D. Anti-inflammatory Flashcards
anti-inflammatory drugs:
Pathophysiology
•Inflammation
- Reaction to tissue injury
- Caused by release of chemical mediators
- Leads to a vascular response
- Fluid and WBCs migrate to injured site
•Chemical mediators
- Histamines
- Kinins
- Prostaglandins
signs of inflammation
- erythema ( redness)
- edema (swelling)
- heat
- pain
- loss of function
cyclo-oxygenase (COX)
COX-1 platelets/GI protective effect
COX-2 Pain
anti-inflammatory
Ind/Contra
- Indications or Uses
- Reduce inflammation and pain
- Gout, inflammation, fever, platelet
inhibition, rheumatoid & osteoarthritis
- Not recommended for fever or headaches
- Except aspirin, ibuprofen
- Contraindications: allergy and pts at risk of
bleeding
•EX: low platelet ct
, peptic ulcer disease
1st generation NSAID
•Salicylates
•Aspirin*
•Propionic
acid derivatives
•Ibuprofen (Advil)*
•Naproxen (Naprosyn)
NSAID effects/action
Effects:
Anti-inflammatory,
Analgesic, Antipyretic*(Aspirin and Advil only),
Second generation NSAID
- COX-2 inhibitors
1. Celecoxib (Celebrex)
salicylates-lab-food interactions
•Drugs
- Anticoagulants (Coumadin & warfarin) Increases anticoagulation= bleed, bleed, bleed
- ↑ hypoglycemia with oral hypoglycemic drugs
- ↑ gastric ulcer risk with glucocorticoids
•Lab
- Increase PT, INR, bleeding time, uric acid
- Decrease potassium, cholesterol, T3 and T4 levels
- Foods containing salicylates
- Prunes, raisins, licorice, certain
spices
Salicylates -Aspirin
Caution
- Do not take with other NSAIDs
- Avoid during third trimester of pregnancy
- Do not give to children with flu or virus
symptoms–Reyes’ syndrome
Aspirin SE/AR
•Side effects/adverse reactions
•Tinnitus(ringing ears)
- Gastric distress (heartburn); Peptic ulcer
- Urticaria
- Life threatening: Agranulocytosis, hemolytic
anemia, Anaphylaxis, Thrombocytopenia, Hepatotoxicity, Bronchospasm, Renal Failure
salicytes severe reactions
- Hypersensitivity
- Tinnitus, dizziness, bronchospasm
- Salicylism (mild)
- Tinnitus, dizziness, headache, confusion, sweating, drowsy, thirst, nausea, vomiting, diarrhea
- Severe salicylate poisoning
- Convulsions, cardiovascular collapse, coma
nsaid ibuprofen &
Naproxen
- Ibuprofen
- Nonselective COX inhibitors (blocks both)
- Brand/trade names •Ibuprofen (Motrin, Advil)
•Drug interactions
•Increase effects of warfarin, phenytoin
•Side effects
•Gastric
distress
•Naproxen (Naprosyn)
COX-2 Inhibitors
action/use
•Action
•Selectively inhibits COX-2 enzyme without
inhibition of COX-1 (reduces GI distress)
•Use
- Decrease inflammation and pain
- Drug agents
- Celecoxib (Celebrex)
- Similar agents
- Nabumetone (Relafen), meloxicam (Mobic)
- Some COX-1 inhibition
COX-2 inhibitors
caution/SE
•Caution
•Avoid during third trimester of pregnancy
Side Effects
•Mild: headache, dizziness, nausea, diarrhea,
sinusitis, peripheral edema
•Assess renal function and GI
status (can cause kidney damage with long-term use)
NSAID Patient teaching
- Inform of Drug & Herbal interactions
- Avoid Alcohol
- Inform surgeon and dentist before procedures of
NSAID use
- Avoid NSAIDs 1-2 days prior to menstruation
- Do not take if pregnant
- Inform of SE
- Take with food to ↓ GI upset
NSAID dosage meaning
- dose of > 325- 650 is for pain
- dose < than or equal ro 325 is for the anti-platelet effect
disease -modifying antirheumatic drugs
DMARDS
- Immunosuppressive agents
- Immunomodulators •Antimalarials
- Gold drug therapy
immunosuppressive agents
- Used to treat RA unresponsive to anti- inflammatory drugs
- Also used to treat cancer and prevent rejection after organ transplant
- Examples: Azathioprine (Imuran); Cyclophosphamide (Cytoxan); Methotrexate
- Many serious side effects:
- Bone marrow suppression, hepatic
fibrosis, GI ulcers
immunomodulators
- Interleukin (IL-1) receptor antagonists • Anakinra (Kineret)
- Action: reduces synovial inflammation and joint destruction by blocking IL-1 at receptor
•Tumor necrosis factor (TNF) blockers • Infliximab (Remicade) given IV
• Entanercept (Enbrel) given SQ
• Adalimumab (Humira) given SQ
- Action: disrupts the inflammatory process by neutralizing TNF
- Delay disease progression
immunomodulator infliximab (Remicade)
- Infliximab (Remicade)
- Side effects/adverse reactions
- Headache, dizziness, chills, hot flashes, depression, N&V, diarrhea, urinary frequency
- Hypotension, hypertension, altered liver enzymes, severe infections
- Contraindications
- Renal or hepatic disease
- Immunosuppression, infection
**Predisposes the client to severe infections
DMARD’s Nursing Implications
• Administration:
• Monitor labs for CBC, renal & liver function
• observe for side/adverse effects pre & post-infusion specifically acute infusion reaction
• Teaching:
- report signs of bleeding, infection and skin reactions as medication will need to be stopped.
- Encourage pts to keep all follow up appointments and have scheduled lab testing.
- Avoid live vaccines
- Assess for Side Effects/Adverse Effects
- Instruct patient regarding side effects
- Instruct patient to report symptoms of toxicity
Antigout drugs
- Gout pathophysiology
- Inflammatory disease of joints, tendons
- Usually occurs in great toe
- Defect in purine metabolism leads to uric
acid accumulation
•Purine-containing foods: salmon, liver, sardines, alcohol
- Antigout drugs
- Colchicine
- Uric acid inhibitors
- Allopurinol
- Uricosurics
Colchicine
•Inhibit migration of leukocytes to
inflamed site
•Side effects
•N&V, Diarrhea, abdominal pain •Taken with food to avoid GI distress
• Contraindications
•Severe renal, cardiac, or GI problem
Used for an acute attack
uric acid inhibitors
•Allopurinol (Zyloprim) Not a NSAID
• Action
- Decreases uric acid levels
- Used to prevent gout attacks
• Nursing Interventions
Monitor CBC, liver enzymes, renal function
Yearly eye exams for visual changes
Client to avoid alcohol, caffeine, and thiazide diuretics that increase uric acid level
Increase fluid intake to increase uric acid excretion
uricosurics
- Probenecid (Benemid)
- Used for Chronic gout NOT acute attacks
- Side effects
- Gastric irritation; take with food
•Nursing Interventions
- Increase fluid intake to increase uric acid excretion
- Not to be given with other highly protein- bound drugs
antigout: patient teaching
- Regular scheduled lab tests
- Assess kidney, liver function & CBC
•Increase fluid intake •Report SE
•Dietary changes
- Low purine diet
- Alcohol
- Do not take large doses of Vit. C (acidifies urine. slows excretion of uroc acid)
