Adams ch33 ln_inflam&fevr

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Adams ch33 ln_inflam&fevr

  1. 1. Pharmacology for Nurses A Pathophysiologic Approach Third Edition CHAPTER 33 Drugs for Inflammation and FeverPharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc.Adams • Holland All rights reserved.
  2. 2. Inflammation• Natural, nonspecific defense mechanism• Occurs in response to an injury or antigen• Inflammation limits spread of injury or antigen – Contains injury – Destroys microorganisms• Acute- 8-10 days• Chronic – months or years Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  3. 3. Signs of Inflammation• Swelling• Pain• Warmth• Redness Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  4. 4. Chemical Mediators• Alert surrounding tissue of injury – Histamine – Leukotrienes – Bradykinin – Complement – Prostaglandins Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  5. 5. Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc.Adams • Holland All rights reserved.
  6. 6. Acute Inflammation• Occurs after cellular injury causes release of chemical mediators• Five basic steps – Vasodilation – Vascular permeability (edema) – Cellular infiltration (pus) – Thrombosis (clots) – Stimulation of nerve endings (pain) Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  7. 7. Figure 33.1 Steps in acute inflammation Source: Pearson Education/PM College Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  8. 8. Histamine• Key chemical mediator in inflammation• Stored in mast cells• Initiates inflammatory response• Directly stimulate pain receptors Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  9. 9. Histamine (continued)• Release of histamine produces vasodilation – Capillaries become leaky  Causes tissue swelling• Responsible for symptoms of anaphylaxis Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  10. 10. Histamine Receptors• Histamine can produce its effects by interacting with two different receptors – H1 receptors: found in vascular smooth muscle, in bronchi, and on sensory nerves  Stimulation results in itching, pain, edema, vasodilation, bronchoconstriction  Characteristic of inflammation and allergy – H2 receptors located in stomach  Stimulation results in secretion of hydrochloric acid Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  11. 11. Strategies forTreating Inflammation• Identify and treat the underlying cause• Usually self-limiting• Use ice packs and rest for mild symptoms.• Topical agents for inflammation of skin and mucus membranes – Creams, ointments, patches, suppositories, and intranasal sprays Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  12. 12. Goal of Treatment• To prevent or decrease the intensity of the inflammatory response• To reduce fever• Used in many common diseases Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  13. 13. Nonsteroidal anti-Inflammatory Drugs (NSAIDs)• Primary drugs for treatment of mild to moderate inflammation• Include aspirin, ibuprofen, and COX-2 inhibitors (see table 33.2)• All have about same efficacy Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  14. 14. Nonsteroidal anti-Inflammatory Drugs (NSAIDs) (continued)• All are analgesics and antipyretics• Side effects vary• Acetaminophen has no anti-inflammatory action and is not an NSAID Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  15. 15. Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc.Adams • Holland All rights reserved.
  16. 16. Table 33.2 (continued) Selected Nonsteroidal Anti-Inflammatory Drugs Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  17. 17. Cyclooxygenase• Cyclooxygenase -1 (COX-1) – Present in all tissues  Reduces gastric acid secretion, promotes renal blood flow, promotes platelet aggregation  Inhibition of COX-1 results in bleeding, gastric upset, reduced renal function Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  18. 18. Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc.Adams • Holland All rights reserved.
  19. 19. Cyclooxygenase (continued)• Cyclooxygenase-2 (COX-2) – Present at sites of injury  Promotes inflammation, sensitizes pain receptors, mediates fever in brain – Inhibition of COX-2 results in suppression of inflammation Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  20. 20. Aspirin• Treats inflammation by inhibiting both COX-1 and COX-2• Readily available, inexpensive, effective• Large doses needed to relieve severe inflammation Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  21. 21. Aspirin (continued)• Adverse effects – Irritates digestive system – May cause bleeding – Salicylism may occur  Tinnitus, dizziness, headache, excessive perspiration Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  22. 22. Ibuprofen• Alternate to aspirin• Inhibits COX-1 and COX-2• Common side effect- nausea and vomiting• Causes less gastric irritation and bleeding than aspirin Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  23. 23. COX-2 Inhibitors• Newest and most controversial class• No inhibition of COX-1 – Do not affect blood coagulation – Do not irritate digestive system – Were treatment of choice for moderate to severe inflammation Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  24. 24. COX-2 Inhibitors (continued)• Rofecoxib (Vioxx) found to double risk of heart attack and stroke- removed from market in 2004• Valdecoxib (Bextra) also removed from market in 2005• Celecoxib (Celebrex) only remaining COX- 2 inhibitor Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  25. 25. Systemic Glucocorticoids• Effective in treating severe inflammation• Naturally released from adrenal cortex• Suppress histamine and prostaglandins• Can inhibit immune system to reduce inflammation Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  26. 26. Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc.Adams • Holland All rights reserved.
