Antiinflammatory and Antigout Drugs Flashcards
Allopurinol
Chemical Classification
Xanthene oxidase inhibitor
Allopurinol
Mechanism of Action
Inhibits the enzyme xanthine oxidase, reducing uric acid synthesis
Allopurinol
Uses
Chronic gout, hyperuricemia associated with malignancies, recurrent calcium oxalate, calculi, uric acid calculi
Allopurinol
Contraindications
Hypersensitivity
Allopurinol
Side Effects
CNS: Headache, drowsiness, neuritis, paresthesia
EENT: retinopathy, cataracts, epistaxis
GI: Nausea, Vomiting, Anorexia, Malaise, metallic taste, cramps, peptic ulcer, diarrhea, stomatitis
HEMA: AGRANULOCYTOSIS, THROMBOCYTOPENIA, APLASTIC ANEMIA, PANCYTOPENIA, LEUKOPENIA, BONE MARROW SUPPRESSION, EOSINOPHILIA
INTEG: fever, chills, dermatitis, pruritus, purpura, erythema, ecchymosis, alopecia, rash, STEVENS-JOHNSON SYNDROME
MISC: myopathy, arthralgia, hepatomegaly, CHOLESTATIC JAUNDICE, RENAL FAILURE, EXFOLIATIVE DERMATITIS
Allopurinol
Nursing Considerations
ASSESS:
- FOR GOUT: joint pain, swelling; may use with NSAIDs for acute gouty attacks; uric acid levels q2wk; uric acid levels should be =6mg/dl
- CBC, AST, BUN, creatinine before starting treatment, periodically
- I&O ratio; increase fluids to 2L/day to prevent stone formation and toxicity
- For rash, hypersensitivity reactions, discontinue allopurinol
Aspirin
Functional Classification
Nonopioid Analgesic, Nonsteroidal Antiinflammatory, Antipyretic
Aspirin
Chemical Classification
Salicylate
Aspirin
Mechanism of Action
Blocks pain impulses in CNS, reduces inflammation by inhibition of prostaglandin synthesis; antipyretic action results from vasodilation of peripheral vessels; decreases platelet aggregation
Aspirin
Uses
Mild to moderate pain or fever including RA, osteoarthritis, thromboemolic disorders; TIAs, rheumatic fever, post MI, prophylaxis of MI, ischemic stroke, angina, acute MI
Aspirin
Contraindications
Pregnancy (D) 3rd trimester, breastfeeding, children <12yr, children with flulike symptoms, hypersensitivity to salicylates, tartrazine (FDC yellow dye #5), GI bleeding, bleeding disorders, vit K deficiency, peptic ulcer, acute bronchospasm, agranulocytosis, increased intracranial pressure, intracranial bleeding, nasal polyps, urticaria
Aspirin
Side Effects
CNS: stimulation, drowsiness, dizziness, confusion, SEIZURES, headache, flushing, hallucinations, COMA
CV: rapid pulse, pulmonary edema
EENT: tinnitus, hearing loss
ENDO: hypoglycemia, hyponatremia, hypokalemia
GI: Nausea, Vomiting, GI BLEEDING, diarrhea, heartburn, anorexia, HEPATITIS
HEMA: THROMBOCYTOPENIA, AGRANULOCYTOSIS, LEUKOPENIA, NEUTROPENIA, HEMOLYTIC ANEMIA, increased PT, aPTT, bleeding
INTEG: Rash, urticaria, bruising
RESP: wheezing, hyperpnea
SYST: REYE’S SYNDROME (CHILDREN), ANAPHYLAXIS, LARYNGEAL EDEMA
Aspirin
Nursing Considerations
ASSESS:
- PAIN: character, location, intensity; ROM before and 1hr after administration
- FEVER: temp before and 1hr after administration
- Hepatic studies: AST, ALT, bilirubin, creatinine if patient is receiving long-term therapy
- Renal studies: BUN, urine creatinine; I&O ratio; decreasing output may indicate renal failure (long-term therapy)
- Blood studies: CBC, Hct, Hgb, PT if patient is receiving long-term therapy
- HEPATOTOXICITY: dark urine, clay-colored stools, yellowing of skin, sclera, itching, abdominal pain, fever, diarrhea if patient is receiving long-term therapy
- ALLERGIC REACTIONS: rash, urticaria; if these occur, product may have to be discontinued; patients with asthma, nasal polyps, allergies: severe allergic reaction may occur
- OTOTOXICITY: tinnitus, ringing, roaring in ears; audiometric testing needed before, after long-term therapy
- SALICYLATE LEVEL: therapeutic level 150-300mcg/ml for chronic inflammation
- Edema in feet, ankles, legs
- Product history; many product interactions
Aspirin
Overdose Treatment
Lavage, activated charcoal, monitor electrolytes, VS
Celecoxib (Celebrex)
Functional Classification
Nonsteroidal antiinflammatory, antirheumatic
Celecoxib (Celebrex)
Chemical Classification
COX-2 inhibitor
Celecoxib (Celebrex)
Mechanism of Action
