1. Chapter 12 Anti-inflammatory Agents

2. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 2 Nonsteroidal Anti-inflammatory Drugs Group of frequently prescribed drugs Treat pain Common drug  Acetylsalicylic acid (ASA)  Hermann Kolbe

3. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 3 Uses for NSAIDs Analgesic (mild to moderate) Antigout Anti-inflammatory Antipyretic Relief of vascular headaches Platelet inhibition

4. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 4 How NSAIDs Work Stop the activation of the arachidonic acid pathway Reduce:  Pain  Headache  Fever  Inflammation

5. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 5 Analgesics Reduce pain by blocking prostaglandins

6. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 6 Antipyretics Inhibit prostaglandin E 2 in the brain

7. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 7 Inflammation Relief Inhibit either the:  Leukotriene pathway  Prostaglandin pathway  Or both pathways

8. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 8 Pain Relief Relief of mild to moderate pain  Bone, joint, and muscle pain  Osteoarthritis  Rheumatoid arthritis  Juvenile rheumatoid arthritis  Dysmenorrhea

9. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 9 Common NSAIDs Common drugs that are used:  Ibuprofen (Motrin, Advil)  Ketoprofen (Orudis)  Ketorolac (Toradol)  Naproxen (Naprosyn)

10. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 10 Gastrointestinal Side Effects First-generation NSAIDs  Dyspepsia, heartburn, epigastric distress, nausea  Gastrointestinal bleeding  Mucosal lesions (erosions or ulcerations) (continues)

11. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 11 Gastrointestinal Side Effects Second-generation NSAIDs  Called COX-2 inhibitors  More specific in their action  Reduce gastrointestinal distress (continued)

12. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 12 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

13. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 13 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

14. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 14 Renal Side Effects Creatinine clearance reduced Renal failure  Acute tubular necrosis

15. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 15 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

16. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 16 Medical History Medication history Serious drug interactions  Alcohol  Heparin and warfarin (Coumadin)  Phenytoin  Steroids  Sulfonamides

17. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 17 Salicylates Do not give salicylates to children under age 12.  Reye’s syndrome Give with food and milk.

18. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 18 Client Education Educate clients about precautions. Watch for:  Unusual bleeding, abdominal pain, and cardiac problems Enteric-coated tablets should not be crushed or chewed.

19. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 12 - 19 Therapeutic Effects Monitor for:  Decrease in swelling  Decrease in pain  Decrease in joint tenderness