Inflammation and NSAIDs
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Questions and Answers

What is the primary function of inflammation in the body?

  • To protect the body by destroying, diluting, or walling off the injurious agent and the injured tissue (correct)
  • To reduce pain and fever
  • To promote the healing process
  • To destroy the injured tissue

    • Which of the following is a common use of NSAIDs?

  • Treatment of high blood pressure
  • Treatment of bacterial infections
  • Treatment of cancer
  • Treatment of gout and hyperuricemia (correct)

    • What is the mechanism of action of NSAIDs?

  • Inhibition of the leukotriene pathway, the prostaglandin pathway, or both (correct)
  • Stimulation of the immune system
  • Inhibition of the neurotransmitter pathway
  • Inhibition of the COX-3 enzyme

    • Which NSAID is an irreversible inhibitor of COX-1 receptors within the platelets themselves?

    <p>Aspirin</p> Signup and view all the answers

    What is a potential adverse effect of NSAIDs on the gastrointestinal system?

    <p>Both heartburn and severe GI bleeding</p> Signup and view all the answers

    What is a potential interaction of NSAIDs with other medications?

    <p>Increased risk of bleeding with anticoagulants</p> Signup and view all the answers

    What is the role of prostaglandins in renal function?

    <p>Renal function depends partly on prostaglandins</p> Signup and view all the answers

    What is a common symptom of inflammation?

    <p>Fever</p> Signup and view all the answers

    What is the anti-inflammatory effect of NSAIDs due to?

    <p>All of the above</p> Signup and view all the answers

    What is a potential adverse effect of NSAIDs on the cardiovascular system?

    <p>Increased risk of heart attack</p> Signup and view all the answers

    Which of the following is a contraindication for aspirin administration?

    <p>Vitamin K deficiency</p> Signup and view all the answers

    Which of the following NSAIDs is used to prevent GI bleeding?

    <p>Misoprostol</p> Signup and view all the answers

    What is the primary indication for the use of ketorolac?

    <p>Moderate to severe acute pain</p> Signup and view all the answers

    Which of the following is a common adverse effect of NSAIDs?

    <p>All of the above</p> Signup and view all the answers

    What is the mechanism of action of misoprostol?

    <p>Unclear</p> Signup and view all the answers

    Which of the following NSAIDs has a black box warning regarding an increased risk of adverse cardiovascular thrombotic events?

    <p>All NSAIDs except aspirin</p> Signup and view all the answers

    What is a common complication of Reye's syndrome?

    <p>Both A and B</p> Signup and view all the answers

    Which of the following is a characteristic of COX-2 inhibitors?

    <p>Little effect on platelet function</p> Signup and view all the answers

    What is the primary indication for the use of celecoxib?

    <p>All of the above</p> Signup and view all the answers

    What is the primary mechanism of action of diclofenac sodium?

    <p>Inhibition of prostaglandin synthesis</p> Signup and view all the answers

    What is the primary mechanism of action of probenecid in the treatment of gout?

    <p>Inhibiting the reabsorption of uric acid in the kidneys</p> Signup and view all the answers

    Which of the following NSAIDs is better tolerated gastrointestinally than some other NSAIDs?

    <p>Nabumetone</p> Signup and view all the answers

    What is the primary therapeutic effect of colchicine in the treatment of gout?

    <p>Reducing inflammatory response to urate crystals</p> Signup and view all the answers

    Which of the following is a common adverse effect of NSAIDs that patients should be educated about?

    <p>Gastrointestinal distress</p> Signup and view all the answers

    What is the contraindication for giving salicylates to children and teenagers?

    <p>Risk of Reye's syndrome</p> Signup and view all the answers

    Which of the following is a nursing implication for patients taking NSAIDs or antigout drugs?

    <p>Assessing for conditions that may be contraindications to therapy</p> Signup and view all the answers

    What is the mechanism of action of lesinurad in the treatment of gout?

    <p>Inhibiting the transporter proteins involved in renal uric acid reabsorption</p> Signup and view all the answers

    What is the primary therapeutic effect of allopurinol in the treatment of gout?

