Drugs for Management of Fever & Inflammation Brenda B. Rowe

Prostaglandin Synthesis COX –1 enzyme – synthesizes prostaglandins involved in regulation of normal cell activity COX –2 enzyme – produces prostaglandins at site of inflammation Most NXAIDS are nonselective in targeting COX-1 & COX-2

Nonsteroidal Anti-inflammatory Agents (NSAIDS) Salicylates Acetylsalicylic acid (aspirin) Has antipyretic, anti-inflammatory and antiplatelet effects AE – GI (Give with milk or food) Contraindications – peptic ulcer disease, gout, renal or hepatic impairment, bleeding disorders, children with varicella or flu like illness, pregnancy, lactating women

Teaching Points with aspirin Watch for AEs Avoid alcohol and smoking Take as directed Caution about OTC use with aspirin Effects of long term aspirin use

Prostaglandin Synthetase Inhibitors Subgroup of NSAIDS Ibuprofen (Motrin, Advil) Higher doses required for anti-inflammatory effect than analgesia AEs – GI – Give with milk or food Cautious use with many diseases

COX-2 Inhibitors Celecoxib (Celebrex) Selective inhibit of COX-2 prostaglandin synthesis but not platelet aggregation Anti-inflammatory, analgesic, & antipyretic Tx osteoarthritis & dysmenorrheal Contraindicated if have sulfa allergy AE – GI - but not as likely

Para-Aminophenol derivative Acetaminophen (Tylenol) No anti-inflammatory effect Tx fever & pain Use with caution with pregnancy & lactation but safest antipyretic for children and pregnancy AEs – hepatic, renal, hematologic & GI systems Issues with self-administration

Antirheumatic drugs (DMARDS) Auranofin (Ridaura) Tx RA when patient have not responded to NSAIDS Many contraindications & precautions AEs – most significant is bone marrow suppression, most common is GI - diarrhea Takes 8-12 weeks to get therapeutic response Monitor CBC, platelets, renal & hepatic function

Antigout Drugs Colchicine Decreases inflammatory response caused by hyperuricemia Tx acute gout AEs – GI Many contraindications & precautions Take at first sign of acute gout & d/c when symptoms resolve Avoid alcohol & diet high in purines

Uricosuric Drugs Probenecid (Benemid) Reduces uric acid level Tx chronic gout AEs – serious is blood dyscrasias, common is headache, nausea, vomiting & anorexia – take with milk or food Do not take during acute attack Limit taking with vitamin C or cranberry juice

Sample Question Which of the following drugs is a prototype drug for NSAIDS Prostaglandin Synthetese Inhibitor? A. aspirin B. acetaminophen (Tylenol) C. ibuprofen (Motrin) D. celecoxib (Celebrex)

Sample Question What is the drug of choice for pregnant women & children with fever or mild to moderate pain? A. aspirin B. acetaminophen (Tylenol) C. ibuprofin (Motrin) D. codeine

Sample Question Patients taking colchicine should be educated regarding limiting which of the following foods? A. liver B. cheese C. beef D. citrus fruits