nsaid Immuno Vaccines

8/7/2019 nsaid Immuno Vaccines

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PAINWhen tissue damage occurs, injured cells release chemicalmediators, such as bradykinin, serotonin and prostaglandin, thataffects the exposed nerve endings of nocireceptor.

Classification of Pain are:

1. Acute Pain

2. Cancer Pain

3. Chronic Pain

4. Somatic Pain5. Superficial Pain

6. Vascular Pain

7. Visceral Pain


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Non Narcotic AnalgesicyAspirin

yAcetaminopen

y Ibufropeny Naproxen

* use to treat mild to moderate pain

* may be purchased over the counter


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SalicylatesyAspirin comes from the family of salicylates

derived from salicylic acidy

Also called ASA (acetylsalicylic acid)y Developed in 1899 by Adolph BayeryAlso called Prostaglandin inhibitoryAnti-platelet drugy

Should not be taken with other NSAIDs because itdecreases blood level and effectiveness of NSAIDsyAspirin inhibits COX-1 and COX-2y Never use in children below 12 years old


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Side effect and adverse

reactiony Gastric irritation

y Should be taken with food or full glass of fluid


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Acetaminopheny For infants children and adults

y Not NSAID

y Safe and effective analgesic and antipyretic drugs usedfor muscular aches and pain and for fever caused by

viral infection.

y Large dose can be toxic to the hepatic cells

y It weakly inhibits prostaglandin synthesis, whichdecrease pain sensation.


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NARCOTIC ANALGESICy Narcotic agonist, are prescribed for moderate and

severe pain.

y Opium was used as early as 350BC to relieved painyActs mostly on CNS, while Non narcotic acts in the

Peripheral Nervous system.

y Morphine and Codeine are derivatives of opiod


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MorphineyA potent narcotic analgesic effective against acute pain

resulting from AMI.

y May also be used as pre operative medicationy Can cause respiratory depression, orthostatic

hypertension, urinary retention, constipation.

yAntidote is Naxolone(Narcar) narcotic antagonist


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y Narcotic antagonist must be available whenadministering morphine IV


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Meperidiney Synthetic Narcotic

y Prepared during pregnancy because iit does not

diminished uterine contractions and cause lessneonatal respiratory depression.

y Not indicated for clients with chronic pain, severe liverdysfuction, sickle cell disease, history of seisure,

Coronary Artery Disease and Cardiac Dysrythmia.y Not prescribed for long term.


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NursingManagementSome can cause allergic reaction

Store at room temperature and protect it from light band

freezingNote that meperedine is incompatible with

aminophylline, heparin, phenobarbital, phenytoin,and Sodium Bicarbonates


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NalbuphineyA narcotic agonist and antagonist

y Effective in alleviating moderate to severe pain.

y Side effect- dizziness, confusion, hallicination, blurredvision, headache, depression

yAdverse effect Bradycardia, tachycardia

y Life threatening respiratory depression


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ANTIINFLAMMATORY AGENTy Inflammation is a response to tissue injury and

infection. When the inflammation process occurs, a

vascular reaction takes place in which fluids, elementsof blood , leukocytes and chemical , mediatorsaccumulate at the injured tissue on infection sites.

y The process of inflammation is a protective

mechanism


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Cardinal Sign of Inflammation1. Redness

2. Swelling

3. Heat4. Pain

5. Loss of Function


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Non-Steroidal Anti-inflammatory DrugsI. Salicylates

II. Para- ChlorobenzoicAcid Derivatives

III. Phenylacetic Acids

IV. Propionic acidDerivatives

V. FenamatesVI.Oxicams

VII.Selective COX-2Inhibitors


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Parachlorbenzoic Acidy Used for the treatment of Rheumatoid Arthritis,Gouty Arthritis and Osteoarthritis

y Highly protein bound 90%

y

This group of NSAIDs may cause sodium andwater retention as well as increased blood pressure

y indomethacin, sulindac, tolmetin


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Phenylacetic Acid Derivatives

y Used for the treatment of Rheumatoid Arthritis,Osteoarthritis, Ankylosing Spondylitis

y diclofenac sodium (Voltaren)

y ketorolac- first injectible NSAID-short termmanagement of pain


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Propionic Acid Derivatives

y New group of NSAIDs

yAspirin-like but have stronger effects and lessGI irritation

y Better tolerated than other NSAIDsy ibupfropen (Motrin) is the most widely used

NSAIDs which can be purchased OTC.

y ketoprofen (Orodis)


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Fenamates

y Includes potent NSAIDs used for acute andchronic arthritic conditions

y mefenamic Acid

y

meclofen-amate sodium monohydrate(Meclomen)


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Oxicams

y Indicated for long-term arthritic condition

y Longer half-life

y piroxicam (Feldene)


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Selective COX-2 Inhibitors

y Drug of choice forclients with severe

arthritic conditionswho need high doses ofanti-inflammatorydrug.

y Celecoxib is anexample.


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CorticosteroidyWidely prescribed for arthritic conditionsy Numerous side-effects

y Half-life greater than 24 hours

y Discontinouing steroids

Examples:

Prednisone

PrednisiloneDexamethasone


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Disease-Modifying Antirheumatic

Drugs

y Gold Drug Therapy

y

Immunosuppresive Agentsy Immunomodulators

yAnti-malarials


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Gold Drug Therapyy

Most frequently used DMARDsy Used to arrest progression of rheumatoid

Arthritis and prevent deformities

y Depresses migration of leukocytes and suppresses

prostaglandin activity.y Not used in the early stages of arthritis unless

the illness is progressing rapidly and isunresponsive to other therapy, nor used in far-

advanced arthritis.y Palliative and not curative

y Response in alleviating symptoms is slow.


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y Injectible-2 monthsy Oral-3-6 monthsy Half-life-7-25 daysy Gold Salt Auranofin (Ridaura) oraly Sodium aurothiomalate, aurothioglucose - injection

Side Effects:y Dermatitis Gastritis

y Urticaria(hives) Pharyngitisy Erythema StomatitisyAlopecia


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Immunosuppressive Agentsy To treat refractory arthritis

y In low doses, have been effective

Example:y azathioprine (Imuran)

y cyclophosphamide (Cytoxan)

ymethotrexate (Mexate)


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Immunomodulatorsy To treat moderate to severe rheumatoid arthritis

bydisrupting the inflammatory process

delaying disease progression.y Interleukin (IL-1) receptor antagonist and Tumor

Necrosis Factor (TNF) Blockers


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y anakinra- subcutaneously

y etanercept(Enbrel) Subcutaneously

y Signs and symptoms are suppressed rapidly but

reappears if discontinuedy Both IL1 and TNF inhibitors predisposes a client to

severe infections

yVery expensive approximately $14,000-$37,000 peryear


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Antimalarials

y Mechanism is unclear

y 4-12 weeks before effects to become apparent

y Plaquenil


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Anti- Gout Drugs

y Gout disease of Kings

y Unwalkable Disease

y Podagra according to Hippocrates

or Foot SeizureyJoints of the large toe, elbows, hand,

knee and shoulder are affected.

y Hippocrates recommended use of

purgatives(Strong laxatives)


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Colchicine

y 1st drug for GoutyAlleviating acute symptoms of gout

y Not effective in decreasing inflammationoccurring in other inflammatory disorders

y Should not be used in clients with severe renal,cardiac or GI problem (GI irritation)


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Uric Acid Inhibitory allopurinol (Zyloprim)

y InhibitsUric Acid Biosynthesis

y Lowers uric acid level

y Prevents precipitation of an attack

yDrug of choice for Chronic tophaceous gout


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