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Chapter 12

Chapter 12. Anti-inflammatory Agents. Nonsteroidal Anti-inflammatory Drugs. Group of frequently prescribed drugs Treat pain and inflammation Common drugs Acetylsalicylic acid (ASA) Ibuprofen (Motrin) Indomethacin (Indocin) Celecoxib (Celebrex) Ketorolac (Toradol) Naproxen (Aleve).

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Chapter 12

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  1. Chapter 12 Anti-inflammatory Agents

  2. Nonsteroidal Anti-inflammatory Drugs • Group of frequently prescribed drugs • Treat pain and inflammation • Common drugs • Acetylsalicylic acid (ASA) • Ibuprofen (Motrin) • Indomethacin (Indocin) • Celecoxib (Celebrex) • Ketorolac (Toradol) • Naproxen (Aleve)

  3. Uses for NSAIDs • Analgesic (mild to moderate) • Anti-inflammatory • Antipyretic • Relief of vascular headaches • Platelet inhibition • No salicylates usually given for kids <12 if febrile viral illness

  4. How NSAIDs Work • Stop the activation of the arachidonic acid pathway • Reduce: • Pain • Headache • Fever • Inflammation

  5. Gastrointestinal Side Effects • First-generation NSAIDs • Dyspepsia, heartburn, epigastric distress, nausea • Gastrointestinal bleeding • Mucosal lesions (erosions or ulcerations) (continues)

  6. Gastrointestinal Side Effects • Second-generation NSAIDs • COX-2 inhibitors • More specific in their action • Reduce gastrointestinal distress

  7. Cardiovascular Side Effects • Second-generation NSAIDs • Serious side effects: • Cardiac arrhythmias • Heart attack • Stroke • Celecoxib (Celebrex): contraindicated after coronary bypass (CABG); limited use • Rofecoxib (Vioxx) removed from market by the FDA

  8. Precautions • First and second generation NSAIDs • Contraindications: • Hx stomach ulcers and bleeding • Hx asthma • Hx allergic response to aspirin or sulfa • Have severe kidney or liver problems  • Are pregnant

  9. Renal Side Effects • May increase BUN, ALT, AST • renal failure • lymphoma and RA and RA treatment

  10. Other Precautions • Caution: clients taking anticoagulants or antiplatelet therapy • Immune suppression with DMARDs, teach clients about increased risk for infection

  11. Disease-Modifying Antirheumatic Drugs (DMARDs) and other Antirheumatic Drugs • Adimumab (Humira) • Etanercept (Enbrel) • Methotrexate (Rheumatrex) • Gold Therapy • Antimalarial- hydroxychloroquine sulfate

  12. Nursing care: DMARDs • Risk for infection while taking drugs in this class • Leflunomide (Arava) can cause hepatotoxicity and diabetes mellitus • Monitor liver function in patients taking these drugs • Pain, redness, edema at injection sites should be reported

  13. Corticosteroids • Uses • Severe inflammation • Asthma or COPD Exacerbations • Allergic Reactions • Addison’s Disease or other cortisol deficiency • Cancer

  14. Corticosteroids • Action • Produce a glucocorticoid effect (anti-inflammatory) • Produce a mild mineralocorticoid effect (salt retention)

  15. Cortisol Deficiency • Hypotension • Weakness/Lethargy • Headache • Dehydration • N/V • Diarrhea

  16. Corticosteroids • Examples: • Dexamethasone (Decadron) • Hydrocortisone (Cortef) • Hydrocortisone sodium succinate (Solu-Cortef) • Methylprednisolone (Medrol) • Prednisolone (Delta-Cortef) • Prednisone (Deltasone)

  17. Corticosteroids • Side/Adverse Effects: • Increased HCl acid in stomach leads to gastric ulceration • Water/Salt retention • Weight gain • Hypertension • Hyperglycemia

  18. Corticosteroids Side effects (cont’d) • Risk for low potassium blood levels • Insomnia • Increased risk for osteoporosis • Immunosuppresion • Must be tapered off – don’t stop abruptly

  19. Therapeutic Effects of anti-inflammatory agents • Monitor for: • Decrease in swelling • Decrease in pain • Decrease in joint tenderness • Breathing improvement or difficulty

  20. Nursing Assessment • Prior to start, assess: • Gastrointestinal lesions or peptic ulcer disease • Bleeding disorders • Diabetes • Infection • Hypertension or Heart Failure

  21. Client Education • Take with food or milk • Educate clients about precautions • Immune suppression • Watch for: • Abdominal pain, blood in GI contents • Infection • Increase in blood sugar levels • Weight gain (>2 lbs in one day)

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