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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    NSAIDs: Mechanism of Action

    Activation of the arachidonic acidpathway causes:

    pain

    headache

    fever

    inflammation

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    NSAIDs: Mechanism of Action

    Analgesiatreatment of headaches and pain

    Block the undesirable effects of prostaglandins,

    which cause headaches

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    NSAIDs: Mechanism of Action

    Antipyretic: reduce fever

    Inhibit prostaglandin E2 within the area of the brain

    that controls temperature

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    NSAIDs: Mechanism of Action

    Relief of inflammation

    Inhibit the leukotriene pathway, the prostaglandin

    pathway, or both

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    NSAIDs

    Six structurally related groups:

    Acetic acids

    Carboxylic acids Propionic acids

    Enolic acids

    Fenamic acids

    Nonacidic compounds

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    NSAIDs: Acetic Acid

    diclofenac sodium (Voltaren)

    diclofenac potassium (Cataflam)

    etodolac (Lodine)

    indomethacin (Indocin)

    sulindac (Clinoril)

    tolmetin (Tolectin)

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    NSAIDs: Carboxylic Acids

    Acetylated

    aspirin (ASA)

    choline magnesium salicylate (Trilisate) diflunisal (Dolobid)

    Nonacetylated

    salicylamide

    salsalate (Disalcid)

    sodium salicylate

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    NSAIDs: Propionic Acids

    fenoprofen (Nalfon)

    flurbiprofen (Ansaid)

    ibuprofen (Motrin, others)

    ketoprofen (Orudis)

    ketorolac (Toradol)

    naproxen (Naprosyn)

    oxaprozin (Daypro)

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    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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    NSAIDs: Other Agents

    COX-2 Inhibitors

    celecoxib (Celebrex)

    rofecoxib (Vioxx)

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    NSAIDs: Drug Effects

    Analgesic (mild to moderate)

    Antigout

    Antiinflammatory

    Antipyretic

    Relief of vascular headaches Platelet inhibition (ASA)

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    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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    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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    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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    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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    NSAIDs: Side Effects

    Renal

    reductions in creatinine clearance

    acute tubular necrosis with renal failure

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    NSAIDs: Side Effects

    Cardiovascular

    noncardiogenic pulmonary edema

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    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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    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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    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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    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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    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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    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