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

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



Visit NurseReview.Org for more medical / nursing slides that will surely help you in your nle, nclex and cgfns exams

Visit NurseReview.Org for more medical / nursing slides that will surely help you in your nle, nclex and cgfns exams



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

    • 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
    • NSAIDs: Mechanism of Action
      • Analgesia—treatment of headaches and pain
      • Block the undesirable effects of prostaglandins, which cause headaches
    • NSAIDs: Mechanism of Action
      • Antipyretic: reduce fever
      • Inhibit prostaglandin E 2 within the area of the brain that controls temperature
    • NSAIDs: Mechanism of Action
      • 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.
    • NSAIDs: Side Effects
      • Renal
      • reductions in creatinine clearance
      • acute tubular necrosis with renal failure
    • NSAIDs: Side Effects
      • 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).
    • NSAIDs: Nursing Implications
      • Perform a medication history to assess for potential drug interactions.
      • Several serious drug interactions exist:
        • alcohol
        • heparin
        • phenytoin
        • oral anticoagulants
        • steroids
        • sulfonamides
    • NSAIDs: Nursing Implications
      • 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.
    • NSAIDs: Nursing Implications
      • 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.
    • NSAIDs: Nursing Implications
      • 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