1. Antiinflammatory, Musculoskeletal, Antiarthritis Medications
Chapter 15
Antiinflammatory, Musculoskeletal, Antiarthritis Medications
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2. Muscular and Skeletal Systems
Bones, joints, muscles, and ligaments
Antiinflammatory and analgesic drugs
Skeletal muscle relaxants
Drugs arthritis
Drugs gout
Which conditions require short-term use of drugs from this classification?
When would a patient receive skeletal muscle relaxants?
Does arthritis require long- or short-term drug management?
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3. Antiinflammatory and Analgesic Agents
Acetaminophen Tylenol (decreases pain)
Aspirin acetylsalicylic acid (ASA)
(decrease pain and inflammation)
NSAIDs
Which of these three agents produces the greatest antiinflammatory response in the body?
Acetaminophen is used to treat inflammation and provide analgesia.
NSAIDS decrease pain and inflammation.
How are the actions of salicylates and NSAIDS similar?
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4. Rheumatoid Arthritis RA Overview
Chronic disorder
Autoimmune and inflammatory
Pharmacological management
provides symptomatic relief
will not cure
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5. Rheumatoid Arthritis
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6. Rheumatoid Arthritis RA Overview
Different categories of medications
(May be used individually or in combination)
DMARDs
Glucocorticoids
Immunosuppressants
NSAIDs
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7. RA MEDICATIONS DMARDs Glucocorticoids Prednisone
Nonsteroidal Anti‑Inflammatory Drugs (NSAIDs)
Aspirin
Ibuprofen (Motrin, Advil)
Indomethacin (Indocin)
Meloxicam (Mobic)
Naproxen (Naprosyn)
Celecoxib (Celebrex)
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8. DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs)
Slow joint degeneration Slow progression of rheumatoid arthritis. Decrease pain and inflammation DMARDs I – Major Nonbiologic DMARDs DMARDs II – Major Biologic DMARDs DMARDs III -Minor Nonbiologic and Biologic DMARDs
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9. DMARDs I Methotrexate (Immunosuppressant, cytotoxic)
Bone marrow suppression. Hepatic fibrosis. Fetal death/congenital defects
minocycline (Minocin) Tetracycline
Dizziness, lightheadedness. Increased risk digoxin toxicity. Take with meals.
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10. DMARDs II Infliximab (Remicade) Adalimumab (Humira)
Abatacept (Orencia)
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11. DMARDs II Infliximab (Remicade)
SQ injection-site irritation
(redness, swelling, pain, itching)
IV infusion reactions: influenza-like findings, hypotension, anaphylaxis
Risk of infection. Test for hepatitis B, and TB
Severe skin reactions (Stevens-Johnson syndrome)
Heart failure (JVD, crackles, dyspnea)
Blood dyscrasias (bleeding, bruising, fever)
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12. DMARDs III Gold salts: auranofin (Ridaura)
Penicillamine (Cuprimine, Depen)
Immunosuppressant medications: azathioprine (Imuran), cyclosporine (Sandimmune,
Gengraf, Neoral)
GLUCOCORTICOIDS PREDNISONE
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13. DMARDs III Gold salt auranofin (Ridaura)–
Toxicity (severe pruritus,rashes, stomatitis)
Renal toxicity
Blood dyscrasias (thrombocytopenia, leukopenia, agranulocytosis, aplastic anemia)
Hepatitis
GI discomfort
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14. Glucocorticoids provide symptomatic relief of inflammation and pain.
NSAIDs provide rapid, symptomatic relief of inflammation and pain.
Therapeutic Uses
Analgesia for pain, swelling, and joint stiffness
Maintenance of joint function
Slow/delay the worsening of the disease
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15. DMARDs III GLUCOCORTICOIDS PREDNISONE
Risk of infection (fever and/or sore throat)
Osteoporosis calcium supplements
Adrenal suppression
Fluid retention
GI discomfort
Hyperglycemia
Hypokalemia
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16. Aspirin
Salicylism (tinnitus, sweating, h/a, dizziness, respiratory alkalosis.
Aspirin toxicity (sweating, high fever, acidosis, dehydration, electrolyte
imbalances, coma, respiratory depression).
Medical emergency in the hospital.
Correct dehydration and electrolyte imbalance- IV fluids
Bicarbonate promotes salicylate excretion
Gastric lavage
Activated charcoal
Hemodialysis
Reye syndrome (rare but serious)
avoid giving aspirin when a child/adolescent-viral illness, chickenpox/flu

17. ACETAMINOPHEN Tylenol
Therapeutic Uses
Analgesic (relief of pain) effect
Antipyretic (reduction of fever) effects
Acute toxicity (liver damage) early manifestations nausea, vomiting, diarrhea, abdominal discomfort, sweating, hepatic failure, coma, and death.
Follow FDA recommended dosages to prevent toxicity (4 g/day)
Antidote: acetylcysteine (Mucomyst).
Alcohol increases the risk of liver damage/toxicity.
warfarin (Coumadin) ^ INR
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18. NSAIDs Complications
Gastrointestinal discomfort (dyspepsia, abdominal pain, heartburn, nausea).
Observe for manifestations of bleeding
proton pump inhibitor, omeprazole (Prilosec)
H2-receptor antagonist ranitidine (Zantac)
Renal dysfunction
(decreased urine output, weight gain, ^ BUN and creatinine).
Increased risk of heart attack and stroke

19. MUSCLE RELAXANTS diazepam (Valium) dantrolene (Dantrium)
Tizanidine (Zanaflex)
Baclofen
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20. MUSCLE RELAXANTS Nursing
Monitor for Hepatic toxicity(anorexia, nausea, vomiting, abdominal pain, jaundice)
Advise to avoid hazardous activities
Do not to discontinue the medication abruptly.
Start at low doses
Avoid concurrent CNS depressants
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21. MUSCLE RELAXANTS Complications
CNS depression (sleepiness, lightheadedness, fatigue)
Physical dependence
Hepatic toxicity
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22. GOUT
Antigout Medications act either by reducing inflammation or decreasing serum uric acid levels
Gout is caused by elevated levels of uric acid, which can accumulate and cause localized inflammationin synovial areas.
High serum uric acid levels lead to the formation of uric acid crystals, usually in the kidneys and joint spaces. These crystals are long and jagged and cause the swelling, inflammation, and severe pain of gout.
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23. GOUT Colchicine Only effective for inflammation
Treatment of acute attacks Abort an acute gout attack prophylactic use
Decrease incidence of acute attacks
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24. GOUT Colchicine Adverse Effects
Mild GI distress, which can progress to GI toxicity
(abdominal pain, diarrhea, nausea, vomiting) take with food. antidiarrheal agents
Thrombocytopenia, suppressed bone marrow
Sudden onset of muscle pain, tenderness (rhabdomyolysis)
Use cautiously in older adults; clients who are debilitated; and clients who have renal, cardiac, hepatic, or gastrointestinal dysfunction.
Grapefruit juice may increase adverse effects.
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25. GOUT Allopurinol inhibits uric acid production.
no analgesic or antiinflammatory properties
not beneficial in the treatment of acute gout.
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26. GOUT Allopurinol Adverse Effects
May cause a gout attack during the initial treatment phase.
Kidney injury
Hepatitis
GI distress (nausea and vomiting)
Rhabdomyolysis is most likely with long-term use.
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27. ANTI GOUT Medications Nursing Administration
monitor uric acid levels, CBC, urinalysis, liver and kidney function tests.
avoid alcohol and foods high in purine (red meat, scallops, cream sauces).
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