Transcript Chapter 27
Chapter 25
ANTIINFLAMMATORY DRUGS
Antiinflammatory Drugs
Pathophysiology
Inflammation
Reaction to tissue injury
Caused by release of chemical mediators
Leads to a vascular response
Fluid and WBCs migrate to injured site
Chemical mediators
Histamines
Kinins
Prostaglandins
Antiinflammatory Drugs (cont’d)
Pathophysiology
Chemical mediators
Histamines
First mediator in inflammatory process
Cause dilation of arterioles
Increase capillary permeability
Kinins (Bradykinin)
Increase capillary permeability
Increase pain
Prostaglandins
Increase capillary permeability
Increase vasodilation
Increase pain and fever
Antiinflammatory Drugs (cont’d)
Pathophysiology
Cardinal signs of inflammation
Redness
Swelling
Heat
Pain
Loss of function
Antiinflammatory Drugs (cont’d)
Pathophysiology
Inflammation
Cyclo-oxygenase (COX) enzyme
Converts arachidonic acid into prostaglandins
Has two enzyme forms:
o COX-1: protects stomach lining and regulates blood platelets
o COX-2: triggers inflammation and pain
Antiinflammatory Drugs (cont’d)
Antiinflammatory drug groups
Nonsteroidal antiinflammatory drugs (NSAIDs)
Corticosteroids
Disease-modifying antirheumatic drugs
Antigout drugs
Antiinflammatory Drugs (cont’d)
NSAIDs
Inhibit biosynthesis of prostaglandins
Analgesic effect
Antipyretic effect
Inhibit platelet aggregation
Mimic effects of corticosteroids
NSAIDs
Action
Inhibit COX enzyme
Inhibit prostaglandin synthesis
Uses
Reduce inflammation and pain
Not recommended for fever or headaches
Except aspirin, ibuprofen
NSAIDs (cont’d)
First-generation NSAIDs
Salicylates (aspirin)
Parachlorobenzoic acid
Pyrazolone derivatives
Propionic acid derivatives
Fenamates
Oxicams
Phenylacetic acid derivatives
Second-generation NSAIDs
COX-2 inhibitors
Salicylates
Aspirin (acetylsalicylic acid) (ASA)
Action
Antiinflammatory, antiplatelet, antipyretic effects
Therapeutic serum salicylate level
10 to 30 mg/dl
Toxic serum salicylate level
Greater than 30 mg/dL
Salicylates (cont’d)
Drug-lab-food interactions
Drugs
Increased bleeding with anticoagulants
Hypoglycemia with oral antidiabetics
Increased gastric ulcer risk with glucocorticoids
Lab
Increase PT, bleeding time, INR, uric acid
Decrease potassium, cholesterol, T3 and T4 levels
Foods containing salicylates
Prunes, raisins, licorice, certain spices
Salicylates (cont’d)
Aspirin
Caution
Do not take with other NSAIDs.
Avoid during third trimester of pregnancy.
Do not give to children with flu or virus symptoms (Reye’s
sydrome).
Side effects/adverse reactions
Tinnitus, hearing loss
Dizziness, confusion, drowsiness
GI distress, peptic ulcer
Thrombocytopenia, leukopenia, agranulocytosis
Hepatotoxicity
Salicylates (cont’d)
Hypersensitivity
Tinnitus, dizziness, bronchospasm
Salicylism (mild)
Tinnitus, dizziness, headache, confusion, sweating,
drowsiness, thirst, nausea, vomiting, diarrhea
Severe salicylate poisoning
Convulsions, cardiovascular collapse, coma
Propionic Acid Derivatives
Ibuprofen (Motrin, Advil)
Nonselective COX inhibitors
Drug interactions
Increased bleeding with warfarin, increased effects with phenytoin,
sulfonamides, warfarin
Decreased effect with aspirin
Side effects
Gastric distress (to be taken with food)
Tinnitus, dizziness, confusion, edema
Blood dyscrasias, dysrhythmias, nephrotoxicity
Other propionic acid drugs
Naproxen (Naprosyn)
Oxaprozin (Daypro)
COX-2 Inhibitors
Action
Selectively inhibits COX-2 enzyme without inhibition of
COX-1
Use
Decrease inflammation and pain
Drug agents
Celecoxib
Similar agents
Nabumetone (Relafen), meloxicam (Mobic)
Some COX-1 inhibition
COX-2 Inhibitors (cont’d)
Caution
Avoid during third trimester of pregnancy.