Inhibits prostaglandin synthesis by selectively inhibiting cyclooxygenase-2 (COX-2), an enzyme needed for biosynthesis
Celecoxib (Celebrex)
Uses
Acute, chronic rheumatoid arthritis, osteoarthritis, acute pain, primary dysmenorrhea, ankylosing spondylitis, juvenile rheumatoid arthritis (JRA)
Celecoxib (Celebrex)
Contraindications
Pregnancy (D) 3rd trimester; hypersensitivity to salicylatesm iodides, other NSAIDs, sulfonamides, CABG
Celecoxib (Celebrex)
Side Effects
CNS: Fatigue, Anxiety, Depression, Nervousness, Paresthesia, dizziness, insomnia
CV: STROKE, MI, TACHYCARDIA, CHF, angina, palpitations, dysrhythmias, hypertension, fluid retention
EENT: tinnitus, hearing loss, blurred vision, glaucoma, cataract, conjunctivitis, eye pain
GI: nausea, anorexia, vomiting, constipation, dry mouth, diverticulitis, gastritis, gastroenteritis, hemorrhoids, hiatal hernia, stomatitis, GI BLEEDING/ULCERATION
GU: NEPHROTOXICITY: Dysuria, HEMATURIA, OLIGURIA, AZOTEMIA, cystitis, UTI, RENAL PAPILLARY NECROSIS
HEMA: BLOOD DYSCRASIAS, epistaxis, bruising, anemia, PLATELET AGGREGATION
INTEG: SERIOUS (SOMETIMES FATAL) STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, purpura, rash, pruritus, sweating, erythema, petechiae, photosensitivity, alopecia
RESP: pharyngitis, SOB, pneumonia, coughing
Celecoxib (Celebrex)
Nursing Considerations
ASSESS:
- PAIN of rheumatoid arthritis, osteoarthritis; check ROM, inflammation of joints, characteristics of pain
- For cardiac disease that may be worse after taking product; MI, stroke; do not use with coronary artery bypass graft (CABG)
- CBC during therapy; watch for decreasing platelets; if low, therapy may need to be discontinued, restarted after hematologic recovery; LFTs, serum creatinine/BUN, stool guaiac
- For blood dyscrasias (thrombocytopenia): bruising, fatigue, bleeding, poor healing
- GI TOXICITY: black, tarry stools; abdominal pain
- SERIOUS SKIN DISORDERS: Stevens-Johnson syndrome, toxic epidermal necrolysis; may be fatal
Ibuprofen
Functional Classification
Nonsteroidal antiinflammatory, antipyretic, nonopioid analgesics
Ibuprofen
Chemical Classification
Propionic acid derivative
Ibuprofen
Mechanism of Action
Inhibits COX-1, COX-2 by blocking arachidonate; analgesic, antiinflammatory, antipyretic
Ibuprofen
Uses
Rheumatoid arthritis, osteoarthritis, primary dysmenorrhea, gout, dental pain, musculoskeletal disorders, fever, migraine
Ibuprofen
Contraindications
Pregnancy (D) 3rd trimester; hypersensitivity to this product, NSAIDs, salicylates; asthma; severe renal/hepatic disease
Ibuprofen
Side Effects
CNS: Headache, dizziness, drowsiness, fatigue, tremors, confusion, insomnia, anxiety, depression
CV: tachycardia, peripheral edema, palpitations, dysrhythmias, CV THROMBOTIC EVENTS, MI, STROKE
EENT: tinnitus, hearing loss, blurred vision
GI: nausea, Anorexia, vomiting, diarrhea, jaundice, HEPATITIS, constipation, flatulence, cramps, dry mouth, peptic ulcer, GI BLEEDING, ULCERATION, NECROTIZING ENTEROCOLITIS, GI PERFORATION
GU: NEPHROTOXICITY: dysuria, hematuria, oliguria, azotemia
HEMA: BLOOD DYSCRASIAS, increased bleeding time
INTEG: purpura, rash, pruritus, sweating, urticaria, NECROTIZING FASCIITIS
SYST: ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME
Ibuprofen
Nursing Considerations
ASSESS:
- Renal, hepatic, blood studies: BUN, creatinine, AST, ALT, Hgb, stool guaiac, before treatment, periodically thereafter
- PAIN: note type, duration, location, intensity with ROM 1hr after administration
- Audiometric, ophthalmic exam before, during, after long-term treatment; for eye, ear problems: blurred vision, tinnitus; may indicate toxicity
- INFECTION, may mask symptoms; fever: temp before 1hr after administration
- Cardiac status: edema (peripheral), tachycardia, palpitations; monitor BP, pulse for character, quality, rhythm, especially in patients with cardiac disease, geriatric patients
- For history of peptic ulcer disorder; asthma, aspirin, hypersensitivity; check closely for hypersensitivity reactions
Ibuprofen
Overdose Treatment
Lavage, activated charcoal, induce diuresis
Indomethacin (Indocin)
Functional Classification
