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

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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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  • 1. Antiinflammatory Agents and Nonsteroidal Antiinflammatory Drugs (NSAIDs)
  • 2. NSAIDs
    • Large and chemically diverse group of drugs with the following properties:
      • Analgesic
      • Antiinflammatory
      • Antipyretic
  • 3. NSAIDs: Mechanism of Action
    • Activation of the arachidonic acid pathway causes:
    • pain
    • headache
    • fever
    • inflammation
  • 4. Instructors may wish to use EIC Image #107: Arachidonic Acid Pathway
  • 5. NSAIDs: Mechanism of Action
    • Analgesia—treatment of headaches and pain
    • Block the undesirable effects of prostaglandins, which cause headaches
  • 6. NSAIDs: Mechanism of Action
    • Antipyretic: reduce fever
    • Inhibit prostaglandin E 2 within the area of the brain that controls temperature
  • 7. NSAIDs: Mechanism of Action
    • Relief of inflammation
    • Inhibit the leukotriene pathway, the prostaglandin pathway, or both
  • 8. NSAIDs
    • Six structurally related groups:
    • Acetic acids
    • Carboxylic acids
    • Propionic acids
    • Enolic acids
    • Fenamic acids
    • Nonacidic compounds
  • 9. NSAIDs: Acetic Acid
    • diclofenac sodium (Voltaren)
    • diclofenac potassium (Cataflam)
    • etodolac (Lodine)
    • indomethacin (Indocin)
    • sulindac (Clinoril)
    • tolmetin (Tolectin)
  • 10. NSAIDs: Carboxylic Acids
    • Acetylated
    • aspirin (ASA)
    • choline magnesium salicylate (Trilisate)
    • diflunisal (Dolobid)
    • Nonacetylated
    • salicylamide
    • salsalate (Disalcid)
    • sodium salicylate
  • 11. NSAIDs: Propionic Acids
    • fenoprofen (Nalfon)
    • flurbiprofen (Ansaid)
    • ibuprofen (Motrin, others)
    • ketoprofen (Orudis)
    • ketorolac (Toradol)
    • naproxen (Naprosyn)
    • oxaprozin (Daypro)
  • 12. NSAIDs: Other Agents
    • Enolic acids
    • phenylbutazone (Butazolidin)
    • piroxicam (Feldene)
    • Fenamic acids
    • meclofenamic acid (Meclomen)
    • mefenamic acid (Ponstel)
    • Nonacidic compounds
    • nabumetone (Relafen)
  • 13. NSAIDs: Other Agents
    • COX-2 Inhibitors
    • celecoxib (Celebrex)
    • rofecoxib (Vioxx)
  • 14. NSAIDs: Drug Effects
    • Analgesic (mild to moderate)
    • Antigout
    • Antiinflammatory
    • Antipyretic
    • Relief of vascular headaches
    • Platelet inhibition (ASA)
  • 15. 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
  • 16. 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
  • 17. 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
  • 18. 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.
  • 19. NSAIDs: Side Effects
    • Renal
    • reductions in creatinine clearance
    • acute tubular necrosis with renal failure
  • 20. NSAIDs: Side Effects
    • Cardiovascular
    • noncardiogenic pulmonary edema
  • 21. 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.
  • 22. 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).
  • 23. 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
  • 24. 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.
  • 25. 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.
  • 26. 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