Side effects
Headache, dizziness, sinusitis
GI distress
Peripheral edema
NSAIDs in older adults
Greater incidence of GI distress, ulceration
Reduced dose decreases risk of side effects
Disease-Modifying Antirheumatic
Drugs
Gold drug therapy (chrysotherapy)
Immunosuppressive agents
Immunomodulators
Antimalarials
Disease-Modifying Antirheumatic
Drugs (cont’d)
Gold drug therapy
Auranofin (Ridaura)
Action
Decreases leukocytes migration.
Suppresses prostaglandin synthesis.
Stops progression of joint degeneration.
Use
Rheumatoid arthritis
Disease-Modifying Antirheumatic
Drugs (cont’d)
Gold drug therapy
Side effects/adverse reactions
Photosensitivity, corneal gold deposits
Stomatitis, metallic taste
Bradycardia, profound hypotension
GI distress, severe rash
Hematuria, proteinuria
Nephrotoxicity, agranulocytosis, thrombocytopenia
Contraindications
Severe renal or hepatic disease
Pregnancy, blood dyscrasias, colitis
Systemic lupus erythematosus
Immunomodulators
Tumor necrosis factor (TNF) blockers
Entanercept (Enbrel)
Infliximab (Remicade)
Adalimumab (Humira)
Anakinra (Kineret)
Abatacept (Orencia)
Action
Neutralize TNF
Disrupt inflammatory process
Delay disease progression
Used for rheumatoid arthritis
Immunomodulators (cont’d)
Infliximab (Remicade)
Side effects/adverse reactions
Headache, dizziness, depression
Chills, hot flashes
Hypotension, hypertension
GI distress
Urinary frequency
Altered liver enzymes
Severe infections
Contraindications
Renal or hepatic disease
Immunosuppression, infection
Antigout Drugs
Gout pathophysiology
Inflammatory disease of joints, tendons
Usually occurs in great toe
Defect in purine metabolism leads to uric acid
accumulation
Purine-containing foods: salmon, liver, sardines
Antigout drugs
Colchicine
Uric acid inhibitors
Uricosurics
Antigout Drugs (cont’d)
Colchicine
Inhibit migration of leukocytes to inflamed site
Side effects
GI distress
Taken with food to avoid GI distress
Contraindications
Severe renal, cardiac, or GI problem
Antigout Drugs (cont’d)
Uric acid inhibitors
Allopurinol (Zyloprim)
Action
Decreases production of uric acid
Prophylactic to prevent gout attacks
Nursing Interventions
Monitor CBC, liver enzymes, renal function.
Tell client to get yearly eye examinations for visual changes.
Advise client to avoid alcohol, caffeine, and thiazide diuretics that
increase uric acid level.
Advise client to increase fluid intake to increase uric acid excretion.
Antigout Drugs (cont’d)
Uricosurics
Probenecid (Benemid)
Action
Increases uric acid excretion by blocking reabsorption of uric acid
Side effects
Gastric irritation; client should take with food.
Nursing Interventions
It is not to be given with other highly protein-bound drugs.
Client should increase fluid intake to increase uric acid excretion.
Case Study
A client with gout is prescribed the antiinflammatory
drug colchicine.
Critical Thinking
1. Compare the action of colchicine with that of uric acid
inhibitors and uricosurics.
2. In what case would colchicine be contraindicated?
Practice Question #1
Which teaching does the nurse realize would have
the highest priority for the client with gout who is
taking colchicine?
A.
B.
C.
D.
Increase vitamin C.
Avoid alcohol and caffeine.
Increase foods high in purine.
Take colchicine 2 hours before meals.
Practice Question #1 (cont’d)
Answer: B
Rationale: Alcohol and caffeine are to be avoided because
they may increase uric acid levels.
Vitamin C should not be taken in large doses because it may
promote kidney stone formation. Purine foods increase uric
acid levels and should be avoided. Antigout medications,
especially colchicine, should be taken with food or at
mealtime.
Practice Question #2
A client has been advised to take ibuprofen (Motrin). Which topic
should the nurse teach the client about Motrin? (Select all that
apply.)
A. Tell client to avoid taking aspirin with Motrin.
B. Advise client to take with food to reduce GI upset.
C. Monitor for bleeding gums, nosebleeds, black tarry stools.
D. Encourage client to take herbs, such as ginkgo and garlic, with Motrin.
E. Advise female clients to take NSAIDs 2 days before menstruation to
decrease discomfort.
Practice Question #2 (cont’d)
Answer: A, B, C
Rationale: One should avoid aspirin with NSAIDs. Food may be
taken with NSAIDs to reduce GI upset. Clients should be taught to
monitor for bruising and bleeding. Many herbs, such as ginkgo,
garlic, and ginger should be avoided because bleeding may increase.
Female clients should avoid NSAIDs for 1 to 2 days before menses to
prevent excessive bleeding.