ANTI – INFLAMMATORY DRUGS

INFLAMMATION – is a reaction to tissue injury caused by the release of chemical mediators that cause both vascular response and the migration of fluids and cells to the injured site.

INFLAMMATION – the process of protective mechanism in which the body attempts to neutralize and destroy harmful agents at the site of tissue injury and establish condition for tissue repair.

CHEMICAL MEDIATORS Histamine – dilates arterioles, increase

capillary permeability allowing fluid to leave the capillary and flow to the injured area.

Kinins – dilate the arterioles and increase capillary permeability

Prostaglandin – cause vasodilation, increase capillary permeability, pain and fever

Anti – inflammatory Agent – drugs that inhibit the biosynthesis of prostaglandin are called PROSTAGLANDIN INHIBITORS

NSAID

Are aspirin and aspirin like drugs that inhibit the enzyme COX which is needed for the synthesis of prostaglandin.

There are 8 groups of NSAIDS

1. Salicylates related to aspirin2. Parachlorobenzoic Acid derivatives or

indoles3. Pyrazolone Derivatives4. Propionic Acid Derivatives5. Fenamates6. Oxicams7. Phenylacetic Acid8. Selective Cox 2 inhibitors

1. ASPIRIN 4 A’s – anti inflammatory

analgesic antipyretic anticoagulant

Adverse ReactionGI: nausea, vomiting, G.I. distress, occult bleeding, G.I. bleedingEENT: Tinnitus, hearing lossHEMA: prolonged bleeding time, Thrombocytopenia

2. Para chlorobenzoic Acid Derivatives or IndolesIndomethacin (Indocin)Therapeutic Effect – relieves pain, fever and inflammationIndications – rheumatoid arthritis, gouty arthritisDysmennorhea, PDADosage: 25 – 50 mg/ capOral susp. 25mg/5mlSuppositories: 50 mg

Injection: 100 mg vialSide effects: GI: ANVD, and abdominal painCNS: headache, dizziness, and vertigoHypersensitivity rxn. UrticariaNursing Implication: 1. If G.I. upset occurs, give oral form of drugs with food, milk, or antacid.2. If patient has bleeding, stop giving the medication and notify the physician

3. Instruct patient not to drink alcohol during therapy.

3. Pyrazolone DerivativesPhenylbutazone (butazolidin)Indications: Rheumatoid arthritis

Acute goutAdverse Effect: blood dyscrasia such as agranulocytosis, and aplastic anemia

4. Propionic Acid GroupThese are aspirin like but have stronger effects and create less GI irritation.

Ibuprofen (advil)Naproxen (naprosyn)Suprofen (profenal)Ketoprofen (Orudis)Therapeutic Effect: relieves pain, fever, and inflammationSide Effect: CNS: headache, drowsiness, dizzinessEENT: visual disturbance, tinnitusGI: epigastric distress, nausea, occult bloodHEMA: prolonged bleeding time

Nursing Implication1. Give with meals or with milk to reduce adverse GI reactions.2. Serious GI toxicity, including peptic ulceration and bleeding despite absence of GI symptoms.3. Instruct patient not to drink alcohol during therapy.5. Fenamates – includes potent NSAIDS used for acute and chronic arthritic conditions Meclofenamate Na monohydrate (meclomen)Mefenamic Acid (Ponstan)

Side Effects: Gastric irritationClients with peptic ulcer should not take this drugs.6. Oxicams – for long term treatment of arthritic conditions such as rheumatoid arthritis and osteoarthritis Piroxicam (feldene)7. Phenylacetic acid derivativesanalgesic and anti – inflammatory effects are similar to those of aspirin but it has minimal or no antipyretic effectDiclofenac Na (voltaren)Ketorolac (toradol)

8. Selective Cox 2 inhibitorTherapeutic effect: relieves pain and inflammation of joints and smooth muscle tissue.Celecoxib (celebrex)Rofecoxib (vioxx)

CORTICOSTERIODS

Steroidal agents or corticosteroids are most commonly used treatment of local inflammation disorders such as those affecting skin.For systemic inflammatory disorder that require a potent and aggressive therapy for control

Betamethasone (celestone)Cortisone (cortone)hydrocortisone (solu cortef)Methylprednisolone (medrol)

Anti gout drugs Gout – an inflammatory conditin that attacks

joints, tendons, and other tissues. It is characterized by uric acid metabolism disorder and a defect in PURINE metabolism resulting in increase in urates and accumulation of uric acid or an ineffective clearance of uric acid by the kidneys.

Anti inflammatory Gout drugsColchicine – used to inhibit the migration of leukocytes to the inflamed siteUric Acid Inhibitor Allopurinol (Zyloprim)Not an anti inflammatory drug instead it inhibits the final steps of uric acid biosynthesis and lowers uric acid levelUricosuricsProbenicid (Benemid)

Increase the rate nor uric acid excretion by inhibiting the reabsorption