22 Antiinflamma and NSAIDs

8/22/2019 22 Antiinflamma and NSAIDs

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The nonnarcoticanalgesics are a group

of drugs used to relievepain


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The NONNARCOTICANALGESICS are:Salicylates

nonsalicylates(acetaminophen),

nonsteroidal anti-inflammatorydrugs (NSAIDs)


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include aspirin (acetylsalicylicacid)

analgesic (relieves pain),

antipyretic (reduces elevatedbody temperature)

anti-inflammatory effects.

SALICYLATES


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MECHANISM OF ACTIONanalgesic action of the salicylates isdue to the inhibition of prostaglandins

PROSTAGLANDINS are fatty acidderivatives found in almost everytissue of the body and body fluid.

increase the sensitivity of peripheralpain receptors.

SALICYLATES


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USESThe salicylate nonnarcotic analgesicsare used for the following reasons:

Relief of mild to moderate pain; Reduction of elevated body

Treatment of inflammatory

conditions, such as rheumatoidarthritis, osteoarthritis, andrheumatic fever

SALICYLATES


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USES Reduction of the risk of myocardialinfarction in those with unstableangina or previous myocardialinfarction (aspirin only);

Reduction of the risk of transientischemic attacks or strokes in men

who have had transient ischemia ofthe brain due to fibrin platelet emboli(aspirin only)

SALICYLATES


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ADVERSE REACTIONS Gastric upset, heartburn, nausea,vomiting, anorexia, and

gastrointestinal bleedingallergic reactions : hives, rash,angioedema,

bronchospasm with asthma-likesymptoms, and anaphylactoidreactions

SALICYLATES


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SALICYLATE TOXICITY Salicylate toxicity produces acondition called SALICYLISM

SALICYLISM Dizziness

Tinnitus (a ringing sound in the ear) Impaired hearing Nausea

SALICYLATES


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SALICYLISM Vomiting Flushing

Sweating Rapid deep breathing Tachycardia Diarrhea

SALICYLATES


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SALICYLISM

Mental confusion Lassitude Drowsiness

Respiratory depression andcoma (large doses)

SALICYLATES


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CONTRAINDICATIONS hypersensitivity to the salicylates orthe NSAIDs

Pregnancy: produce adversematernal effects

Anemia

postpartum hemorrhage Prolonged gestation or labor

SALICYLATES


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CONTRAINDICATIONS

adverse fetal effectslow birth weight intracranial hemorrhage inpremature infantsStillbirthsneonatal death

SALICYLATES


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CONTRAINDICATIONSChildren or teenagers withinfluenza or chickenpox (aspirin)

Reyes syndromea life threatening conditioncharacterized by vomiting andlethargy, progressing tocoma).

SALICYLATES


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INTERACTIONS

Food containing salicylate (currypowder, paprika, licorice, prunes,raisins, and tea) may increase the riskof adverse reactions.

Coadministration of the salicylateswith activated charcoal decreases the

absorption of the salicylates. Antacids may decrease the effects ofthe salicylates

SALICYLATES


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INTERACTIONS

Coadministration with the carbonicanhydrase inhibitors increases the

risk of salicylism.Aspirin may increase the risk ofbleeding during heparin

administration.Coadministration with the NSAIDsmay increase NSAID blood levels

SALICYLATES


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Acetaminophen (Tylenol, Datril,Panadol)

Substitute for patients who are

allergic to aspirin or who experienceextreme gastric upset when takingaspirin.

drug of choice for treating childrenwith fever and flu-like symptoms.

NONSALICYLATES


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MECHANISM OF ACTIONAcetaminophen is a nonsalicylatenonnarcotic analgesic whose

mechanism of action is unknown.analgesic and antipyretic activityNo antiinflammatory action

NONSALICYLATES


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USESmild to moderate painreduce elevated body

temperature (fever). aspirin allergy bleeding disorders, such as

bleeding ulcer or hemophilia receiving anticoagulant therapy, minor surgical procedures

NONSALICYLATES


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ADVERSE REACTIONSusually occur with chronic use orwhen the recommended dosage is

exceeded.Adverse reactions include skin eruptions

urticaria (hives) hemolytic anemia pancytopenia (a reduction in all

cellular components of the blood)

NONSALICYLATES


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ADVERSE REACTIONS Hypoglycemia

jaundice (yellow discoloration

of the skin) hepatotoxicity (damage to theliver)

hepatic failure (seen in chronicalcoholics

NONSALICYLATES


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ACUTE ACETAMINOPHENPOISONINGAcute acetaminophen poisoning or

toxicity single 10- to 15-g dose

Dosages of 20 to 25 g may be fatal

the liver cells necrose or die The risk of liver failure increases

patients who are chronic alcoholics.Acute hepatic and renal failure

NONSALICYLATES


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SIGNS OF ACUTE ACETAMINOPHENPOISONINGNausea

VomitingConfusionLiver tenderness

HypotensionArrhythmiasJaundice

Acute hepatic and renal failure

NONSALICYLATES


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CONTRAINDICATIONS,PRECAUTIONS, ANDINTERACTIONS

Hypersensitivitychronic alcoholicsused cautiously during pregnancy andlactation.

