NSAID's _ Arthritis Drugs answers by xiaopangnv


									                                         Non-Steroid Anti-inflammatory Drugs (NSAIDs)

               Class & Mechanism of
                                                                                                                        Drug Interactions, Precautions
    Drug        Anti-inflammatory           Pharmacokinetics         Therapeutic Uses            Adverse Effects
                                                                                                                            & Contraindications

Aspirin       as a NSAID aspirin is an     Rapidly absorbed in     Suppression of platelet    Gastric erosion &
              irreversible                 small intestine;        aggregation                ulceration
              Cyclooygenase inhibitor      excreted in kidneys                                                          Warfarin – intensify the
                                                                   Suppression of             Bleeding tendencies
              (COX-1 & COX-2)                                                                                           anticoagulant effect; greater risk
                                                                   inflammation               Acute renal failure       of bleeding
                                                                   analgesia                  Salicylism – tinnitus,    Aspirin overdose – respiratory
                                                                   Reduction of fever         sweating, headache,       alkalodosis
                                                                                              Reye’s Syndrome
                                                                                                                        Glucocorticoids – increase risk of
Other First   reversible Cyclooygenase     Generally well          Anti-inflammatory,         Gastric ulceration,       gastric ulcers
Generation    inhibitor (COX-1 &           absorbed;               analgesic, and             renal failure
NSAIDs        COX-2)                       metabolized in liver    antipyretic properties                               Alcohol increases the risk of
Ibuprofen,                                 and excreted in urine   similar to aspirin                                   gastric irritation
                                                                                              Some cause less gastric
                                                                                              irritation than aspirin
                                                                   Little or no suppression                             Avoid NSAIDs in children with
                                                                   of platelet aggregation                              viral infection – Reye’s
sodium                                                                                                                  Syndrome

Second        COX-2 inhibitor              Generally well          Anti-inflammatory;         Less than with aspirin    Walfarin – may increase
Generation                                 absorbed; food may      analgesic                  and first generation      anticoagulant effect in come
NSAIDs                                     decrease rate of                                   NSAIDs                    patients
(COX-2                                     absorption but not
Inhibitors                                 extent
                                                                                              Does not promote          Lithiam – may increase plasma
celecoxib                                                                                     platelet aggregation.     levels of lithium
(Celebrex)                                 Similar to naproxen                                GI ulceration is rare
              Does not suppress platelet
                                           in relieving pain and                              Doesn’t cause renal
              aggregation and does not                                                                                  ACE inhibitors - may decrease
                                           inflammation of                                    failure
              promote bleeding                                                                                          the antihypertensive effect
Nursing Actions related to the Modalities
                                                      Drug or Drug Class:
                     Direct Care                                 Teaching/Counseling                          Social Support
                                                      Avoid alcohol
 Aspirin & 1st generation NSAIDs

 Give with food, milk or full glass of water to       Notify physician of persistent or severe
 minimize GI affects                                  gastric irritation

                                                      Notify physician of tarry stools; bleeding;
 Large doses need to check renal function – or        tinnitus, dizziness.
 advise patient to have “routine” lab work done to
 measure renal function
                                                      Occult blood should be performed at a
                                                      yearly physical for an older adult. If on an
                                                      NSAID also prescribed prevacid, prilosec,
                                                      and zantac

Clinical Experiences with Drugs of this Class:

   Drug (Generic & Trade           Dose and Route    Why this client was receiving                   Comments or notes
          Name)                                                  drug
                                            Disease Modifying Antirheumatic Drugs (DMARDs)

                                                                                                                                        Drug Interactions,
                         Mechanism of
        Drug                                    Pharmacokinetics              Therapeutic Uses              Adverse Effects               Precautions
                                                                                                                                       & Contraindications

Methotrexate            blocks the            Most rapid acting of       considered to be first-choice   hepatic fibrosis,          contraindicated during
(Rhumatrex)             conversion of         the DMARDs                 drug for RA among the           bone marrow                pregnancy
Used later for          folic acid to its     Therapeutic effects        DMARDs; in low doses to         suppression,
                        active form           develop in 3 to 6 weeks    treat severe psoriasis;
treatment                                                                immunosuppressant in kidney
                                                                                                         GI ulceration,             Use in caution in patients
class:                                        Usually given PO for                                       pneumonitis                with peptic ulcer, ulcerative
                                                                         transplantation treatment of
antimetabolite and                            RA. An be given IM or                                                                 colitis
                                                                         neoplastic diseases including   Nausea and vomiting,
                                              IV. Excreted in the
folic acid antagonist                                                    non-Hodgkin’s lymphoma,         renal damage
dose for RA is 7.5-                                                      acute lymphocytic leukemia,
20 mg per week                                                           osteogenic sarcoma

Hydroxychloroquine      unknown               delayed onset of action;   Used in RA for patients with    retinal damage which       Use with caution in patients
(Plaquenil)                                   takes 3 to 6 months for    mild symptoms                   may irreversible; visual   with hepatic disease,
                                              full therapeutic effect    Antimalarial                    loss is dose related;      alcoholism, hepatotoxic
                                              Taken orally, partially                                    Others (rare) GI           drugs, impaired renal
                                              metabolized in liver to                                    disturbances, fatigue,     function; laxatives and
                                              active metabolite,                                         vertigo, headache,         antacids decrease
                                              excreted in urine                                          anxiety, mood changes,     absorption

Sulfasalazine           Antinflammatory       Absorbed from GI           Retard the progression of       GI symptoms (N&V,          pregnancy, lactation,
(Azulfidine)            effect thought to     tract, metabolized in      joint deterioration             diarrhea anorexia, abd.    patients with
class:                  be due to             intestines and liver,      Inflammatory bowel disease      pain)                      hypersensitivity to
sulfonamide             inhibition of         excreted in urine                                          Pruritis, rash uticaria    sulfonamides and related
                        prostaglandins                                                                                              drugs (thiazide and loop
                                                                                                         Rare: hepatitis and
                                                                                                         bone marrow                diuretics, sulfonylurea-type
                                                                                                         suppression                oral hypoglycemics)
                                                                                                                                    renal impairment

Gold salts                                    Given IM (except           Relieve pain and stiffness of   Many toxic side
Gold sodium                                   auronofin) Requires        RA; may arrest the              effects: intense
thiomalate                                    repeated injections        progression of joint            pruritis, rashes and
(Myochrysine),                                                           degeneration                    stomatitis; renal
                                                                                                         toxicity, severe blood
                                                                                                         dyscrasias, hepatitis,
(Solganal), and                                                                                          encephalitis
Nursing Actions related to the Modalities
                                                                 Drug or Drug Class:
                       Direct Care                                      Teaching/Counseling                          Social Support
 Methotrexate                                               Methotrexate
 Patient should be well hydrated. Increase fluid intake     Keep drug in tight, light resistant container
 to 2000 ml/day                                             Don’t use OTC drugs that contain folic acid
 Take one hour before or 2 hours after meals

 Give with meals
 Give antacids and laxative at lease 4 h before or after

Clinical Experiences with Drugs of this Class:

   Drug (Generic & Trade             Dose and Route        Why this client was receiving                    Comments or notes
          Name)                                                        drug

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