    <p>Inhibiting the production of uric acid</p> Signup and view all the answers

    Which of the following NSAIDs is the most commonly used?

    <p>Ibuprofen</p> Signup and view all the answers

    What is the primary therapeutic effect of febuxostat in the treatment of gout?

    <p>Inhibiting the production of uric acid</p> Signup and view all the answers

    Study Notes

    Inflammation

    • Inflammation is a localized protective response to tissue injury, which aims to destroy, dilute, or wall off the injurious agent and injured tissue.
    • Symptoms of inflammation include pain, fever, loss of function, redness, and swelling.
    • Endogenous compounds involved in inflammation include proteins of the complement system, histamine, serotonin, bradykinin, leukotrienes, and prostaglandins.

    Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

    • NSAIDs are a large and chemically diverse group of drugs with analgesic, anti-inflammatory, antipyretic, and aspirin-platelet inhibition properties.
    • Common uses of NSAIDs include:
      • Mild to moderate headaches
      • Myalgia
      • Neuralgia
      • Arthralgia
      • Postoperative pain
      • Pain associated with arthritic disorders (e.g., rheumatoid arthritis, osteoarthritis)
      • Gout and hyperuricemia
    • All NSAIDs share antipyretic, analgesic, and anti-inflammatory properties.

    Salicylates

    • Examples of salicylates include aspirin, diflunisal (Dolobid), and others.
    • Aspirin is an irreversible inhibitor of COX-1 receptors and reduces thromboxane A2 formation, promoting platelet aggregation.
    • Other NSAIDs lack this antiplatelet effect.

    Mechanism of Action of NSAIDs

    • NSAIDs inhibit the leukotriene pathway, prostaglandin pathway, or both.
    • Blocking the chemical activity of the enzyme COX, which has two isoforms:
      • COX-1: involved in maintaining the gastrointestinal (GI) mucosa
      • COX-2: involved in inflammation

    Adverse Effects of NSAIDs

    • Gastrointestinal: heartburn to severe GI bleeding
    • Renal: acute renal failure
    • Cardiovascular: increased risk of myocardial infarction (MI) and stroke
    • Hematological: altered hemostasis
    • Hepatic: hepatotoxicity
    • Dermatological: skin eruption, sensitivity reaction
    • Otological: tinnitus, hearing loss

    Interactions of NSAIDs

    • Serious interactions can occur with:
      • Anticoagulants
      • Aspirin
      • Corticosteroids and other ulcerogenic drugs
      • Protein-bound drugs
      • Diuretics and ACE inhibitors
      • Others

    Renal Function and NSAIDs

    • Renal function depends partly on prostaglandins, which can be disrupted by NSAIDs, leading to acute or chronic renal failure.
    • NSAIDs can compromise existing renal function, especially in patients with dehydration, heart failure, liver dysfunction, or those taking diuretics or ACE inhibitors.

    Black Box Warning for NSAIDs

    • All NSAIDs (except aspirin) carry a black box warning regarding the increased risk of adverse cardiovascular thrombotic events, including fatal MI and stroke.
    • NSAIDs may counteract the cardioprotective effects of aspirin.

    Salicylate Toxicity

    • Cardiovascular: increased heart rate
    • Central nervous system: tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion, lassitude, and drowsiness
    • Gastrointestinal: nausea, vomiting, diarrhea
    • Metabolic: sweating, thirst, hyperventilation, hypoglycemia, or hyperglycemia

    Aspirin

    • Uses:
      • Reduce cardiac death after myocardial infarction (MI)
      • Should be administered at the first sign of MI
    • Contraindications:
      • Known drug allergy
      • Conditions that place the patient at risk of bleeding (e.g., vitamin K deficiency, peptic ulcer disease)
      • Reye's syndrome: an acute and potentially life-threatening condition involving progressive neurologic deficits, triggered by viral illnesses and salicylate therapy.

