Anti Inflammatory Drugs

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Anti-inflammatory Drugs

• PathophysiologyInflammation

• 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

Inflammation

Chemical mediatorsHistamine

Kinins

Prostaglandins

Inflammation

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PathophysiologyCardinal signs of inflammation

Cyclooxygenase (COX) enzymeConverts arachidonic acid into

prostaglandinsHas two enzyme forms:COX-1: protects stomach lining and

regulates blood plateletsCOX-2: triggers inflammation and pain

Inflammation (Cont.)

• Anti-inflammatory drug groupsNonsteroidal anti-inflammatory drugs (NSAIDs)CorticosteroidsDisease-modifying antirheumatic drugsAntigout drugs

• NSAIDsInhibit biosynthesis of prostaglandinsAnalgesic effectAntipyretic effectInhibit platelet aggregationMimic effects of corticosteroids

Antiinflammatory Drugs

•ActionInhibit COX enzymeInhibit prostaglandin synthesis

•UsesReduce inflammation and painNot recommended for fever or

headaches• Except aspirin, ibuprofen

NSAIDs

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•First-generation NSAIDsSalicylates Parachlorobenzoic acid

IndomethacinPhenylacetic acidsPropionic acid derivatives

IbuprofenFenamatesOxicams

•Second-generation NSAIDsCOX-2 inhibitors

NSAIDs (Cont.)

•Aspirin (acetylsalicylic acid) (ASA)Action

• Antiinflammatory, • antiplatelet, • antipyretic effects

Therapeutic serum salicylate level• 15 to 30 mg/dL

Toxic serum salicylate level• Greater than 30 mg/dL

Salicylates

•Drug-lab-food interactionsDrugs

• Increased bleeding with anticoagulants• Hypoglycemia with oral antidiabetics• Increased gastric ulcer risk with

glucocorticoidsLab

• Increase PT, bleeding time, INR, uric acid• Decrease potassium, cholesterol, T3 and T4

levelsFoods containing salicylates

• Prunes, raisins, licorice, certain spices

Salicylates (Cont.)

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•Aspirin•Cautions•Side effects•Hypersensitivity•Salicylism (mild)•Severe salicylate poisoning

Salicylates (Cont.)

•Assessment•Nursing diagnosis•Planning•Nursing interventionsPatient teachingCultural considerations

•Evaluation

Nursing Process: Salicylates

Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

• Ibuprofen• 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, edemaBlood dyscrasias, dysrhythmias, nephrotoxicity

Propionic Acid Derivatives (Cont.)

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• Assessment• Nursing diagnoses• Planning• Nursing interventions

Patient teachingCultural considerations

• Evaluation

Nursing Process: Ibuprofen


• ActionSelectively inhibits COX-2 enzyme without inhibition of

COX-1• Use

Decrease inflammation and pain• Drug agents

Celecoxib• Similar agents

Nabumetone (Relafen)

Selective COX-2 Inhibitors


• CautionAvoid during third trimester of pregnancy.

• Side effectsHeadache, dizziness, sinusitisGI distressPeripheral edema

• NSAIDs in older adultsGreater incidence of GI distress, ulcerationReduced dose decreases risk of side effects.

Selective COX-2 Inhibitors (Cont.)

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• Prednisone, prednisolone, dexamethasone • Control inflammation by suppressing or preventing

many of the components of the inflammatory process at the injured site

• Not the drug of choice for arthritis because of their numerous side effects

• Frequently used to control arthritic flare-ups• Taper off

Corticosteroids


• Immunosuppressive agents• Immunomodulators• Antimalarials

Disease-Modifying Antirheumatic Drugs


• Gout pathophysiologyInflammatory disease of joints, tendons, and other

tissuesUsually occurs in great toeDefect in purine metabolism leads to uric acid

accumulation.• Purine-containing foods: organ meats, sardines, salmon, gravy,

herring, liver, meat soups, and alcohol (especially beer)

Gout

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• ColchicineInhibit migration of leukocytes to inflamed siteSide effects

• GI distressTaken with food to avoid GI distressContraindications

• Severe renal, cardiac, or GI problem

Antigout Drugs


• Uric acid inhibitorsAllopurinol (Zyloprim)Action

• Decreases production of uric acid • Prophylactic to prevent gout attacks

Nursing interventions• Monitor CBC, liver enzymes, renal function.• Tell patient to get yearly eye examinations for visual changes.• Advise patient to avoid alcohol, caffeine, and thiazide diuretics

that increase uric acid level.• Advise patient to increase fluid intake to increase uric acid

excretion.

Antigout Drugs (Cont.)


• Assessment • Nursing diagnoses• Planning• Nursing interventions

Patient teachingCultural considerations

• Evaluation

Nursing Process: Allopurinol

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• UricosuricsProbenecid (Benemid)Sulfinpyrazone (Anturane)Action

• Increase uric acid excretion by blocking reabsorption of uric acid

Side effects• Gastric irritation; patient should take with food.

Nursing interventions• Use caution when giving with other highly protein-bound

drugs.• Patient should increase fluid intake to increase uric acid

excretion.

Antigout Drugs (Cont.)


A 35-year-old woman diagnosed with rheumatoid arthritis has been prescribed infliximab (Remicade). The nurse identifies infliximab as which type of medication?

A. ImmunosuppressiveB. ImmunomodulatorC. AntimalarialD. Steroid

Case Study


The nurse identifies Infliximab (Remicade) as useful in the treatment of rheumatoid arthritis as well as

A. Crohn’s disease.

B. asthma.

C. peptic ulcer disease.

D. multiple sclerosis.

Case Study

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The patient asks the nurse how the infliximab(Remicade) will be administered. The nurse should respond that this medication is administered

A. orally.

B. subcutaneously.

C. intramuscularly.

D. intravenously.

Case Study


A patient with gout is prescribed colchicine. It is most important for the nurse to give which instruction to the patient?

A. Increase vitamin C intake.

B. Avoid alcohol and caffeine.

C. Increase foods high in purines.

D. Take colchicine 2 hours before meals.

Practice Question #1


A patient has been advised to take ibuprofen (Motrin). When teaching the patient about Motrin, which instruction should the nurse include? (Select all that apply.)

A. Avoid taking aspirin with Motrin.

B. Take with food to reduce GI upset.

C. Monitor for bleeding gums, nosebleeds, black tarry stools.

D. Take herbs, such as ginkgo and garlic, with Motrin.

E. Take NSAIDs 2 days before menstruation to decrease discomfort.


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An older adult patient takes tolmetin (Tolectin) for arthritis pain. Which statement made by the patient is of most concern to the nurse?

A. “I feel like I am coming down with a cold.”

B. “My stomach aches and burns.”

C. “I have a bad headache.”

D. “I feel dizzy when I get up fast.”



A patient is ordered to receive low-dose aspirin (ASA) to prevent a heart attack. Which assessment, if found in the patient, is the highest priority for the nurse?

A. Otitis externa

B. Multiple bruises

C. Dry mouth

D. Aches in the joints



A 65-year-old man has been diagnosed with chronic gout. The nurse anticipates that the patient will be treated with

A. allopurinol (Zyloprim).

B. colchicine.

C. adalimumab (Humira).

D. infliximab (Remicade).

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Which herb is associated with the development of bleeding if taken with nonsteroidalantiinflammatory drugs?

A. Garlic

B. Echinacea

C. St. John’s wort

D. Cinnamon

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Anti Inflammatory Drugs