Pharm110 Chp 12 Anti Inflammatory Agents

Question 1

Anti Inflammatory Agents

Answer 1

Anti Inflammatory Drugs 2 types
Corticosteriods

NSAIDS 2 types:
Salicylates

Non-Salicylates NSAIDS 2 types:
1st generation:
1st gen NSAIDS inhibit COX-1 and COX-2 prostaglandins. e.g. ibuprofen, naproxen, ketorolac

2nd generation:
2nd gen NSAIDS inhibit mostly COX-2 prostaglandins. e.g. celecoxib (Celebrex)

Cox-1 are protective prostaglandins in stomach to keep mucosa strong

Cox-2 pain causing prostaglandins

Question 2

NSAID Drugs

Answer 2

Treat pain
Most common drug
Acetylsalicylic acid (Aspirin)

Question 3

Uses for NSAIDs

Answer 3

Analgesic (mild to moderate pain)
Anti-Inflammatory
Platelet inhibition

Question 4

How NSAIDs work

Answer 4

Reduce
Pain
Headache
Fever
Inflammation

Reduce pain by blocking prostaglandins

Question 5

Inflammation relief

Answer 5

Inhibit either the:
Leukotriene pathway
Prostaglandin pathway
Or both pathways

Question 6

Common NSAIDs

Answer 6

Common drugs that are used:
Ibuprofen (Motrin, Advil)
Ketoprofen (Orudis)
Ketorolac (Toradol)
Naproxen (Naprosyn)

Question 7

GI side effects

Answer 7

1st generation GI effects:
GI bleeding
Mucosal lesions (erosions or ulcerations)

2nd generation GI effects:
Reduce GI distress

Question 8

Cardiovascular side effects

Answer 8

2nd generation:
Serious side effects
Cardiac arrhythmias
Heart attack
Stroke

Question 9

Precautions

Answer 9

1st and 2nd generation:
Do not take if you:
Have or had stomach ulcers and bleeding
Have had an allergic response to acetylsalicylic acid (Aspirin)
Have severe kidney problems
Have severe liver problems
Are pregnant

Question 10

Salicylates

Answer 10

Do not give salicylates to children under age 12 due to risk of Reyes disease.
Give with food and milk to lessen GI irritation.

Question 11

Client education

Answer 11

Watch for:
Unusual bleeding, abdominal pain, and cardiac problems.
Enteric coated tablets should not be crushed or chewed

Question 12

Therapeutic effects

Answer 12

Monitor for:
Decrease in swelling
Decrease in pain
Decrease in joint tenderness

Question 13

Corticosteroids

Answer 13

Types:
Hydrocortisone (least potent, topical use)
Triamcinolone acetonide (topical)
Prednisone (glucocorticoid effects)
Prednisolone (glucocorticoid effect)

Use corticosteroids as a last resort when NSAIDs cannot relieve inflammation

Question 14

Corticosteroids adverse effects

Answer 14

Fluid retention
Altered glucose levels (check blood glucose daily)
Altered fat deposition (“moon face”, “buffalo hump”)
Wasting of muscle tissue in extremities
Delayed growth in children

Question 15

What corticosteroids do

Answer 15

Prevent or suppress the development of inflammatory symptoms, such as heat, redness, pain and swelling.
Work by inhibiting early phenomena e.g. capillary dilation, leukocyte migration into the inflamed area, etc.
Remember!!!
They suppress many inflammatory symptoms, it is important to recognize the underlying cause of the disease and it may progress even though the patient may seem to have improved.

Question 16

Corticosteroid dangers

Answer 16

Patients taking them should regularly should NOT stop taking them suddenly, even is symptoms improve, this may cause an adrenal crisis!!!
Dosages should be reduced gradually.
Clients are often placed on sodium restricted diets, due to sodium and water retention with these drugs.

Question 17

Corticosteroid cautions

Answer 17

Corticosteroids slow wound healing- a concern for clients with surgical incisions.
Clients often bruise easily. Give Vitamin C.
Administer early in the day to prevent insomnia.
Monitor blood glucose levels daily.
Clients may have labile emotions, which may be manifested as euphoria, depression or both.
Be alter for nightmares and social withdrawal- these may indicate depression and possible suicidal behavior.