    Misoprostol (Cytotec)

    • Prevents GI bleeding by:
      • Inhibiting gastric acid secretion
      • Having a cytoprotective component
    • Mechanism of action: unclear

    Acetic Acid Derivatives

    • Examples: diclofenac sodium (Voltaren), indomethacin (Indocin), sulindac (Clinoril), tolmetin (Tolectin), etodolac (Lodine), ketorolac (Toradol)
    • Uses:
      • Rheumatoid arthritis (RA)
      • Osteoarthritis (OA)
      • Acute bursitis or tendonitis
      • Ankylosing spondylitis
      • Acute gouty arthritis
      • Patent ductus arteriosus (PDA)
      • Treatment of preterm labor
    • Adverse effects:
      • Renal impairment
      • Edema
      • GI pain
      • Dyspepsia
      • Nausea

    Cyclooxygenase-2 (COX-2) Inhibitors

    • Example: celecoxib (Celebrex)
    • Indicated for:
      • OA
      • RA
      • Acute pain symptoms
      • Ankylosing spondylitis
      • Primary dysmenorrhea
    • Adverse effects:
      • Headache
      • Sinus irritation
      • Diarrhea
      • Fatigue
      • Dizziness
      • Lower extremity edema
      • Hypertension
    • Little effect on platelet function
    • Contraindication: known sulfa allergy

    Enolic Acid Derivatives

    • Examples: nabumetone (Relafen), meloxicam (Mobic), piroxicam (Feldene)
    • Uses:
      • Mild to moderate OA
      • RA
      • Gouty arthritis
    • Adverse effects:
      • GI distress
      • Renal impairment

    Propionic Acid Derivatives

    • Examples: fenoprofen (Nalfon), flurbiprofen (Ansaid), ibuprofen (Motrin, Advil, others)
    • Uses:
      • Analgesic effects in RA, OA, primary dysmenorrhea, gout, dental pain, musculoskeletal disorders
      • Antipyretic actions
    • Adverse effects:
      • GI distress
      • Renal impairment
      • Headache
      • Dizziness
      • Nausea

    Gout

    • Condition resulting from inappropriate uric acid metabolism:
      • Underexcretion of uric acid
      • Overproduction of uric acid
    • Uric acid crystals are deposited in tissues and joints, resulting in pain and hyperuricemia.

    Antigout Drugs

    • Allopurinol (Zyloprim):
      • Used to prevent uric acid production and prevent acute tumor lysis syndrome
      • Adverse effects: exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis
    • Febuxostat (Uloric):
      • Nonpurine selective inhibitor of xanthine oxidase
      • May pose a greater risk of cardiovascular events than allopurinol
    • Colchicine (Colcrys):
      • Reduces inflammatory response to the deposits of urate crystals in joint tissue
      • Used for short-term management or prevention of gout
      • Adverse effects: short-term leukopenia and bleeding into the GI or urinary tracts
    • Probenecid (Benemid):
      • Inhibits the reabsorption of uric acid in the kidneys and thus increases the excretion of uric acid
      • Uricosuric
      • Must have good renal function
    • Lesinurad (Zurampic):
      • Uric acid transporter inhibitors
      • Inhibits the transporter proteins involved in renal uric acid reabsorption resulting in lower serum uric acid levels and increased renal clearance of uric acid
      • Given in combination with xanthine oxidase inhibitor
      • Teaching: at least 2 liters of fluid a day

    Nursing Implications

    • Assess for conditions that may be contraindications to therapy, especially GI lesions or peptic ulcer disease, bleeding disorders, and sulfa allergy.
    • Perform laboratory studies as indicated (cardiac, renal, and liver function studies; complete blood count; platelet count).
    • Perform a medication history to assess for potential drug interactions.
    • Educate patients about the various adverse effects of NSAIDs and inform them to notify their prescribers if these effects become severe or if bleeding or GI pain occurs.
    • Inform patients to watch closely for the occurrence of any unusual bleeding, such as in the stool.

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    Description

    Learn about the localized protective response of inflammation, its characteristics, and the properties of Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

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