1. INFLAMMATION AND FEVER Chapter 44

2. Inflammation Chronic Acute Non- Pharmicologic Non- Pharmicologic Treatment Goals Treatment Goals S & S Anti- inflammatory Anti- inflammatory

3. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Selective Cyclooxygenase-2- inhibitors Aspirin Ibuprofen/like

4. Salicylates Analgesic Anti- inflammatory Antipyretic Anticoagulant Indications

6. Aspirin Acetylsalicylic Acid Aspirin Acetylsalicylic Acid Prostaglandin temperature vasodilation Prostaglandin temperature vasodilation NSAID Preg C & D NSAID Preg C & D Methotrexate Probenecid and sulfinpyrazone Beta Blockers Donquai, feverfew, garlic, ginger horse chestnut, red clover Caffeine St. John’s wort Methotrexate Probenecid and sulfinpyrazone Beta Blockers Donquai, feverfew, garlic, ginger horse chestnut, red clover Caffeine St. John’s wort Pain and Inflammation Prevent Clots Stroke prevention Afib MI prophylaxis Coronary thrombosis Pain and Inflammation Prevent Clots Stroke prevention Afib MI prophylaxis Coronary thrombosis Action Class Indications Drug Interactions

7. ASA Head trauma ICP GI bleed Hypoprothrombinemia Vit K deficiency CHF Flu – flu-like illness in kids Pregnancy Head trauma ICP GI bleed Hypoprothrombinemia Vit K deficiency CHF Flu – flu-like illness in kids Pregnancy Aspirin Triad Allergy nasal polyps asthma Aspirin Triad Allergy nasal polyps asthma Choline and Mangesium Trisalicylate Magnesium Salicylate Choline and Mangesium Trisalicylate Magnesium Salicylate Hypothyroid Immunosuppression Asthma,gout or anemia Renal and hepatic impairment G^PD deficiency Hypothyroid Immunosuppression Asthma,gout or anemia Renal and hepatic impairment G^PD deficiency Contraindications Precautions Similar Drugs

8. Adverse Effects Severe Adverse Effects ASA

9. ASA – Nursing Responsibilities

10. Patient Family Teaching - ASA

11. Ibuprofen and Ibuprofen-like Agents Ibuprofen and Ibuprofen-like Agents Inhibit COX Weak acids, GI damage Weak acids, GI damage Analgesic Anti-inflammatory Antipyritic Analgesic Anti-inflammatory Antipyritic Nephrotoxic Bound to albumin metabolized by liver Bound to albumin metabolized by liver

12. Ibuprofen (Naproxen) Ibuprofen (Naproxen) NSAID Cat B & D NSAID Cat B & D Inhibits COX 1 & 2 Inhibits chemotaxis Decr. release of radicals Scavenger of radicals Inhibits COX 1 & 2 Inhibits chemotaxis Decr. release of radicals Scavenger of radicals RA- fever and pain Myalgia, HA, Dental pain Dysmenorrhea RA- fever and pain Myalgia, HA, Dental pain Dysmenorrhea HTN, GI Bld, DM, Impaired Renal or Hepatic Functions CHF, stroke, MI Kids with asthma HTN, GI Bld, DM, Impaired Renal or Hepatic Functions CHF, stroke, MI Kids with asthma Allergy PUD, bleeding abnl CABG Severe Hepatic Impair Allergy PUD, bleeding abnl CABG Severe Hepatic Impair Action Indications Contraindications Precautions

13. Ibuprofen Oral anticoagulants Digoxin, Lithium, Methotrexate NSAIDS, ETOH,Steroids Diuretic, BB, ACE Feverfew, garlic, Ginger, Ginko Oral anticoagulants Digoxin, Lithium, Methotrexate NSAIDS, ETOH,Steroids Diuretic, BB, ACE Feverfew, garlic, Ginger, Ginko Drug Interactions Adverse Effects Serious Adverse Effects

14. Ibuprofen-Nursing Responsibilities

15. Ibuprophen-Patient Education

17. 2 nd Gen. NSAID Preg Cat. C Anti-Inflammatory 2 nd Gen. NSAID Preg Cat. C Anti-Inflammatory *Mild to mod pain – RA OA, dysmenorrhea, dental, HA, ankylosing spondylitis *Prophylaxis of adenomas/polyps *Mild to mod pain – RA OA, dysmenorrhea, dental, HA, ankylosing spondylitis *Prophylaxis of adenomas/polyps *Hepatic Insuff. *Adv. Renal *Anemia *Post-op CABG *Hx GI bld or PUD *Hepatic Insuff. *Adv. Renal *Anemia *Post-op CABG *Hx GI bld or PUD *Poor CYP – metabolizers *Anticoagulants *Hx asthma, bone marrow suppression, VCA, PVD, elevate LFTs, CHF, KD *Poor CYP – metabolizers *Anticoagulants *Hx asthma, bone marrow suppression, VCA, PVD, elevate LFTs, CHF, KD Celebrex COX-2 Celebrex COX-2 Indications Precautions Contraindications

18. Celebrex COX-2 Celebrex COX-2 ~Oral Coagulation modifiers ~Lithium ~ETOH, Steroids, ASA, NSAIDs ~Diuretics or ACE ~Fluconazole ~Oral Coagulation modifiers ~Lithium ~ETOH, Steroids, ASA, NSAIDs ~Diuretics or ACE ~Fluconazole MI Stroke HTN Peripheral edema Renal Impair Hepatic Impair MI Stroke HTN Peripheral edema Renal Impair Hepatic Impair GI Neuro Derm U.Resp GI Neuro Derm U.Resp Drug Interactions Adverse Effects Serious A.E.

19. Celebrex – Nursing Responsibilities

20. Celebrex – Patient Teaching

21. Acetaminophen (Tylenol) Acetaminophen (Tylenol) Relieve pain and fever NO NSAID PROPERTIES Non-opiod analgesic Antipyretic Preg. Cat. B Relieve pain and fever NO NSAID PROPERTIES Non-opiod analgesic Antipyretic Preg. Cat. B ~Inhibits COX ~Inhibits chem. mediators ~Heat-regulation. ctr in hypothalmus ~Inhibits COX ~Inhibits chem. mediators ~Heat-regulation. ctr in hypothalmus Anemia G6PD deficiency Hepatic disease RA/OA Malnutrtion Bone marrow suppression Immunosuppression Anemia G6PD deficiency Hepatic disease RA/OA Malnutrtion Bone marrow suppression Immunosuppression Mild to mod. pain OA of hip/knee Dysmenorrhea Dental HA/myalgia Fevers Mild to mod. pain OA of hip/knee Dysmenorrhea Dental HA/myalgia Fevers Action Indications Precautions

22. Acetaminophen (Tylenol) Acetaminophen (Tylenol) ETOH Barbiturates, carbamazemine lamotrigine levels Warfarin Zidovudine Echinacea ETOH Barbiturates, carbamazemine lamotrigine levels Warfarin Zidovudine Echinacea Well Tolerated Hepatic Failure Poisoning Chronic use: Blood dyscrasias Hepatic Failure Poisoning Chronic use: Blood dyscrasias Drug Interactions Adverse Effects Serious Adverse Effects

23. Tylenol – Nursing Responsibilities

24. Tylenol – Patient Education