Transcript Chapter_022--ppt-Intro-to-Cl-Phar-6th-ed

Chapter 22
Antiinflammatory, Musculoskeletal, and
Antiarthritis Medications
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Chapter 22
Lesson 22.1
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Learning Objectives
• List medications commonly used for the
treatment of minor musculoskeletal pain
and inflammation
• Compare the actions of various
antiinflammatory and muscle relaxant
agents
• Identify the appropriate use for
musculoskeletal relaxants
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Muscular and Skeletal
Systems
• Bones, joints, muscles, and ligaments
• Antiinflammatory and analgesic drugs
• Skeletal muscle relaxants
• Drugs used to treat arthritis
• Drugs used to treat gout
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The Skeletal System
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The Muscular System
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The Muscular System
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The Inflammatory Response
• Triggers to inflammation
• Phases of the inflammatory response
• Symptoms of inflammation
• Cellular response
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Antiinflammatory and
Analgesic Agents
• Aspirin: acetylsalicylic acid (ASA)
• Acetaminophen
• NSAIDs
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Salicylates
Action
• Analgesic, antipyretic, and antiinflammatory effects
• Stop the production of prostaglandins
• Table 22-1
Uses
• Treatment of mild to moderate pain; reduces the risk of myocardial
infarctions and stroke, as well as transient ischemic attacks (TIAs) in
men
• First-line therapy for various forms of arthritis, fever, myalgia,
neuralgia, arthralgia, headache, and dysmenorrhea
• Systemic lupus erythematosus, acute rheumatic fever
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Salicylates (cont.)
Adverse Reactions
• Tinnitus, visual disturbances, edema, urticaria,
anorexia, epigastric discomfort, and nausea
Drug Interactions
• Alcohol use increases the chance for GI
bleeding; NSAIDs; sulfonamides, sulfonylureas;
phenytoin
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Salicylates (cont.)
Nursing Implications
• Assessment, diagnosis, planning,
implementation, and evaluation
Patient Teaching
• Administration time, adverse effects; time for
drug effectiveness; implications for drug
interactions and when to contact the
healthcare provider; storage and safety; other
routes of administration if PO is not tolerated
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Acetaminophen
• Over-the-counter drug used to treat fever and
pain; no antiinflammatory effect
• Action: antipyretic – direct action of the
hypothalamic heat-regulating center; blocks
pyogenic cytokines through vasodilation and
sweating
• Use: chronic, nonmalignant pain; osteoarthritis
• Adverse reactions: rare blood response; liver
toxicity; overdosage can be fatal
• Drug interactions and hepatotoxicity
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Nonsteroidal Antiinflammatory
Drugs
• Action: unknown; may block prostaglandins;
analgesic, antiinflammatory, and antipyretic
effects
• Uses: rheumatic disease, degenerative joint
disease, osteoarthritis, and acute
musculoskeletal problems
• Adverse reactions: GI most common
• Drug interactions
• Nursing implications and patient teaching
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Skeletal Muscle Relaxants
• Action: reduce muscle tone and involuntary
movement without loss of voluntary motor
function
– Centrally acting or direct myotropic blocking
• Uses: relief of pain in musculoskeletal and
neurologic disorders involving peripheral injury
and inflammation; relief of spasticity in chronic
conditions
• Table 22-2
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Skeletal Muscle Relaxants (cont.)
• Adverse reactions: symptoms
• Drug interactions: sedatives, narcotic
analgesics, antianxiety agents,
hypnotics, alcohol, general anesthetics,
MAOIs, and tricyclics
– Cyclobenzaprine and orphenadrine:
anticholinergic effects that interfere with
antihypertensive activity of alphaadrenergic blockers
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Skeletal Muscle Relaxants (cont.)
• Nursing implications: assessment,
diagnosis, planning, implementation, and
evaluation
• Patient and family teaching: administration
considerations; avoiding activities requiring
alertness; drug interactions; missed
dosages; when to contact the health care
provider; HS administration; storage and
safety
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Chapter 22
Lesson 22.2
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Learning Objectives
• Explain the mechanisms of action for
different antiarthritis medications
• Describe adverse reactions often found
in the use of antiarthritis medications
• Describe the clinical situations in which
uricosuric therapy may be indicated
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Antiarthritis Medications
• Inflammation of the joints
• Rheumatoid arthritis: autoimmune
response
• Osteoarthritis: local joint destruction of
weight-bearing joints
• Symptoms
• Complementary and Alternative
Therapies
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Slow-Acting
Antirheumatic Drugs
SAARDs
•
•
•
•
Gold Compounds
Hydroxychloroquine sulfate
Penicillamine
Methotrexate
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Gold Compounds
• Chrysotherapy
• Action: unknown; interference with biochemical
reactions at the cellular level; inhibit lysosomal
enzyme activity; effect on antigen response in
rheumatoid arthritis; stops synovitis
• Adverse reactions and toxicities
• Dosage and administration
• Forms of medication
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Hydroxychloroquine Sulfate
• Action: unknown; antimalarial drug; acts
to stop antigen formation in the body
• Uses
• Adverse reactions
• Drug effectiveness
• Drug interactions
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Infliximab
• Action/Use: in combination with
methotrexate to reduce signs and
symptoms of rheumatoid arthritis,
Crohn’s disease, other orthopedic
inflammatory or destructive processes
• Adverse reactions: FDA warning;
symptoms
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Leflunomide
• Action: pyrimidine synthesis inhibitor
that has an antiinflammatory effect
• Use: adults with rheumatoid arthritis
– Therapy: initial and maintenance
• Adverse reactions: FDA warning label
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Methotrexate
• Action: unknown, may affect the
immune function to reduce inflammation
• Uses: treatment of cancer and
rheumatoid arthritis
• Toxicities
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Penicillamine
• Action: chelating agent
• Use: rheumatoid arthritis
• Nursing implications: assessment, diagnosis,
planning, implementation, evaluation
• Patient and family teaching: treatment
length/drug effectiveness; toxic effects; when to
contact healthcare provider; monitoring; brief
pain increase following injection; adverse
reactions
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Antigout Medications
•
•
•
•
•
Uric acid
Uric acid levels; crystal formation
Symptoms
Gouty arthritis
Relief of pain and inflammation – acute
period
• Uricosuric agents
• Table 22-4
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Uricosuric Agents
• Action: increase excretion of urate salts
in the urine by blocking tubular
reabsorption of these salts in the
kidney; decrease amounts of circulating
urate and deposition of urate; promote
reabsorption of urate deposits
• Uses: reduce uric acid levels in patients
who do not excrete enough uric acid
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Uricosuric Agents (cont.)
• Adverse reactions: drug-specific
symptoms
• Drug interactions
– Salicylates
– Increased drug effects
– Acidifying and alkalinizing agents
– Anticoagulants
– Hypersensitivity reactions
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Uricosuric Agents (cont.)
• Nursing implications: assessment,
diagnosis, planning, implementation,
evaluation
• Patient and family teaching: preventing
attacks; drug administration; diet and fluid
intake; self-monitoring of urine and stools;
when to contact the health care provider;
colchicine administration; drug interactions
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