Transcript Anti-inflammatory Agents

Chapter 12
Anti-inflammatory
Agents
Inflammation p 325
• Tissue response to injury
• Characterized by
– Vasodilation
– Increased capillary permeability to plasma
proteins
– Release of histamine
– Accumulation of leukocytes to the inflamed tissue
– Increased vascular permeability and leakage
• Erythema, warmth, swelling, tenderness
Agents used to treat inflammation
p326
• Nonsteroidal agents
• Steroidal agents
Nonsteroidal Anti-inflammatory Drugs p326
Table 12-1 p 327-330
• Salicylates
– Acetylsalicylic acid (ASA) (aspirin)
• Anti-inflammatory effect in large dosages
• Inhibits platelet aggregation
• Most common adverse effect: GI intolerance and GI
bleeding.
• NSAIDS:
– Celecoxib
– Diclofenac
– Etodolac
– Ibuprofen
– Naproxen
Uses of NSAIDs p330
• Relief of mild to moderate pain caused by
inflammation
– Bone, joint, and muscle pain
– Osteoarthritis
– Rheumatoid arthritis
– Dysmenorrhea
• Pt need to give NSAIDs a 2 week trial to
reach full therapeutic effect
Gastrointestinal Side Effects of NSAIDs
– Dyspepsia
– Heartburn
– Epigastric distress
– Nausea
– Gastrointestinal bleeding
– Mucosal lesions
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NSAIDs Contraindications
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•
•
•
Stomach ulcers
G I bleeding
Allergy to aspirin or sulfa
Pregnancy
Cardiovascular Side Effects of NSAIDs
p326,330
• Second-generation NSAIDs (Celebrex)
– Serious side effects:
• Cardiac arrhythmias
• Heart attack
• Stroke
Nursing Assessment NSAIDS
• Before beginning therapy, perform thorough
assessment for:
– Gastrointestinal lesions or peptic ulcer disease
– Bleeding disorders
– Heart disorders
Therapeutic Effects NSAIDs
• Monitor for and document:
– Decrease in swelling
– Decrease in pain
– Decrease in joint tenderness
Client Education NSAIDS
• Monitor for:
– Unusual bleeding, abdominal pain, and cardiac
problems
• Enteric-coated tablets should not be crushed or
chewed
• Administration with food, milk, or antacids will
reduce likelihood of GI upset
Corticosteroids p 344-345
• A&P review: adrenal cortex
hormones
– Anti-inflammatory
glucocorticoids: cortisol
– Salt-retaining
mineralocorticoids:
aldosterone
• Corticosteroid agents mimic
these adrenal hormones
and have both
glucocorticoid and
mineralocorticoid
properties
Corticosteroids p 335-339
• Systemic use
–
–
–
–
Dexamethasone
Methylprednisone
Prednisone
Triamcinolone
• Local injection
– Dexamethasone
– Hydrocortisone
– Prednisolone
• Topical use
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–
–
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Betamethasone
Dexamethasone
Fluticasone
Hydrocortisone
Mometasone
Topical Corticosteroids p333
• Treat local inflammatory disorders
– disorders of the skin
• dermatitis
• psoriasis
– Example: hydrocortisone cream
• Treat respiratory disease
– Asthma
– COPD
– Example: mometasone
Systemic Corticosteroids p333
Table 12-4 335-336
• Treat systemic inflammatory disorders
– Bronchial asthma not well treated with inhaled
corticosteroids
– Neoplastic diseases
– Autoimmune diseases
– Example of drug: prednisone
Systemic corticosteroids p334
• Suppress inflammatory
symptoms:
– Local heat, redness,
swelling, tenderness
• Adverse effects:
– Fluid retention
– elevated glucose levels
– altered fat deposition
– wasting of muscle tissue
in extremities
– immune system
suppression
Systemic corticosteroids p335
• Underlying cause of inflammation may remain and continue
to progress
• Masking potential
• Systemic corticosteroids may cause:
• gastric ulceration
• suppression of the hypothalmic/pituitary/adrenal system
• hypertension
• changes in body fat deposits
• Immune system suppression is a result of decreased
lymphocytes
Systemic corticosteroids p335
• Observe pt for therapeutic and adverse effects
• Routinely assess vital signs
• Pt that have been on corticosteroid meds must not abruptly
discontinue their medication.
– Physicians will taper off corticosteroid therapy.
– Abrupt discontinuation will result in adrenal insufficiency
with a hypotensive crisis.
• It may take up to 2 years for a pt body to be able to secrete
adequate adrenal hormones during times of stress. p348
Nursing considerations for pt on
corticosteroids p344
• Monitor for:
• GI bleeding
• Elevated blood glucose levels
• Weight gain
• Labile emotions
• Patients must carry identification and information about
their meds
• Dietary modifications:
• Sodium restriction,
• Increased calcium intake,
• Take corticosteroids early in the day to avoid insomnia
.
Nursing considerations cont.
• Teaching:
– Do not abruptly discontinue steroids
– S/S impending adrenal crisis
• Hypotension
• Restlessness
• weakness
• lethargy
• headache
• dehydration
• nausea
• vomiting
• diarrhea
.