Chapter 12 Antiinflammatory Agents Nonsteroidal Antiinflammatory Drugs Group

Nonsteroidal Anti-inflammatory Drugs Group of frequently prescribed drugs Treat pain Common drug l l

Uses for NSAIDs Analgesic (mild to moderate) Antigout Anti-inflammatory Antipyretic Relief of vascular headaches

How NSAIDs Work Stop the activation of the arachidonic acid pathway Reduce: l l

Analgesics Reduce pain by blocking prostaglandins l 5 Copyright 2007 Thomson Delmar Learning, a

Antipyretics Inhibit prostaglandin E 2 in the brain l 6 Copyright 2007 Thomson Delmar

Inflammation Relief Inhibit either the: l £ £ £ Leukotriene pathway Prostaglandin pathway Or

Pain Relief of mild to moderate pain l £ £ £ Bone, joint, and

Common NSAIDs Common drugs that are used: l £ £ Ibuprofen (Motrin, Advil) Ketoprofen

Gastrointestinal Side Effects First-generation NSAIDs l £ £ £ 10 Dyspepsia, heartburn, epigastric distress,

(continued) Gastrointestinal Side Effects Second-generation NSAIDs l £ Called COX-2 inhibitors u u More

Cardiovascular Side Effects Second-generation NSAIDs l £ Serious side effects: u u u £

Precautions First and second generation l £ Do not take if you: u u

Renal Side Effects Creatinine clearance reduced Renal failure l l £ Acute tubular necrosis

Nursing Assessment Before beginning therapy, perform thorough assessment for: l £ £ Gastrointestinal lesions

Medical History l l Medication history Serious drug interactions £ £ £ Alcohol Heparin

Salicylates Do not give salicylates to children under age 12. l £ Reye’s syndrome

Client Education Educate clients about precautions. Watch for: l l £ Unusual bleeding, abdominal

Therapeutic Effects Monitor for: l £ £ £ Decrease in swelling Decrease in pain

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Chapter 12 Anti-inflammatory Agents

Nonsteroidal Anti-inflammatory Drugs Group of frequently prescribed drugs Treat pain Common drug l l l £ £ Acetylsalicylic acid (ASA) Hermann Kolbe 2 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 l l l 3 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: l l £ £ Pain Headache Fever Inflammation 4 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

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

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

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

Gastrointestinal Side Effects First-generation NSAIDs l £ £ £ 10 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.

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

Cardiovascular Side Effects Second-generation NSAIDs l £ Serious side effects: u u u £ £ Cardiac arrhythmias Heart attack Stroke Celecoxib (Celebrex) may be removed Rofecoxib (Vioxx) removed from market by the FDA 12 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Precautions First and second generation l £ Do not take if you: u u u 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 13 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Nursing Assessment Before beginning therapy, perform thorough assessment for: l £ £ Gastrointestinal lesions or peptic ulcer disease Bleeding disorders Heart disorders Perform lab studies u CBC, platelet count, cardiac, renal, and liver 15 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

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

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

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

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