NSAIDS and Tylenol - Ravenwood-PA
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Transcript NSAIDS and Tylenol - Ravenwood-PA
NSAIDS & Tylenol
Jane E. Smith, MHSA, RN, C, ONC
Objectives
Review the pathophysiology of the inflammatory
response
Discuss the mechanism of action for non-steroidal
anti-inflammatory drugs and Tylenol
Discuss the indications, side effects, and nursing
implications related to NSAIDS and Tylenol
Identify key information to include in
patient/family education
NSAIDS and Tylenol
Pain Management
Causes
Primary
Infection
Pathogenesis
The ABC’s
Ask
Believe
Choose
Deliver
Empower
Follow-up
Wayne Heim/arthrw.jpg
Inflammatory Response
Triggers
Provoking Factors
Physical &
Chemical
Infectious Agents
Art from: MayoClinic.com
Evolution of Inflammation
Injury
Release of Kinins & Histamines
Vasoconstriction
Vasodilatation
Capillary Permeability
Swelling
Pain and Impaired Function
Tylenol
Properties
Indications
Dosage
Hepatotoxicity
NSAIDs – How do they work?
http://elfstrom.com/arthritis/NSAIDS/action.html
NSAIDs – Many Categories (COX-1)
Carboxylic acids
Acetylated salicylates
Nonacetylated
salicylates
Acetic acids
Propionic acids
Ibuprofen
Naproxen
Fenamates
Meclomen
Pyrazoles
Oxicams
Piroxicam (Feldene)
Cyclooxygenase (COX – 2) Inhibitors
Cox–1 and Cox–2 Drugs
Indications
Rheumatoid Arthritis
Osteoarthritis
Juvenile Arthritis
Dysmenorrhea
Fever
Cox–1 and Cox–2 Drugs
Contraindications
Angioedema
Syndrome of nasal
polyps
Bronchospasm reaction
to ASA or other
NSAIDs
Hypersensitivity
Cox–1 and Cox–2 Drugs
Drug to Drug Interactions
Antihypertensives, thiazide diuretics, lasix NSAIDs effectiveness of these meds
NSAIDs digoxin and lithium levels
Sun exposure – photosensitivity
Cox–1 and Cox–2 Drugs
Side Effects
Gastrointestinal bleeds
Hematologic changes- bleeding time,
various anemias (prolongs INR, BUN
& K+,
blood glucose levels)
Renal – acute renal failure
Cox–1 and Cox–2 Drugs
Patient/Family Education
Take medication
with food
No ASA
No ETOH
Use sunscreen
Efficacy of
Cyclooxygenase-2-Specific Inhibitors
COX-2 specific agents superior to placebo
and equivalent to conventional NSAIDs
COX-2 specific inhibitors offer advantages
over conventional NSAIDs on the basis of
decreased toxicity but not in terms of efficacy.
The role and guidelines for the use of COX-2
inhibitors should be based on toxicity and
other issues.
Cannon, G. W. & Breedveld, F. C. (2001) American Journal of Medicine
Costs of NSAIDS vs. Tylenol
McPhee, S. J., Pignone, M., & Schroeder, S.A. (2002)
Drug
Cost Per Unit
Cost Per 30 Days
ASA
$0.01/325 mg
$3.60
Tylenol
$0.01/325 mg
$3.60
Toradol
$0.93/10 mg
Not recommended for > 5 days
Motrin
$0.28/600 mg
$33.60
Naproxen
$1.16/500 mg
$104.40
Celebrex
$2.52/200 mg
$75.60 – OA
$151.20 - RA
Vioxx
$2.52/12.5 mg
$75.60 - OA
Key Points
NSAIDs are effective in the management of pain by
interrupting prostaglandin synthesis.
Tylenol is an effective medication in the
management of pain but it has no anti-inflammatory
action.
COX-1 and COX-2 Inhibitors have similar efficacy
in the management of pain.
NSAIDs have significant side effects and
patient/family teaching is an integral component of
the treatment plan.
Reference List
Boh, L. E. (1999). Osteoarthritis. In J.T. DiPiro, R.L. Talbert, G.C. Yee, G.R. Matzke, B.G.
Wells & L.M. Posey (Eds.). Pharmacotherapy: A pathophysiologic approach (4th ed.) (pp.
1441-1459). Stamford, CT: Appleton & Lange.
Cannon, G. W. & Breedveld, F. C. (2001, February). Efficacy of cyclooxygenase-2 –
specific inhibitors. American Journal of Medicine, 110, Suppl 3A. Retrieved from:
http://home.medconsult.com/das/article/body/1/jorg=journal&source=MI&sp=11895791.
Chyka, P. A. (1999). Clinical toxicology. In J.T. DiPiro, R.L. Talbert, G.C. Yee, G.R.
Matzke, B.G. Wells & L.M. Posey (Eds.). Pharmacotherapy: A pathophysiologic approach
(4th ed.) (pp. 70-90). Stamford, CT: Appleton & Lange.
Hellmann, D. B. & Stone, J. H. (2002). Arthritis & musculoskeletal disorders. In L. W.
Tierney, Jr., S. J. McPhee, & M. A. Papadakis (Eds.), Current medical diagnosis & treatment
(833-889). New York, NY: Lange Medical Books/McGraw-Hill.
McPhee, S. J., Pignone, M., & Schroeder, S. A. (2002). General approach to the patient ;
health maintenance & disease prevention; & common symptoms. In L. W. Tierney, Jr., S. J.
McPhee, & M. A. Papadakis (Eds.), Current medical diagnosis & treatment (1-31). New
York, NY: Lange Medical Books/McGraw-Hill.