Chapter 12 Anti-inflammatory Agents

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Nonsteroidal Anti-inflammatory Drugs Group of frequently prescribed drugs Treat pain Common drug  Acetylsalicylic acid (ASA)  Hermann Kolbe

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Uses for NSAIDs Analgesic (mild to moderate) Antigout Anti-inflammatory Antipyretic Relief of vascular headaches Platelet inhibition

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved How NSAIDs Work Stop the activation of the arachidonic acid pathway Reduce:  Pain  Headache  Fever  Inflammation

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Analgesics Reduce pain by blocking prostaglandins

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Antipyretics Inhibit prostaglandin E 2 in the brain

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Inflammation Relief Inhibit either the:  Leukotriene pathway  Prostaglandin pathway  Or both pathways

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Pain Relief Relief of mild to moderate pain  Bone, joint, and muscle pain  Osteoarthritis  Rheumatoid arthritis  Juvenile rheumatoid arthritis  Dysmenorrhea

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Common NSAIDs Common drugs that are used:  Ibuprofen (Motrin, Advil)  Ketoprofen (Orudis)  Ketorolac (Toradol)  Naproxen (Naprosyn)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Gastrointestinal Side Effects First-generation NSAIDs  Dyspepsia, heartburn, epigastric distress, nausea  Gastrointestinal bleeding  Mucosal lesions (erosions or ulcerations) (continues)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Gastrointestinal Side Effects Second-generation NSAIDs  Called COX-2 inhibitors  More specific in their action  Reduce gastrointestinal distress (continued)

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Cardiovascular Side Effects Second-generation NSAIDs  Serious side effects:  Cardiac arrhythmias  Heart attack  Stroke  Celecoxib (Celebrex) may be removed  Rofecoxib (Vioxx) removed from market by the FDA

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Precautions First and second generation  Do not take if you:  Have or had stomach ulcers and bleeding  Have had asthma  Have had an allergic response to aspirin or sulfa  Have severe kidney problems  Have severe liver problems  Are pregnant

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Renal Side Effects Creatinine clearance reduced Renal failure  Acute tubular necrosis

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Nursing Assessment Before beginning therapy, perform thorough assessment for:  Gastrointestinal lesions or peptic ulcer disease  Bleeding disorders  Heart disorders  Perform lab studies  CBC, platelet count, cardiac, renal, and liver

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Medical History Medication history Serious drug interactions  Alcohol  Heparin and warfarin (Coumadin)  Phenytoin  Steroids  Sulfonamides

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Salicylates Do not give salicylates to children under age 12.  Reye’s syndrome Give with food and milk.

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Client Education Educate clients about precautions. Watch for:  Unusual bleeding, abdominal pain, and cardiac problems Enteric-coated tablets should not be crushed or chewed.

Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved Therapeutic Effects Monitor for:  Decrease in swelling  Decrease in pain  Decrease in joint tenderness