Nonsteroidal antiinflammatory product (NSAID), antirheumatic
Indomethacin (Indocin)
Chemical Classification
Propionic Acid Derivative
Indomethacin (Indocin)
Mechanism of Action
Inhibits prostaglandin synthesis by decreasing enzyme needed for biosynthesis; analgesic, antiinflammatory, antipyretic
Indomethacin (Indocin)
Uses
RA, ankylosing spondylitis, osteoarthritis, bursitis, tendinitis, acute gouty arthritis; closure of patent ductus arteriosus in premature infants (IV)
Indomethacin (Indocin)
Contraindications
Pregnancy (D) 3rd trimester, neonates, aortic coarctation, bleeding salicylate/NSAID hypersensitivity, ulcer disease
Indomethacin (Indocin)
Side Effects
CNS: dizziness, drowsiness, fatigue, tremors, confusion, insomnia, anxiety, depression, Headache
CV: tachycardia, peripheral edema, palpitations, dysrhythmias, hypertension, CV THROMBOTIC EVENTS, MI, STROKE
EENT: tinnitus, hearing loss, blurred vision
GI: Nausea, anorexia, Vomiting, diarrhea, jaundice, CHOLESTATIC HEPATITIS, Constipation, flatulence, cramps, dry mouth, peptic ulcer, ULCERATION, PERFORATION, GI BLEEDING
GU: NEPHROTOXICITY: DYSURIA, HEMATURIA, OLIGURIA, AZOTEMIA
HEMA: BLOOD DYSCRASIAS, prolonged bleeding
INTEG: purpura, rash, pruritus, sweating
Indomethacin (Indocin)
Nursing Considerations
ASSESS
- Arthritis symptoms: ROM, pain, swelling before and 2hr after treatment
- Cardiac disease, CV, thrombotic events (MI, stroke) before administration
- Patent ductus arteriosus: respiratory rate, character, heart sounds
- Renal, hepatic, blood studies: BUN, creatinine, AST, ALT, Hgb before treatment, periodically thereafter; if renal function has decreased, do not give subsequent doses
- Eye/ear problems: blurred vision, tinnitus; may indicate toxicity; audiometric, ophthalmic exam before, during, after treatment if patient receiving long-term therapy
- Confusion, mood changes, hallucinations, especially among geriatric patients
- Asthma, nasal polyps, aspirin sensitivity, may develop hypersensitivity to indomethacin
Ketorolac (Toradol)
Functional Classification
Nonsteroidal antiinflammatory/nonopioid analgesic
Ketorolac (Toradol)
Chemical Classification
Acetic acid
Ketorolac (Toradol)
Mechanism of Action
Inhibits prostaglandin synthesis by decreasing an enzyme needed for biosynthesis; analgesic, antiinflammatory, antipyretic effects
Ketorolac (Toradol)
Uses
Mild to moderate pain (short term); seasonal allergic conjunctivitis (ophthalmic)
Ketorolac (Toradol)
Contraindications
Pregnancy (D) 3rd trimester, hypersensitivity, asthma, hepatic disease, peptic ulcer disease, CV bleeding
Breastfeeding, severe renal disease, L&D, perioperative pain in CABG, prior to major surgery, epidural/intrathecal administration, GI bleeding, hypovolemia
Ketorolac (Toradol)
Side Effects
CNS: dizziness, Drowsiness, tremors, SEIZURES
CV: hypertension, flushing, syncope, pallor, edema, vasodilation, CV THROMBOTIC EVENTS, MI, STROKE
EENT: tinnitus, hearing loss, blurred vision
GI: nausea, anorexia, vomiting, diarrhea, constipation, flatulence, cramps, dry mouth, peptic ulcer, GI BLEEDING, PERFORATION, taste change, HEPATITIS, HEPATIC FAILURE
GU: NEPHROTOXICITY: DYSURIA, HEMATURIA, OLIGURIA, AZOTEMIA
HEMA: BLOOD DYSCRASIAS, prolonged bleeding
INTEG: purpura, rash, pruritus, sweating, ANGIEDEMA, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS
Ketorolac (Toradol)
Nursing Considerations
ASSESS:
- Aspirin sensitivity, asthma: patients may be more likely to develop hypersensitivity to NSAIDs; monitor for hypersensitivity
- Pain: type, location, intensity, ROM before and 1hr after treatment
- Renal, hepatic, blood studies: BUN, creatinine, AST, ALT, Hgb before treatment, periodically thereafter; check for dehydration
- Bleeding times; check for bruising, bleeding, occult blood in urine
- Eye/ear problems: blurred vision, tinnitus (may indicate toxicity)
- Hepatic dysfunction: jaundice, yellow sclera and skin, clay-color stool
- CV thrombotic events: MI, stroke
- Audiometric, ophthalmic exam before, during, after treatment
Allopurinol
Functional Classification
Antigout drug, antihyperuricemic