Use with the barbiturates, hydantoins,isoniazid, and rifampin may increasethe toxic effects and possibly decrease

the therapeutic effects of

NONSALICYLATES


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NONNARCOTIC ANALGESICS


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have analgesic and antipyreticproperties.

exact mechanisms of actions are notknown, inhibiting prostaglandin (synthesis

by inhibiting the action of the enzymecyclooxygenase, the enzymeresponsible for prostaglandinsynthesis.

NONNARCOTIC ANALGESICS:

NONSTEROIDAL ANTI-INFLAMMATORY

DRUGS (NSAIDS)


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Prostaglandins

sensitize pain receptors andincrease the pain associated withother chemical mediators such asbradykinin and histamine

act as pyrogens (fever-producingagents).


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The NSAIDs act to inhibit theactivity of two related enzymes:1. cycloo1xygenase-1 (COX-1)

helps to maintain the stomachlining; and2. cyclooxygenase-2 (COX-2)

that triggers pain andinflammation.


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newer NSAIDs (celecoxib androfecoxib) appear to work byspecifically inhibiting the COX-2enzyme, without inhibiting theCOX-1 enzyme.


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USESOsteoarthritis , rheumatoid arthritis,and other musculoskeletal disorders

Mild to moderate pain reliefdysmenorrhea Fever reduction



DRUGS (NSAIDS)



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ADVERSE REACTIONSGastrointestinal tract

nausea, vomiting, diarrhea,constipation, epigastric pain,indigestion,abdominal distress ordiscomfort, intestinalulceration,stomatitis, jaundice,bloating, anorexia, and dry mouth



DRUGS (NSAIDS)



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ADVERSE REACTIONSCentral Nervous System

dizziness, anxiety,lightheadedness,vertigo,headache, drowsiness, insomnia,confusion, depression, andpsychic disturbances



DRUGS (NSAIDS)



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ADVERSE REACTIONS Cardiovascular

congestive heart failure, decrease orincrease in blood pressure, andcardiac arrhythmias

Renalhematuria, cystitis, elevated bloodurea nitrogen, polyuria, dysuria,oliguria, and acute renal failure in

those with impaired renal function



DRUGS (NSAIDS)



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ADVERSE REACTIONSSpecial sensesvisual disturbances,

blurred or diminished vision, diplopia,swollen or irritated eyes, photophobia,reversible loss of color vision, tinnitus,

taste change, and rhinitis



DRUGS (NSAIDS)



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CONTRAINDICATIONS,PRECAUTIONS, AND

INTERACTIONShypersensitivityused cautiously in patientswithbleeding disorders, renal disease,cardiovascular disease,or hepaticimpairment and in the elderly.

used with extreme caution durin



DRUGS (NSAIDS)


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COMMON ADVERSE REACTIONSOF SELECTED NSAIDs

Celecoxib

most common adverse reactions

dyspepsia, abdominal pain,

diarrhea, nausea, and headache.may compromise renal function.


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COMMON ADVERSE REACTIONS OF

SELECTED NSAIDsIbuprofen used in children with juvenile

arthritis and for fever reduction inchildren 6 months to 12 years.

Common adverse reactions seen

with ibuprofen include headache,dizziness, somnolence, nausea,dyspepsia, gastrointestinal pain, andrash.


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COMMON ADVERSE REACTIONS OFSELECTED NSAIDs

Naproxen

Common adverse reactions seenwith naproxen include headache,vertigo (dizziness), somnolence,

insomnia, nausea, dyspepsia,gastrointestinal pain, and rash.


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NSAIDs: NURSING IMPLICATIONSBefore beginning therapy, assess forconditions that may becontraindications to therapy,especially:

GI lesions or peptic ulcer disease

Bleeding disordersAssess also for conditions that requirecautious use.

Perform lab studies as indicated(cardiac, renal, liver studies, CDC,

latelet count).


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NSAIDs: NURSING IMPLICATIONS

Perform a medication history to assess

for potential drug interactions. Several serious drug interactions exist:

alcohol

heparin

phenytoin

oral anticoagulants

steroids

sulfonamides


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NSAIDs: NURSING IMPLICATIONSSalicylates are NOT to be given tochildren under age 12 because of therisk of Reyes syndrome.

Because these agents generallycause GI distress, they are oftenbetter tolerated if taken with food,milk or an antacid to avoid GIirritation.

Explain to patients that therapeuticeffects may not be seen for 3 to 4weeks.


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NSAIDs: NURSING IMPLICATIONS

educate patients about the variousside effects of NSAIDs, and to notifytheir physician if these effectsbecome severeor if bleeding or GI pain occur.

Patients should watch closely for theoccurrence of any unusual bleeding,such as in the stool.

Enteric-coated tablets should not becrushed or chewed.


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NSAIDs: NURSING IMPLICATIONSMonitor for therapeutic effects,which vary according to the

condition being treated:

decrease in swelling, pain,

stiffness, and tenderness of a jointor muscle area

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No Alcohol

SE BIRTH bone marrow depression,increased GI distress, Renal Toxicity, Tinnitusand Hepatotoxicity

Aspirin sensitivity do not give

Inhibits prostaglandins

Do take with food

Stop 5-7 days before surgery

22 Antiinflamma and NSAIDs

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