Nonsteroidal Anti-inflammatory Drugs (NSAIDs) and Analgesics
Antiinflamma and NSAIDs
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Transcript of Antiinflamma and NSAIDs
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
Antiinflammatory Agents
and NonsteroidalAntiinflammatory Drugs
(NSAIDs)
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs
Large and chemically diverse group of drugswith the following properties:
Analgesic
Antiinflammatory
Antipyretic
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Mechanism of Action
Activation of the arachidonic acidpathway causes:
pain
headache
fever
inflammation
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Mechanism of Action
Analgesiatreatment of headaches and pain
Block the undesirable effects of prostaglandins,
which cause headaches
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Mechanism of Action
Antipyretic: reduce fever
Inhibit prostaglandin E2 within the area of the brain
that controls temperature
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Mechanism of Action
Relief of inflammation
Inhibit the leukotriene pathway, the prostaglandin
pathway, or both
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs
Six structurally related groups:
Acetic acids
Carboxylic acids Propionic acids
Enolic acids
Fenamic acids
Nonacidic compounds
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Acetic Acid
diclofenac sodium (Voltaren)
diclofenac potassium (Cataflam)
etodolac (Lodine)
indomethacin (Indocin)
sulindac (Clinoril)
tolmetin (Tolectin)
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Carboxylic Acids
Acetylated
aspirin (ASA)
choline magnesium salicylate (Trilisate) diflunisal (Dolobid)
Nonacetylated
salicylamide
salsalate (Disalcid)
sodium salicylate
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Propionic Acids
fenoprofen (Nalfon)
flurbiprofen (Ansaid)
ibuprofen (Motrin, others)
ketoprofen (Orudis)
ketorolac (Toradol)
naproxen (Naprosyn)
oxaprozin (Daypro)
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Other Agents
Enolic acids
phenylbutazone (Butazolidin)
piroxicam (Feldene)
Fenamic acids
meclofenamic acid (Meclomen)
mefenamic acid (Ponstel)
Nonacidic compounds
nabumetone (Relafen)
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Other Agents
COX-2 Inhibitors
celecoxib (Celebrex)
rofecoxib (Vioxx)
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Drug Effects
Analgesic (mild to moderate)
Antigout
Antiinflammatory
Antipyretic
Relief of vascular headaches Platelet inhibition (ASA)
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Therapeutic Uses
Relief of mild to moderate pain
Acute gout
Various bone, joint, and muscle pain Osteoarthritis
Rheumatoid arthritis
Juvenile rheumatoid arthritis Dysmenorrhea
Fever
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Specific Agents
salicylates (aspirin)
More potent effect on platelet aggregation and
thermal regulatory center in the brain analgesic
antipyretic
antiinflammatory Antithrombotic effect: used in the treatment of MI
and other thromboembolic disorders
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Specific Agents
phenylbutazone (Butazolidin)
Greater effects on uric acid production and
excretion, in addition to antiinflammatory effects More commonly used for treatment of gout
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Side Effects
Gastrointestinal
dyspepsia, heartburn, epigastric distress, nausea
**GI bleeding
**mucosal lesions (erosions or ulcerations)
Misoprostol (Cytotec) can be used to reduce these
dangerous effects.
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Side Effects
Renal
reductions in creatinine clearance
acute tubular necrosis with renal failure
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Side Effects
Cardiovascular
noncardiogenic pulmonary edema
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Salicylate Toxicity
Adults: tinnitus and hearing loss
Children: hyperventilation and CNS effects
Effects arise when serum levels exceed300g/mL.
Metabolic acidosis and respiratory alkalosis
may be present.
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Nursing Implications
Before beginning therapy, assess forconditions that may be contraindications totherapy, especially:
GI lesions or peptic ulcer disease
Bleeding disorders
Assess also for conditions that require
cautious use.
Perform lab studies as indicated (cardiac,renal, liver studies, CDC, platelet count).
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Nursing Implications
Perform a medication history to assess forpotential drug interactions.
Several serious drug interactions exist:
alcohol
heparin
phenytoin
oral anticoagulants
steroids
sulfonamides
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Nursing Implications
Salicylates are NOT to be given to childrenunder age 12 because of the risk of Reyessyndrome.
Because these agents generally cause GIdistress, they are often better tolerated iftaken with food, milk or an antacid to avoid
GI irritation. Explain to patients that therapeutic effects
may not be seen for 3 to 4 weeks.
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Nursing Implications
Educate patients about the various sideeffects of NSAIDs, and to notify theirphysician if these effects become 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 be
crushed or chewed.
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Copyright 2002, 1998, Elsevier Science (USA). All rights reserved.
NSAIDs: Nursing Implications
Monitor for therapeutic effects, which varyaccording to the condition being treated:
decrease in swelling, pain, stiffness,and tenderness of a joint or muscle area