NurseReview.Org - Antiinflamma And Nsai Ds Updates (basic pharmacology for nurses)

Antiinflammatory Agents and Nonsteroidal Antiinflammatory Drugs (NSAIDs)

NSAIDs
Large and chemically diverse group of drugs with the following properties:
Analgesic
Antiinflammatory
Antipyretic

NSAIDs: Mechanism of Action
Activation of the arachidonic acid pathway causes:
pain
headache
fever
inflammation

Instructors may wish to use EIC Image #107: Arachidonic Acid Pathway

Analgesia—treatment of headaches and pain
Block the undesirable effects of prostaglandins, which cause headaches

Antipyretic: reduce fever
Inhibit prostaglandin E 2 within the area of the brain that controls temperature

Relief of inflammation
Inhibit the leukotriene pathway, the prostaglandin pathway, or both

NSAIDs
Six structurally related groups:
Acetic acids
Carboxylic acids
Propionic acids
Enolic acids
Fenamic acids
Nonacidic compounds

NSAIDs: Acetic Acid
diclofenac sodium (Voltaren)
diclofenac potassium (Cataflam)
etodolac (Lodine)
indomethacin (Indocin)
sulindac (Clinoril)
tolmetin (Tolectin)

NSAIDs: Carboxylic Acids
Acetylated
aspirin (ASA)
choline magnesium salicylate (Trilisate)
diflunisal (Dolobid)
Nonacetylated
salicylamide
salsalate (Disalcid)
sodium salicylate

NSAIDs: Propionic Acids
fenoprofen (Nalfon)
flurbiprofen (Ansaid)
ibuprofen (Motrin, others)
ketoprofen (Orudis)
ketorolac (Toradol)
naproxen (Naprosyn)
oxaprozin (Daypro)

NSAIDs: Other Agents
Enolic acids
phenylbutazone (Butazolidin)
piroxicam (Feldene)
Fenamic acids
meclofenamic acid (Meclomen)
mefenamic acid (Ponstel)
Nonacidic compounds
nabumetone (Relafen)

NSAIDs: Other Agents
COX-2 Inhibitors
celecoxib (Celebrex)
rofecoxib (Vioxx)

NSAIDs: Drug Effects
Analgesic (mild to moderate)
Antigout
Antiinflammatory
Antipyretic
Relief of vascular headaches
Platelet inhibition (ASA)

NSAIDs: Therapeutic Uses
Relief of mild to moderate pain
Acute gout
Various bone, joint, and muscle pain
Osteoarthritis
Rheumatoid arthritis
Juvenile rheumatoid arthritis
Dysmenorrhea
Fever

NSAIDs: Specific Agents
salicylates (aspirin)
More potent effect on platelet aggregation and thermal regulatory center in the brain
analgesic
antipyretic
antiinflammatory
Antithrombotic effect: used in the treatment of MI and other thromboembolic disorders

NSAIDs: Specific Agents
phenylbutazone (Butazolidin)
Greater effects on uric acid production and excretion, in addition to antiinflammatory effects
More commonly used for treatment of gout

NSAIDs: Side Effects
Gastrointestinal
dyspepsia, heartburn, epigastric distress, nausea
**GI bleeding
**mucosal lesions (erosions or ulcerations)
Misoprostol (Cytotec) can be used to reduce these dangerous effects.

Renal
reductions in creatinine clearance
acute tubular necrosis with renal failure

Cardiovascular
noncardiogenic pulmonary edema

NSAIDs: Salicylate Toxicity
Adults: tinnitus and hearing loss
Children: hyperventilation and CNS effects
Effects arise when serum levels exceed 300  g/mL.
Metabolic acidosis and respiratory alkalosis may be present.

NSAIDs: Nursing Implications
Before beginning therapy, assess for conditions that may be contraindications to therapy, especially:
GI lesions or peptic ulcer disease
Bleeding disorders
Assess also for conditions that require cautious use.
Perform lab studies as indicated (cardiac, renal, liver studies, CDC, platelet count).

Perform a medication history to assess for potential drug interactions.
Several serious drug interactions exist:
alcohol
heparin
phenytoin
oral anticoagulants
steroids
sulfonamides

Salicylates are NOT to be given to children under age 12 because of the risk of Reye’s syndrome.
Because these agents generally cause GI distress, they are often better tolerated if taken with food, milk or an antacid to avoid GI irritation.
Explain to patients that therapeutic effects may not be seen for 3 to 4 weeks.

Educate patients about the various side effects of NSAIDs, and to notify their physician if these effects become severe or if bleeding or GI pain occur.
Patients should watch closely for the occurrence of any unusual bleeding, such as in the stool.
Enteric-coated tablets should not be crushed or chewed.

Monitor for therapeutic effects, which vary according to the condition being treated:
decrease in swelling, pain, stiffness, and tenderness of a joint or muscle area

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NurseReview.Org - Antiinflamma And Nsai Ds Updates (basic pharmacology for nurses)

by jben501 on Sep 10, 2008

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