Chapter 44 Anitinflammatory and Antigout Flashcards
inflammation
localized protective response stimulation by injury to tissues, which serves to destroy, dilute, or sequester both the injurious agent and injured tissue
5 signs of inflammation
fever, pain, loss of function, redness, swelling
Endogenous compounds released during inflammation
histamine, serotonin, bradykinin, leukotrienes, prostaglandins
NSAID characterisitics
analgesic, anti inflammatory, antipyretic, aspirin- platelet inhibition
NSAIDs are used for the relief of:
-mild to moderate pain
-arthritic disorders such as rheumatoid arthritis, juvenile arthritis, ankylosing spondylitis, osteoarthritis
-treatment of gout and hyperuricemia
Aspirin in reducing cardiac death:
-reduce cardiac death after an MI
-should be administered at first sign of MI
-if not given before arriving to ER, aspirin is one of the first drugs given if there are no contradictions
NSAID types:
-salicylates- aspirin
-acetic acid derivatives- ketorolac
-cyclooxygenase 2 (COX 2) inhibitors- celecoxib (celebrex)
-enolic acid derivatives- meloxicam
-propionic acid derivatives- ibuprofen and naproxen
NSAID mechanism of action
-inhibition of the leukotriene pathway, the prostaglandin pathway, or both
-blocking the chemical activity of the enzyme COX
NSAID contradictions
-allergies!! patients with a aspirin allergy must not receive NSAIDs
-conditions that place the patient at risk for bleeding (Vit K deficiency, peptic ulcer disease)
-sometimes held for surgery and in 3rd trimester pregnancies
-GI BLEED IS GREATEST RISK
NSAID interactions
serious interactions when given with:
- anticoagulants, aspirin, corticosteriods and other ulcerogenic drugs, protein bound drugs, diuretics, ACE inhibitors, etc
NSAID Black Box Warning
-all NSAIDs (except aspirin) share a BB Warning regarding an increased risk of adverse cardio thrombotic events like fatal MI and stroke
-NSAIDs may counteract the cardioprotective effects of aspirin
children should never take _____ because of the risk of ______
aspirin, Reye’s syndrome
aspirin inhibits platelet aggregation ( antithrombotic effect)
used in treatment of MI and other thromboembolic disorders
Types of aspirin
-topical cream (aspercreme), rectal suppositories, oral liquids
-combination products: aspirin-acetaminophen-caffeine such as excedrin, aspirin-antacid combo like bufferin
-enteric coated aspirin (ecotrin)
-big warning of toxicity
81 mg or 325 mg aspirin tablets
-prophylactic therapy for adults who have strong risk factors for developing CAD or cardio accident
-these strength tablets appear to be equally beneficial for prevention of thrombotic events
-these strength aspirins given once daily for thromboprevention
-dosages for pain, fever, or arthritis is much higher
Salicylate toxicity
-cardio: increased heart rate
-CNS: tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion, lassitude, drowsiness
-GI: nausea, vomiting, diarrhea
-metabolic: sweat, thirst, hyperventilation, hypoglycemia or hyperglycemia
acedic acid NSAID derivative
ketorolac
ketorolac characteristics:
-some inflammatory activity
-used primarily for its powerful analgesic effects which are comparable to those of narcotic drugs like morphine
-short term use (5 DAYS) to manage moderate to severe acute pain
ketorolac adverse effects
renal impairment, edema, GI pain, dyspepsia, nausea- if used over 5 days
propionic acid derivatives
ibuprofen and naproxen
ibuprofen (motrin, advil)
- most commonly used NSAID
- used for analgesic effects in management of RA, OA, primary dysmenorrhea, gout, dental pain, musculoskeletal disorders, antipyretic actions
naproxen
-2nd most commonly used NSAID
-better adverse effect profile than ibuprofen
-fewer drug interactions with ACE inhibitors given for HTN
COX 2 inhibitor
celecoxib (celebrex)
celecoxib
- 1st and only remaining COX 2 inhibitor
-indicated for OA, RA, acute pain symptoms, ankylosing spondylitis, primary dysmenorrhea- long standing pain
adverse effects of celecoxib
headache, sinus irritation, diarrhea, fatigue, dizziness, lower extremity edema, HTN
-no GI effects
-do not use on patients with sulfa allergy
enolic acid derivative
meloxicam (mobic)
meloxicam characteristics
-used to treat mild to moderate OA, RA, and gouty arthritis
- Nabumetone is better tolerated gastrointestinally then other NSAIDs
gout
-condition that results from inappropriate uric acid metabolism
- either under excretion or overproduction of uric acid
-uric acid crystals are deposited in tissues and joints, resulting in pain
antigout drug examples
-allopurinol
-feuxostat
-colchicine
-probenecid
-lesinurad
-sulfinpyrazone
allopurinol
-used to prevent uric acid production and to prevent acute tumor lysis syndrome
-could cause exfoliative dermatitis, stevens-johnson syndrome (skin looks burned), toxic epidermal necrolysis
probenecid
-inhibits reabsorption of uric acid in kidneys and thus increases the excretion of uric acid
-must have good renal function!
colchicine
-reduces inflammatory response to the deposits of urate crystals in joint tissue (brings down uric acid)
-used for short term management or prevention of gout
-may cause short term leukopenia and bleeding in GI tract or urinary tracts
-dose may be adjusted if they have a decreased renal function
herbal products- glucosamine and chondroitin
-used to treat pain of OA
adverse effects of glucosamine and chondroitin
GI discomfort, drowsiness, headache, skin reactions
drug interactions with glucosamine and chondroitin
enhances effects of warfarin, may increase insulin resistance
