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


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

  1. 1. Antiinflammatory Agents and Nonsteroidal Antiinflammatory Drugs (NSAIDs)
  2. 2. NSAIDs <ul><li>Large and chemically diverse group of drugs with the following properties: </li></ul><ul><ul><li>Analgesic </li></ul></ul><ul><ul><li>Antiinflammatory </li></ul></ul><ul><ul><li>Antipyretic </li></ul></ul>
  3. 3. NSAIDs: Mechanism of Action <ul><li>Activation of the arachidonic acid pathway causes: </li></ul><ul><li>pain </li></ul><ul><li>headache </li></ul><ul><li>fever </li></ul><ul><li>inflammation </li></ul>
  4. 4. Instructors may wish to use EIC Image #107: Arachidonic Acid Pathway
  5. 5. NSAIDs: Mechanism of Action <ul><li>Analgesia—treatment of headaches and pain </li></ul><ul><li>Block the undesirable effects of prostaglandins, which cause headaches </li></ul>
  6. 6. NSAIDs: Mechanism of Action <ul><li>Antipyretic: reduce fever </li></ul><ul><li>Inhibit prostaglandin E 2 within the area of the brain that controls temperature </li></ul>
  7. 7. NSAIDs: Mechanism of Action <ul><li>Relief of inflammation </li></ul><ul><li>Inhibit the leukotriene pathway, the prostaglandin pathway, or both </li></ul>
  8. 8. NSAIDs <ul><li>Six structurally related groups: </li></ul><ul><li>Acetic acids </li></ul><ul><li>Carboxylic acids </li></ul><ul><li>Propionic acids </li></ul><ul><li>Enolic acids </li></ul><ul><li>Fenamic acids </li></ul><ul><li>Nonacidic compounds </li></ul>
  9. 9. NSAIDs: Acetic Acid <ul><li>diclofenac sodium (Voltaren) </li></ul><ul><li>diclofenac potassium (Cataflam) </li></ul><ul><li>etodolac (Lodine) </li></ul><ul><li>indomethacin (Indocin) </li></ul><ul><li>sulindac (Clinoril) </li></ul><ul><li>tolmetin (Tolectin) </li></ul>
  10. 10. NSAIDs: Carboxylic Acids <ul><li>Acetylated </li></ul><ul><li>aspirin (ASA) </li></ul><ul><li>choline magnesium salicylate (Trilisate) </li></ul><ul><li>diflunisal (Dolobid) </li></ul><ul><li>Nonacetylated </li></ul><ul><li>salicylamide </li></ul><ul><li>salsalate (Disalcid) </li></ul><ul><li>sodium salicylate </li></ul>
  11. 11. NSAIDs: Propionic Acids <ul><li>fenoprofen (Nalfon) </li></ul><ul><li>flurbiprofen (Ansaid) </li></ul><ul><li>ibuprofen (Motrin, others) </li></ul><ul><li>ketoprofen (Orudis) </li></ul><ul><li>ketorolac (Toradol) </li></ul><ul><li>naproxen (Naprosyn) </li></ul><ul><li>oxaprozin (Daypro) </li></ul>
  12. 12. NSAIDs: Other Agents <ul><li>Enolic acids </li></ul><ul><li>phenylbutazone (Butazolidin) </li></ul><ul><li>piroxicam (Feldene) </li></ul><ul><li>Fenamic acids </li></ul><ul><li>meclofenamic acid (Meclomen) </li></ul><ul><li>mefenamic acid (Ponstel) </li></ul><ul><li>Nonacidic compounds </li></ul><ul><li>nabumetone (Relafen) </li></ul>
  13. 13. NSAIDs: Other Agents <ul><li>COX-2 Inhibitors </li></ul><ul><li>celecoxib (Celebrex) </li></ul><ul><li>rofecoxib (Vioxx) </li></ul>
  14. 14. NSAIDs: Drug Effects <ul><li>Analgesic (mild to moderate) </li></ul><ul><li>Antigout </li></ul><ul><li>Antiinflammatory </li></ul><ul><li>Antipyretic </li></ul><ul><li>Relief of vascular headaches </li></ul><ul><li>Platelet inhibition (ASA) </li></ul>
  15. 15. NSAIDs: Therapeutic Uses <ul><li>Relief of mild to moderate pain </li></ul><ul><li>Acute gout </li></ul><ul><li>Various bone, joint, and muscle pain </li></ul><ul><li>Osteoarthritis </li></ul><ul><li>Rheumatoid arthritis </li></ul><ul><li>Juvenile rheumatoid arthritis </li></ul><ul><li>Dysmenorrhea </li></ul><ul><li>Fever </li></ul>