  27. 27. Systemic Glucocorticoids (continued)• Serious adverse effects – Suppression of adrenal-gland function, hyperglycemia – Mood changes, cataracts, peptic ulcers – Electrolyte imbalances, osteoporosis Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  28. 28. Systemic Glucocorticoids (continued)• Can mask infections – Creates potential for existing infection to grow rapidly and undetected – Contraindicated in active infections Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  29. 29. Treatment with Glucocorticoids• Used for short-term treatment of acute inflammation• Long-term treatment – Keep dose as low as possible – Use alternate-day dosing – Cushing’s syndrome may result – Discontinue gradually Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  30. 30. Anti-inflammatory Drugs-NSAIDs • Prototype drug: Ibuprofen (Advil, Motrin, others) • Mechanism of action: to inhibit prostaglandin synthesis Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  31. 31. IbuprofenPharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc.Adams • Holland All rights reserved.
  32. 32. Anti-inflammatory Drugs-NSAIDs (continued) • Primary use: for musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis, mild to moderate pain, reduction of fever, primary dysmenorrheal pain • Adverse effects: nausea, heatrburn, epigastric pain, dizziness Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  33. 33. Anti-inflammatory Drugs- Systemic Glucocorticoids• Prototype drug: prednisone (Meticorten)• Mechanism of action: being metabolized to an active form of glucocorticoid• Primary use: to treat inflammation• Adverse effects: long-term therapy may result in Cushing’s syndrome Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  34. 34. PrednisonePharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc.Adams • Holland All rights reserved.
  35. 35. Antipyretics• Prototype drug: acetaminophen (Tylenol)• Mechanism of action: to reduce fever by direct action at level of hypothalamus and dilation of peripheral blood vessels – Enables sweating and dissipation of heat Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  36. 36. AcetaminophenPharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc.Adams • Holland All rights reserved.
  37. 37. Antipyretics (continued)• Primary use: to relieve pain and reduce fever; no anti-inflammatory actions• Adverse effects: possible liver damage, causes less gastric irritation than aspirin, does not affect blood coagulation Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  38. 38. Patients Receiving Drug Therapy for Inflammation and Fever • Assessment – Obtain complete health history – Obtain vital signs; assess in context of client’ baseline values – Obtain complete medication history, including nicotine and alcohol consumption, herbal- supplement use, use of alternative therapies Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  39. 39. Patients Receiving Drug Therapy forInflammation and Fever (continued) • Nursing Diagnoses – Pain – Hyperthermia; risk for injury (hepatic toxicity) – Fluid Volume Deficit (related to fever) – Risk for Injury (related to adverse drug effects) – Risk for Infections (related to adverse drug effects of glucocorticoids) – Risk for Impaired Skin Integrity (related to adverse drug effects of glucocorticoids) Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  40. 40. Patients Receiving Drug Therapy forInflammation and Fever (continued) • Planning-patient will – Experience diminished fever, decreased or absent pain, decreased signs and symptoms of inflammation. – Be free from, or experience minimal adverse effects. Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  41. 41. Patients Receiving Drug Therapy forInflammation and Fever (continued) • Planning-patient will – Verbalize an understanding of the drug’s use, adverse effects and required precautions. – Demonstrate proper self-administration of the medication (e.g., dose, timing, when to notify provider) Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  42. 42. Patients Receiving Drug Therapy forInflammation and Fever (continued) • Implementation – Assess for intolerance to ASA – Monitor  Hepatic and renal function, hearing and balance ( ototoxicity) and vision  Electrolytes, blood glucose and lipid levels periodically (Hyperglycemia from corticosteroids) Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  43. 43. Patients Receiving Drug Therapy forInflammation and Fever (continued) • Implementation – Monitor for  Abdominal pain and change in color of stool (gastrointestinal bleeding)  Osteoporosis and unusual changes in mood or affect in patients on corticosteroids.  Infection in patients on corticosteroids Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  44. 44. Patients Receiving Drug Therapy forInflammation and Fever (continued) • Implementation – Weigh patient daily and report weight gain or increasing peripheral edema – Avoid use of aspirin or salicylates in children under 18. – Do not stop corticosteroids abruptly – Use with caution in clients with history of excessive alcohol consumption – Use with caution in clients with diabetes Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  45. 45. Patients Receiving Drug Therapy forInflammation and Fever (continued) • Evaluation – Experiences diminished fever, decreased or absent pain, decreased signs and symptoms of inflammation. – Is free from, or experiences minimal adverse effects. Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.
  46. 46. Patients Receiving Drug Therapy forInflammation and Fever (continued) • Evaluation – Verbalizes an understanding of the drug’s use, adverse effects and required precautions. – Demonstrates proper self-administration of the medication (e.g., dose, timing, when to notify provider) Pharmacology for Nurses: A Pathophysiologic Approach, Third Edition Copyright ©2011 by Pearson Education, Inc. Adams • Holland All rights reserved.

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