Antiinflammatory Agents and Nonsteroidal Antiinflammatory Drugs

Antiinflammatory Agents and Nonsteroidal Antiinflammatory Drugs (NSAIDs) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. NSAIDs • Large and chemically diverse group of drugs with the following properties: – Analgesic – Antiinflammatory – Antipyretic Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. NSAIDs: Mechanism of Action • Activation of the arachidonic acid pathway causes: • pain • headache • fever • inflammation Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. Instructors may wish to use EIC Image #107: Arachidonic Acid Pathway Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. NSAIDs: Mechanism of Action Analgesia—treatment of headaches and pain • Block the undesirable effects of prostaglandins, which cause headaches 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 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 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 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) 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 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) 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) Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. NSAIDs: Other Agents COX-2 Inhibitors • celecoxib (Celebrex) • rofecoxib (Vioxx) 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) 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 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 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 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. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. NSAIDs: Side Effects Renal • reductions in creatinine clearance • acute tubular necrosis with renal failure Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. NSAIDs: Side Effects Cardiovascular • noncardiogenic pulmonary edema 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 exceed 300g/mL. • Metabolic acidosis and respiratory alkalosis may be present. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. NSAIDs: Nursing Implications • Before beginning therapy, assess for conditions that may be contraindications to therapy, 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). Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. NSAIDs: Nursing Implications • Perform a medication history to assess for potential drug interactions. • Several serious drug interactions exist: – alcohol – heparin – phenytoin – oral anticoagulants – steroids – sulfonamides Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. NSAIDs: Nursing Implications • Salicylates are NOT to be given to children under age 12 because of the risk of Reye’s syndrome. • Because these agents generally cause GI distress, they are often better tolerated if taken 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. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. NSAIDs: Nursing Implications • Educate patients about the various side effects of NSAIDs, and to notify their physician if these effects become severe or if bleeding or GI pain occur. • Patients should watch closely for the occurrence of any unusual bleeding, such as in the stool. • Enteric-coated tablets should not be crushed or chewed. Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved. NSAIDs: Nursing Implications • Monitor for therapeutic effects, which vary according to the condition being treated: decrease in swelling, pain, stiffness, and tenderness of a joint or muscle area Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.