Anti Inflammatory

ANTI-INFLAMMATORY AGENTS / NSAIDs (Non-steroid anti-inflammatory drugs) 

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Anti-inflammatory drugs - block or alter the chemical reactions associated with the inflammatory response to stop one or more of the signs and symptoms of inflammation Aspirin & other NSAIDs relieve pain by inhibiting the enzyme cyclooxygenase which is needed for biosynthesis of prostaglandins. Non-narcotic analgesics o Aspirin, acetaminophen, ibuprofen & naproxen o are not addictive and less potent than narcotic analgesics

EIGHT GROUPS OF NSAID’S 1. Salicylates 2. Para-chlorobenzoic Acid Derivatives / Indoles 3. Pyrazolone Derivatives 4. Proprionic Acid Derivatives 5. Fenamates 6. Oxicams 7. Phenylacetic Acids 8. Selective COX – 2 Inhibitors 1. Salicylates (ASPIRIN)  Acetylsalicylic acid (ASA)  Oldest non-narcotic  Analgesic, antipyretic, anti-inflammatory and decreases platelet aggregation (powerful)  Should not be taken with other NSAID’s  SIDE EFFECTS : gastric irritation, N/V, dyspepsia, heart burn, epigastric discomfort, rash, bruising, excessive bleeding if taken 1st 2 days of menstruation  ADVERSE EFFECTS: > bleeding  Not to be used for children below 12 y/o because of the danger of Reye’s Syndrome  Salicylism – dizziness, tinnitus, difficulty hearing, N/V, diarrhea, mental confusion & lassitude 20 – 25 g adult dose, 4 g children  NR : > give with full glass of water, milk or with food

o Assess for allergy prior to administration o Assess for PT if on long term therapy ACETAMINOPHEN (TYLENOL)  2. PROPRIONIC ACID DERIVATIVE  Ibuprofen (Motrin), Naproxen (Naprosyn), Ketoprofen (Orudis) o 3. PARA-CHLOROBENZOIC ACID  Indomethacin (Indocin) 4. PYRAZOLONE DERIVATIVES  Phenylbutazone (Butazolidin), Oxyphenbutazone, Aminopyrine, Dipyrone 5. FENAMATES  Mefenamic Acid (Postel, Ponstan) 6. OXICAMS  Piroxicam (Feldene) 7. PHENYLACETIC ACID DERIVATIVE  Diclofenac Sodium (Voltaren)  Ketorolac (Toradol) -1st injectable 8. COX – 2 INHIBITORS  Celocoxib (Celebrex)  Valdecoxib (Bextra) NURSING RESPONSIBILITIES 1. Check history for allergic reactions 2. Assess client for signs of GI stress and edema 3. Observe for any signs of bleeding, petechiae, tarry stool and bleeding time may be prolonged 4. Check laboratory findings (hematology) 5. Take NSAID’s with meals, give w/ full glass of water 6. Avoid taking NSAID’s with Aspirin and Aspirin with NSAID,s 7. Avoid alcoholic beverages 8. Advise the effect of drug may take several days to wks OTHER RELATED DRUGS  Acetaminophen  Corticosteroids  Disease Modifying Antirheumatic Drugs (DMARDs)

ACETAMINOPHEN (TYLENOL)  Antipyretic action results from inhibition of prostaglandins in CNS → peripheral vasodilation, sweating, & dissipation of heat  Usual dose is 325 to 600 mg q4-6h po or pr; max dose is 4 g per day  AE : hepatotoxic, if > 50 - 200 ug/ml  NR : monitor liver enzyme (SGOT / AST & SGPT / AST )  N-acetylcysteine (mucolytic) – antidote for acetaminophen toxicity Gold standard of treatment is to use: NSAIDs & corticosteroids GLUCOCORTICOIDS (STEROIDS)  this drugs have an anti-inflammatory action  it can be given intranasal spray, aerosol inhalation, oral, IM, IV, topically on skin. o Prednisone o Prednisolone o Dexamethasone  Frequently used to control arthritic flareups  Long half-life (>24hrs), given once a day  When discontinuing, dosage should be tapered.  Given in day time or morning w/c mimics the peak levels of diurnal rhythm  Most adverse reaction are seen within 2-4 weeks of therapy. COLCHICINE  Anti-inflammatory gout drug   the migration of leukocytes to the inflamed site by vasoconstriction.  S/E: neuropathy – caution with elderly ALLOPURINOL (ZYLOPRIM)  Not an inflammatory drug  Uric acid inhibitors  S/E : fever & rash  Drug interaction o Amoxicillin or ampicillin -  risk of rash formation o  effect of coumadin and oral hypoglycemics PROBENECID (BENEMID)

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Uricosuric Can be taken with colchicine Inhibits excretion of weak organic acids such as penicillin and some cephalosporin Blocks renal / biliary transport and transport of many other substances and drugs in and out of CSF S/E : headache, rash, kidney stone

Osteoarthritis  More common in women  Degeneration of the cartilage in the joints Rheumatoid arthritis  All ages  Autoimmune disease  High levels of rheumatoid Gouty arthritis  Common in men > 40 years old  Results from deposits of uric acid and urate crystals in the joint  Inflammatory response [usually affects single joint ie. Big toe (tophus)] Common Adverse Reaction to Antigout drugs:  blood dyscrasias  GI upset  abdominal pain NURSING RESPONSIBILITIES:  Increase fluid intake  Alkalinize the urine (↓ Vit. C.)  Avoid food rich in purine and uric acid (wine, alcohol, organ meat, sardines , salmon)  Take acetaminophen instead of aspirin to reduce acidity.  Administer with food if given per orem  Cautiously used to elderly and those with cardiac, renal or gastric diseases  With narrow margin of safety  Monitor blood level DMARDs (Disease modifying anti-rheumatic drugs)  Gold therapy  Immunosuppressive agents  Antimalarials

Gold drug therapy  known as Chrysotherapy  Heavy metal therapy  Alleviate symptoms slowly Orally – 3 – 6 months Parenterally – 2 months Auranofin (Ridaura) – oral agent for long-term therapy Side effects:  May cause photosensitivity  - use sunblock  To report metalic taste or pruritus– possible gold toxicity  Diarrhea – high fiber diet Check for proteinurua, hematuria prior to gold therapy Observe patient 30 mins after gold therapy

Etanercept - for moderately severe arthritis - Injectable form Caution: numbness tingling sensation acute visual changes

Sodium Hyaluronate - given by injection to relieve from pain by the cushioning & lubricating effect of the drug

Immunosuppressive Agent  Used to treat refractory rheumatoid arthritis ( arthritis that does not respond to anti-inflam)  Not the first or second choice of treatment  Primarily suppresses cancer growth and proliferation  Might be used to suppress the inflammatory process when other treatment fails  Azathioprine ( Imuran)  Cyclophosphamide (Cytoxan)  Methotrexate (Mexate)

Antimalarials  To treat rheumatoid arthritis when other methods fail.  Its use is unclear, usually in combination with NSAIDs  Effect takes place after 4 - 12 wks  chloroquine HCl (Aralen)  hydoxychloroquine SO4 (Plaquenil SO4)  mefloquine HCl (Lariam)  quinine SO4 ( Quinamm)