ANTI-INFLAMMATORY AGENTS

ANTI-INFLAMMATORY AGENTS: SALICYLATES

ACTION: -inhibits prostaglandin synthesis that:

(a) sensitize pain receptors to stimulation causing pain; (b) produces s/sy of inflammation; (c) pyrogens by WBC/ release in the brain that causes increase in body temperature

- ASPIRIN -> inhibits platelet aggregation <- inhibits synthesis of thromboxane A2 (vasoconstrictor and platelet aggregation inducer)

ANTI-INFLAMMATORY AGENTS: SALICYLATES

USES: mild to moderate pain, fever, inflammatory conditions (arthritis, headache, myalgia); TIA, stroke, reduce risk of death with MI;

>>not recommended for children (Reye’s syndrome)

PHARMACOKINETICS: A – stomach; M – liver; E – urine

ANTI-INFLAMMATORY AGENTS: SALICYLATES

ADVERSE EFFECTS: Gastric irritation (administer with food,

water or antacid), GI bleeding (test stool/emesis), toxicity (tinnitus, impaired hearing, dimming vision, sweating, fever, lethargy, dizziness, confusion, vomiting – reduce dose/no antidote)

DRUG INTERACTIONS: NSAIDS (reduce platelet –inhibiting effects) –

administer with gap; Probenecid(Salicylates inhibits excretion of uric acid) , Warfarin, OHA, Methotrexate

ANTI-INFLAMMATORY AGENTS: SALICYLATES

CONTRAINDICATIONS: Allergy, bleeding abnormalities, impaired

renal function, chicken pox or influenza (Reye’s), surgery/invasive procedures, pregnancy and lactation

 NURSING CONSIDERATIONS: Assess for contraindications Administer with food; administer drug as

indicated Well-hydrate patient Report untoward signs and

symptoms/increase knowledge

ANTI-INFLAMMATORY AGENTS: NSAIDSCOMMON DRUGS AND USES:a. Propionic Acids > ibuprofen – OTC pain med; long-term management of arthritis, dysmenorrhea;

mostly used NSAIDS> ketoprofen – short-term management of pain> naproxen – OTC; arthritis, dysmenorrhea b. Acetic Acids> diclofenac – acute, long term pain (inflammatory)> indomethacin – oral, topical, rectal; moderate to severe pain; IV –PDA> ketorolac – short-term management of pain; ocular itching c. Fenamates> Mefenamic Acid – short-term > Piroxicam - acute and chronic arthritis> Diflunisal – moderate pain, arthritis d. Oxicam Derivative> Meloxicam – juvenile arthritis, rheumatoid arthritis, osteoarthritis e. Cyclooxygenase-2 Inhibitor> Celecoxib – acute, long-term treatment of arthritis -> who cannot tolerate GI effects

of other NSAIDs

ANTI-INFLAMMATORY AGENTS: NSAIDSACTIONS:

inhibition of prostaglandin synthesis; blocks COX-1 and COX-2

COX-1 turns to arachidonic acid into prostaglandins (needed in protecting the stomach lining, blood clotting, maintaining sodium and water balance); COX-2: present at injury sites

COX-2 Inhibitors affect only COX-2, not COX-1 USES: arthritis, pain, dysmenorrhea, fever PHARMACOKINETICS: A- GIT; D – cross placenta

and breast milk; M – liver; E – urine

ANTI-INFLAMMATORY AGENTS: NSAIDS ADVERSE EFFECTS: Gastric irritation (n/v,

dyspepsia, pain) constipation –administer food, milk, water; stool-softeners, laxatives; hydration; roughage, fruits, vegetables, grains

GI bleeding; hepatotoxicity; nephrotoxicity; rash, hives, swelling,

Others: headache, dizziness, fatigue

CONTRAINDICATIONS: same + cardiovascular dysfunction/HTN, peptic ulcer, GI bleeding,

ANTI-INFLAMMATORY AGENTS: ACETAMINOPHEN

- inhibits prostaglandin in CNS and blocks pain impulses in the peripheral tissue

- inhibiting heat-regulating center in the hypothalamus

 USES: analgesic and pyretic; alternative to

aspirin; no anti-inflammatory response THERAPEUTIC OUTCOME: reduced pain and

fever