anti – inflammatory


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anti – inflammatory

  1. 1. ANTI – INFLAMMATORY DRUGS <ul><li>INFLAMMATION – is a reaction to tissue injury caused by the release of chemical mediators that cause both vascular response and the migration of fluids and cells to the injured site. </li></ul>
  2. 2. <ul><li>INFLAMMATION – the process of protective mechanism in which the body attempts to neutralize and destroy harmful agents at the site of tissue injury and establish condition for tissue repair. </li></ul><ul><li>CHEMICAL MEDIATORS </li></ul><ul><li>Histamine – dilates arterioles, increase capillary permeability allowing fluid to leave the capillary and flow to the injured area. </li></ul>
  3. 3. <ul><li>Kinins – dilate the arterioles and increase capillary permeability </li></ul><ul><li>Prostaglandin – cause vasodilation, increase capillary permeability, pain and fever </li></ul><ul><li>Anti – inflammatory Agent – drugs that inhibit the biosynthesis of prostaglandin are called PROSTAGLANDIN INHIBITORS </li></ul>
  4. 4. NSAID <ul><li>Are aspirin and aspirin like drugs that inhibit the enzyme COX which is needed for the synthesis of prostaglandin. </li></ul>
  5. 5. There are 8 groups of NSAIDS <ul><li>Salicylates related to aspirin </li></ul><ul><li>Parachlorobenzoic Acid derivatives or indoles </li></ul><ul><li>Pyrazolone Derivatives </li></ul><ul><li>Propionic Acid Derivatives </li></ul><ul><li>Fenamates </li></ul><ul><li>Oxicams </li></ul><ul><li>Phenylacetic Acid </li></ul><ul><li>Selective Cox 2 inhibitors </li></ul>
  6. 6. <ul><li>ASPIRIN </li></ul><ul><li>4 A’s – anti inflammatory </li></ul><ul><li> analgesic </li></ul><ul><li> antipyretic </li></ul><ul><li> anticoagulant </li></ul><ul><li>Adverse Reaction </li></ul><ul><li>GI: nausea, vomiting, G.I. distress, occult bleeding, G.I. bleeding </li></ul><ul><li>EENT: Tinnitus, hearing loss </li></ul><ul><li>HEMA: prolonged bleeding time, Thrombocytopenia </li></ul>
  7. 7. <ul><li>2. Para chlorobenzoic Acid Derivatives or Indoles </li></ul><ul><li>Indomethacin (Indocin) </li></ul><ul><li>Therapeutic Effect – relieves pain, fever and inflammation </li></ul><ul><li>Indications – rheumatoid arthritis, gouty arthritis </li></ul><ul><li>Dysmennorhea, PDA </li></ul><ul><li>Dosage: 25 – 50 mg/ cap </li></ul><ul><li>Oral susp. 25mg/5ml </li></ul><ul><li>Suppositories: 50 mg </li></ul>
  8. 8. <ul><li>Injection: 100 mg vial </li></ul><ul><li>Side effects: </li></ul><ul><li>GI: ANVD, and abdominal pain </li></ul><ul><li>CNS: headache, dizziness, and vertigo </li></ul><ul><li>Hypersensitivity rxn. Urticaria </li></ul><ul><li>Nursing Implication: </li></ul><ul><li>1. If G.I. upset occurs, give oral form of drugs with food, milk, or antacid. </li></ul><ul><li>2. If patient has bleeding, stop giving the medication and notify the physician </li></ul>
  9. 9. <ul><li>3. Instruct patient not to drink alcohol during therapy. </li></ul><ul><li>3. Pyrazolone Derivatives </li></ul><ul><li>Phenylbutazone (butazolidin) </li></ul><ul><li>Indications: Rheumatoid arthritis </li></ul><ul><li> Acute gout </li></ul><ul><li>Adverse Effect: blood dyscrasia such as agranulocytosis, and aplastic anemia </li></ul><ul><li>4. Propionic Acid Group </li></ul><ul><li>These are aspirin like but have stronger effects and create less GI irritation. </li></ul>
