenic pulmonary edema
- increased risk of Mi and stroke (black box warning for all NSAIDs except ASA
- altered hemostasis
- hepatotoxicity
- skin eruption, sensitivity reaction
- tinnitus, hearing loss
- many adverse effects of NSAIDs are 2ndary to their inactivation of COX-1
6
Q
Misoprostol (Cytotec)
A
- prevents GI bleeding
- synthetic prostaglandin E1 analogue: inhibits gastric acid secretion and has a cytoprotective component
7
Q
NSAIDs (interactions)
A
- anticoagulants
- aspirin (increased GI toxicity)
- corticosteroids and other ulcerogenic drugs
- protein-bound drugs
- diuretics and ACE inhibitors
- Herbals, feverfew, garlic, ginger, ginkgo
8
Q
NSAIDs and renal function
A
- renal function depends partly on prostaglandins
- disruption of prostaglandin function by NSADs is sometimes strong enough to precipitate acute or chronic renal failure
- can compromise existing renal function
- renal toxicity can occur in patients with dehydration, heart failure, liver dysfunction, or use of diuretics or angiotensin-converting enzyme (ACE inhibitors)
9
Q
NSAIDs (Black box warning)
A
- EXCEPT Asprin
- increased risk of adverse cardiovascular thrombotic events, including fatal MI and Stroke
- may counteract the cardioprotective effects of aspirin
10
Q
Salicylates
A
- salicylic acid (aspirin)
- inhibits platelet aggregation
- antithrombotic effect: used in the treatment of MI and other thromboembolic disorders
EX: asprin diflunisal (Dolobid), choline, magnesium trislicylate (trilisate), and salsalate (Salsitab)
Reye’s Syndrome
11
Q
Asprin
A
- shown to reduce cardiac death after MI
- should be administered at the first sign of MI
- if not given before arriving at ED, one of the 1st drugs given if no contraindication
- must crush tablet with teeth for MI
12
Q
Asprin (uses)
A
- HA, neuralgia, myalgia, and arthralgia
- pain syndromes, resulting from inflammation: arthritis, pleurisy, and pericarditis
- systemic lupus erythematosus: antirheumatic effects
- antipyretic action
13
Q
Reyes Syndrome
A
- association between the use of ASA, during a viral infection such as chicken pox or flu
- most commonly between ages 4-12
- acute and potentially life-threatening condition involving progressive neurologic deficits (encephalopathy) that can lead to coma, and may also involve liver damage
- survivors of this condition may or may not have permanent neurologic damage
- TEACH parents to avoid use of aspirin when child has a viral illness, should not be given for several weeks after the varicella vaccine
14
Q
NSAIDs (salicylate Toxicity)
A
-cardiovascular: increase HR
- Central nervous: tinnitus, hearing loss, dimness of vision, HA, dizziness, mental confusion, lassitude, drowsiness
- GI: n/v/d
- Metabolic: sweating, thirst, hyperventilation, hypoglycemia, hyperglycemia
15
Q
Indomethacin (Indocin)
A
- acetic acid derivatives
- analgesic, anti-inflammatory, antirheumatic, and antipyretic properties
- USES: RA, OA, acute bursitis or tendonitis, ankylosing, spondylitis, acute gouty arthritis, PDS, and treatment of preterm labor
- Oral, rectal, IV
16
Q
Ketorolac (Toradol)
A
- acetic acid derivative
- some antiinflammatory activity
- used primarily for its powerful analgesic effect which is comparable to those of narcotic drugs such as morphine
- short term use (up to 5 days) to manage moderate to severe acute pain
- Adverse effects, renal impairment, edema, GI pain dyspepsia, and nausea
17
Q
Ibuprophen (Motrin, Advil)
A
- most commonly used NSAID
- Propionic acid derivative
- uses: analgesic effect in the management of RA, OA, primary dysmenorrhea, gout, dental pain, musculoskeletal disorders, and antipyretic action
18
Q
Naproxen
A
- 2nd most commonly used NSAID
- propionic acid derivative
- somewhat better adverse effects profile than ibuprofen
- fewer drug interactions with ACE inhibitors given for hypertension
19
Q
Celecoxib (Celebrex)
A
-COX-2 inhibitor
- first and only remaining COX-2 inhibitor
- indicated for OA, RA, acute pain symptoms, ankylosing spondylitis, and primary dysmenorrhea
- adverse effects include headache, sinus irritation, diarrhea, fatigue, dizziness, lower extremity edema and hypertension
- little effect on platelet function
- do not use with known sulfa allergy
20
Q
Enolic Acid Deriviatives
A
- Piroxicam (Feldene)
- Meloxicam (Mobic)
- Nabumetone (Relafen)
- Used to treat mild to moderate OA, RA, and gouty arthritis
21
Q
Nursing Considerations
A
- Assess for renal dysfunction: BUN & creatinine levels/ UOP
- not give ASA to children or teenagers with suspected viral infection (fever)
- Assess for bleeding dysfunction or peptic ulcer disease symptoms
- Teach the patient to recognize and report bleeding abnormalities and GI upset/ disorder.