  16. 16. NSAIDs: Specific Agents <ul><li>salicylates (aspirin) </li></ul><ul><li>More potent effect on platelet aggregation and thermal regulatory center in the brain </li></ul><ul><ul><li>analgesic </li></ul></ul><ul><ul><li>antipyretic </li></ul></ul><ul><ul><li>antiinflammatory </li></ul></ul><ul><li>Antithrombotic effect: used in the treatment of MI and other thromboembolic disorders </li></ul>
  17. 17. NSAIDs: Specific Agents <ul><li>phenylbutazone (Butazolidin) </li></ul><ul><li>Greater effects on uric acid production and excretion, in addition to antiinflammatory effects </li></ul><ul><li>More commonly used for treatment of gout </li></ul>
  18. 18. NSAIDs: Side Effects <ul><li>Gastrointestinal </li></ul><ul><li>dyspepsia, heartburn, epigastric distress, nausea </li></ul><ul><ul><li>**GI bleeding </li></ul></ul><ul><ul><li>**mucosal lesions (erosions or ulcerations) </li></ul></ul><ul><li>Misoprostol (Cytotec) can be used to reduce these dangerous effects. </li></ul>
  19. 19. NSAIDs: Side Effects <ul><li>Renal </li></ul><ul><li>reductions in creatinine clearance </li></ul><ul><li>acute tubular necrosis with renal failure </li></ul>
  20. 20. NSAIDs: Side Effects <ul><li>Cardiovascular </li></ul><ul><li>noncardiogenic pulmonary edema </li></ul>
  21. 21. NSAIDs: Salicylate Toxicity <ul><li>Adults: tinnitus and hearing loss </li></ul><ul><li>Children: hyperventilation and CNS effects </li></ul><ul><li>Effects arise when serum levels exceed 300  g/mL. </li></ul><ul><li>Metabolic acidosis and respiratory alkalosis may be present. </li></ul>
  22. 22. NSAIDs: Nursing Implications <ul><li>Before beginning therapy, assess for conditions that may be contraindications to therapy, especially: </li></ul><ul><ul><li>GI lesions or peptic ulcer disease </li></ul></ul><ul><ul><li>Bleeding disorders </li></ul></ul><ul><li>Assess also for conditions that require cautious use. </li></ul><ul><li>Perform lab studies as indicated (cardiac, renal, liver studies, CDC, platelet count). </li></ul>
  23. 23. NSAIDs: Nursing Implications <ul><li>Perform a medication history to assess for potential drug interactions. </li></ul><ul><li>Several serious drug interactions exist: </li></ul><ul><ul><li>alcohol </li></ul></ul><ul><ul><li>heparin </li></ul></ul><ul><ul><li>phenytoin </li></ul></ul><ul><ul><li>oral anticoagulants </li></ul></ul><ul><ul><li>steroids </li></ul></ul><ul><ul><li>sulfonamides </li></ul></ul>
  24. 24. NSAIDs: Nursing Implications <ul><li>Salicylates are NOT to be given to children under age 12 because of the risk of Reye’s syndrome. </li></ul><ul><li>Because these agents generally cause GI distress, they are often better tolerated if taken with food, milk or an antacid to avoid GI irritation. </li></ul><ul><li>Explain to patients that therapeutic effects may not be seen for 3 to 4 weeks. </li></ul>
  25. 25. NSAIDs: Nursing Implications <ul><li>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. </li></ul><ul><li>Patients should watch closely for the occurrence of any unusual bleeding, such as in the stool. </li></ul><ul><li>Enteric-coated tablets should not be crushed or chewed. </li></ul>
  26. 26. NSAIDs: Nursing Implications <ul><li>Monitor for therapeutic effects, which vary according to the condition being treated: </li></ul><ul><ul><li>decrease in swelling, pain, stiffness, and tenderness of a joint or muscle area </li></ul></ul>