  10. 10. <ul><li>Ibuprofen (advil) </li></ul><ul><li>Naproxen (naprosyn) </li></ul><ul><li>Suprofen (profenal) </li></ul><ul><li>Ketoprofen (Orudis) </li></ul><ul><li>Therapeutic Effect: relieves pain, fever, and inflammation </li></ul><ul><li>Side Effect: CNS: headache, drowsiness, dizziness </li></ul><ul><li>EENT: visual disturbance, tinnitus </li></ul><ul><li>GI: epigastric distress, nausea, occult blood </li></ul><ul><li>HEMA: prolonged bleeding time </li></ul>
  11. 11. <ul><li>Nursing Implication </li></ul><ul><li>1. Give with meals or with milk to reduce adverse GI reactions. </li></ul><ul><li>2. Serious GI toxicity, including peptic ulceration and bleeding despite absence of GI symptoms. </li></ul><ul><li>3. Instruct patient not to drink alcohol during therapy. </li></ul><ul><li>5. Fenamates – includes potent NSAIDS used for acute and chronic arthritic conditions </li></ul><ul><li>Meclofenamate Na monohydrate (meclomen) </li></ul><ul><li>Mefenamic Acid (Ponstan) </li></ul>
  12. 12. <ul><li>Side Effects: Gastric irritation </li></ul><ul><li>Clients with peptic ulcer should not take this drugs. </li></ul><ul><li>6. Oxicams – for long term treatment of arthritic conditions such as rheumatoid arthritis and osteoarthritis </li></ul><ul><li>Piroxicam (feldene) </li></ul><ul><li>7. Phenylacetic acid derivatives </li></ul><ul><li>analgesic and anti – inflammatory effects are similar to those of aspirin but it has minimal or no antipyretic effect </li></ul><ul><li>Diclofenac Na (voltaren) </li></ul><ul><li>Ketorolac (toradol) </li></ul>
  13. 13. <ul><li>8. Selective Cox 2 inhibitor </li></ul><ul><li>Therapeutic effect: relieves pain and inflammation of joints and smooth muscle tissue. </li></ul><ul><li>Celecoxib (celebrex) </li></ul><ul><li>Rofecoxib (vioxx) </li></ul>
  14. 14. CORTICOSTERIODS <ul><li>Steroidal agents or corticosteroids are most commonly used treatment of local inflammation disorders such as those affecting skin. </li></ul><ul><li>For systemic inflammatory disorder that require a potent and aggressive therapy for control </li></ul>
  15. 15. <ul><li>Betamethasone (celestone) </li></ul><ul><li>Cortisone (cortone) </li></ul><ul><li>hydrocortisone (solu cortef) </li></ul><ul><li>Methylprednisolone (medrol) </li></ul>
  16. 16. <ul><li>Anti gout drugs </li></ul><ul><li>Gout – an inflammatory conditin that attacks joints, tendons, and other tissues. It is characterized by uric acid metabolism disorder and a defect in PURINE metabolism resulting in increase in urates and accumulation of uric acid or an ineffective clearance of uric acid by the kidneys. </li></ul>
  17. 17. <ul><li>Anti inflammatory Gout drugs </li></ul><ul><li>Colchicine – used to inhibit the migration of leukocytes to the inflamed site </li></ul><ul><li>Uric Acid Inhibitor </li></ul><ul><li>Allopurinol (Zyloprim) </li></ul><ul><li>Not an anti inflammatory drug instead it inhibits the final steps of uric acid biosynthesis and lowers uric acid level </li></ul><ul><li>Uricosurics </li></ul><ul><li>Probenicid (Benemid) </li></ul><ul><li>Increase the rate nor uric acid excretion by inhibiting the reabsorption </li></ul>