Ppt chapter 16

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Anti-Inflammatory, Antiarthritis,
and Related Agents
Chapter 16

Inflammatory Response
• Protects the body from injury and pathogens
• Used chemical mediators to produce a reaction that helps
destroy pathogens and promotes healing

Anti-Inflammatory, Antiarthritis, and
Related Agents
• Several different types of drugs
• Corticosteroids
• Block or alter the chemical reactions associated with the
inflammatory response
• Over-the-counter (OTC)
• Adverse effects

Salicylates
• Can block the inflammatory response
• Have antipyretic properties (fever-blocking)
• Have analgesic (pain-blocking) properties
• Therapeutic actions and indications
• Pharmacokinetics
• Contraindications and cautions
• Adverse effects
• Clinically important drug-to-drug interactions

Common Salicylates
• Aspirin (Bayer, etc.): Treats inflammatory conditions
• Balsalazide (Colazal): New drug treats ulcerative colitis
• Choline magnesium trisalicylate (Trilisate): Treats mild
pain and fevers and arthritis
• Choline Salicylate (Arthropan): Treats mild pain and fevers
as well as arthritis
• Mesalamine (Pentasa and others): Treats inflammation of
the large intestine

Common Salicylates (cont.)
• Olsalazine (Dipentum): Converted to mesalamine in
the colon; has the same direct anti-inflammatory effects
• Salsalate (Argesic and Others): Used to treat pain,
fever, and inflammation
• Sodium Thiosalicylate (Rexolate): Treats episodes of
acute gout and muscular pain, and rheumatic fever

Salicylates
• Actions /Indications
– Inhibit synthesis of progtagladin, used to treat mild to
moderate pain and fever
– Absorbed from the stomach, peak in 5-30 min.,
metabolized in the liver, excreted in the urine
• Contraindications
– Known allergy, bleeding abnormalities, impaired renal
function
• Drug-to-Drug Interactions
– Interact with other drugs by interfering with absorption

Prototype Salicylates

Nursing Considerations for Patients
Receiving Salicylates
• Assessment: History and Examination
• Nursing Diagnoses
• Implementation With Rationale
• Evaluation

Question
Please answer the following statement as true or false.
A person who does not respond to one salicylate may
respond to a different one.

Answer
True.
Rationale: Salicylates are some of the oldest anti-
inflammatory drugs used. They were extracted from
willow bark, poplar trees, and other plants by ancient
peoples to treat fever, pain, and what we now call
inflammation. They are generally available without
prescription and are relatively nontoxic when used as
directed. A person who does not respond to one salicylate
may respond to a different one.

Nonsteroidal Anti-inflammatory and
Related Agents
• Propionic Acids
– Fenoprofen
– Ibuprofen
• Acetic Acids
– Declofenac
– Etodolac
• Fenamates
– Mefenamic acid
• Cyclooxygenase-2
Inhibitors
– Celecoxib

NSAIDs
• Provide strong anti-inflammatory and analgesic effects
• Sold over the counter, which may lead to abuse
• Therapeutic actions and indications
• Contraindications and cautions
• Adverse effects
• Clinically important drug-to-drug interactions

Prototype NSAIDs

Acetaminophen
• Actions /Indications
– Acts directly on the thermoregulatory cells of the
hypothalamus
– Not sure of the mechanism of action related to analgesic
effects
– Used to treat pain and fever
• Treat pain and fever associated with a variety of
conditions, including influenza
• Prophylaxis of children receiving diphtheria–pertussis–
tetanus (DPT) immunizations
• Relief of musculoskeletal pain associated with arthritis

Acetaminophen (cont.)
– Absorbed from GI tract
– Peak ½ to 2 hours
– Metabolized in the liver
– Excreted in the urine
– T ½ is about 2 hours
– Known allergy
– Use with caution in pregnancy and lactation

Acetaminophen (cont.)
• Adverse Reactions
– Headache, hemolytic anemia, renal dysfunction,
skin rash and fever
– Hepatotoxicity usually associated with chronic
use and overdose
– Oral anticoagulants increase bleeding

Prototype Summary: Acetaminophen

Receiving NSAIDs and Related Agents
• Assessment: History and Examination
– Contraindications or cautions
– Baseline status before beginning therapy and for any
potential adverse effects

Question
When are NSAIDs contraindicated?
A. Allergy to penicillin
B. Allergy to sulfonamides
C. Allergy to antihistamines
D. Allergy to thiazines

Answer
B. Allergy to sulfonamides
Rationale: The NSAIDs are contraindicated in the presence
of allergy to any NSAID or salicylate/ Celecoxib is also
contraindicated in the presence of allergy to
sulfonamides.

Antiarthritis Agents
• Potentially debilitating inflammatory process
• Antiarthritis drugs
• Prevent and suppress arthritis in selected patients with
rheumatoid arthritis

Gold Compounds
• Indications/Action
– Absorbed by macrophages, which results in inhibition
of phagocytosis
– Tissue destruction is decreased
– Absorptions varies based on site of administration
– Widely distributed throughout the body
– Known allergy
– Diabetes, CHF, renal or hepatic impairment

Gold Compounds (cont.)
• Adverse Reactions
– Stomatitis, glossitis, gingivitis, bone marrow
depression, dermatitis
– Penicillamine, antimalarials, cytotoxic drugs, or
immunosuppressive agents

Therapeutic Actions and Indications
• Chrysotherapy
• Indicated to treat selected cases of:
– Rheumatoid arthritis
– Juvenile rheumatoid arthritis
– In patients whose disease has been unresponsive to
standard therapy

Pharmacokinetics
• Absorbed at varying rates
• Excreted in urine and feces
• Cross the placenta and cross into breast milk
• Barrier contraceptives

Contraindications and Cautions
• Gold salts can be quite toxic
• Contraindicated in the presence of any known allergy to
gold
Adverse Effects
– Variety of adverse effects are common with the use
of gold salts

Clinically Important Drug–Drug
Interactions
• Do not combine with:
– Penicillamine
– Antimalarials
– Cytotoxic drugs
– Immunosuppressive agents

Prototype Gold Compound

Disease Modifying Anti-Rheumatic Drugs
• Available for treating arthritis that aggressively affect the
process of inflammation
• Can be severe to life-threatening
• They alter the course of the inflammatory process, many
rheumatologists are selecting to
• Antineoplastic drug methotrexate
• Therapeutic Actions and Indications
– Anakinra
– Leflunomide is slowly absorbed from the GI tract,
reaching peak levels in 6-12 hours

Disease Modifying Anti-Rheumatic Drugs
(cont.)
• Anakinra
• Etanercept I
• Leflunomide is slowly absorbed from the GI tract,
reaching peak levels in 6-12 hours.

Therapeutic Actions and Indications
• Relief of the signs and symptoms of rheumatoid arthritis
and osteoarthritis
• Relief of mild to moderate pain
• Treatment of primary dysmenorrhea
• Fever reduction

Receiving Antiarthritis Agents
• Similar to those for patients receiving NSAIDS and
related agents

Drug Therapy Across the Lifespan

Ppt chapter 16

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