Chapter 13 Drugs For Inflammation, Arthritis, and Gout PDF

Chapter 13 DRUGS FOR INFLAMMATION, ARTHRITIS, AND GOUT Lesson 13.1 (1 of 3)  List the names, actions, and possible adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs).  Explain what to teach patients and families about anti-inflammatory drugs (NSAIDs).  List th...

Chapter 13 DRUGS FOR INFLAMMATION, ARTHRITIS, AND GOUT Lesson 13.1 (1 of 3)  List the names, actions, and possible adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs).  Explain what to teach patients and families about anti-inflammatory drugs (NSAIDs).  List the names, actions, and possible adverse effects of corticosteroid-based anti-inflammatory drugs. Lesson 13.1 (2 of 2)  Explain what to teach patients and families about corticosteroid-based anti-inflammatory drugs.  List the names, actions, and possible adverse effects of disease-modifying antirheumatic drugs (DMARDs) for management of arthritis and other inflammatory disorders. Lesson 13.1 (3 of 3)  Explain what to teach patients and families about disease-modifying antirheumatic drugs (DMARDs) for management of arthritis and other inflammatory disorders.  List the names, actions, and possible adverse effects of antigout drugs.  Explain what to teach patients and families about antigout drugs. Inflammation Causes and Action  Predictable set of tissue and blood vessel actions caused by white blood cells (leukocytes) and their products as a response to injury or infection  Normal body response  Long term inflammation can cause damage to tissues and organs  Symptoms  Inflammation; pain, redness, warmth, swelling, and loss of function The Inflammatory Response  WBC release mediators (kinins, prostaglandins (PGs), histamine and tumor necrosis factor (TNF))  Act on the vessels causing dilation and leaking of fluid from the capillaries  Increased blood flow increased WBC to the site.  COX enzyme  COX1– present in all cells, helpful used to protect you “good COX”  COX2– present at inflammation site, continue inflammation response (bad COX) Inflammation Management  Anti-inflammatory Drugs  Reduce pain and prevent tissue and blood vessel responses  Long term therapy is use to prevent tissue damage  Goal is short term  Nonsteroidal anti-inflammatory drugs (NSAIDs)  Corticosteroids  Disease-modifying antirheumatic drugs (DMARDs)  Antigout drugs  Nonsteroidal Anti-inflammatory Drugs   COX-2– increased risk of MI Action   Reye Syndrome- ASA Slow the production of one or more inflammatory mediators:  Toxicity- tinnitus, analgesic, anti-inflammatory, hyperventilation, diaphoresis, antipyretic electrolyte imbalances **  depression, stupor, Uses convulsions, tachycardia,  Rheumatic disease, respiratory depression degenerative joint disease,  Drug Interaction osteoarthritis, and acute musculoskeletal problems  Alcohol  Adverse reactions  Do not give with vaccinations  Allergy, GI bleeding,  Warfarin hypoglycemia Nonsteroidal Anti- inflammatory Drugs  Cyclooxygenase 1 and 2 Inhibitors:  Aspirin (ASA)- stop taking 1 week before dental procedures  Ibuprofen (Mortrin)  Ketorolac (Toradol)  Naproxen (Aleve)  Cycloxygenase 2 Inhibitors  Celecoxib (Celebrex)- watch with sulfa allergy  Meloxicam (Mobic)  Diclofenac (Voltaren) Nonsteroidal Anti- inflammatory Drugs  Nursing implications and patient teaching  A: Allergies, GI problems, GI bleeding,  P: Take with full glass of water  E: symptom improvement, 1-2 weeks for decrease in inflammation, assess for signs of bleeding  T: Take with full glass of water or food, report ringing in the ears, bleeding, increased bruising, drink 8-10 glasses of water per day, To reduce inflammation take on a regular acheudle for 1-2 weeks, Call MD if fever does not decrease in 24 hours Corticosteroids  Action and uses  Acute adrenal emergencies, allergic states, acute brain injury, severe asthma, and any condition in which chronic inflammation could lead to tissue damage  Expected side effects/adverse reactions  Sodium retention, increased blood pressure, weight gain, bruising, and reduced immunity/adrenal gland suppression and reduced immunity  Drug interactions  Barbiturates, sedatives, narcotics, anticoagulants, oral contraceptives Corticosteroids  Nursing implications and patient teaching  Disease-Modifying Antirheumatic Drugs (DMARDs)  Action and uses  Decreases or suppresses the inflammatory response and, in cases of rheumatoid arthritis, slows down the progression of disease and preserves joint function  Can not take if immunocompromised  Expected side effects/adverse reactions  Injection-site reactions/immune response reduction  Drug interactions  Drugs that reduce immunity  Adalimumab (Humira) Disease-Modifying Antirheumatic Drugs (DMARDs)  Nursing implications and patient teaching  First dose by MD– significant risk of allergic reaction  Take vital signs- keep a crash cart close  Teach self injection  Assess for signs of infection- teach signs of infection  Report signs of liver failure  Increase fluid intake, Gout  Metabolic disorder that causes an increased accumulation of uric acid crystals  Crystals are deposited in joints/tendons/tissues causing:  Pain, redness, swelling, progressive joint damage  Labs- Sed rate, uric acid level, CBC  Treatment and prevention  Lifestyle changes0 eating less shell fish, salmon, red mean, pork, beer/wine, high fructose corn syrup  Lowing weight, avoiding alcohol, low dairy, low carb  Antigout Drugs  Uric acid synthesis inhibitors (treat symptoms not cause)  Allopurinol (Aloprim)  Febuxostat (Uloric)  Actions and uses  Reducing the amount of an enzyme that converts the purines in protein into uric acid in order to reduce gout attacks  Expected side effects/adverse reactions  Headache, rash, and minor nausea/kidney stones, liver failure, heart failure, and stroke  Drug interactions  Aluminum-based antacids, warfarin, chemotherapy drugs Antigout Drugs  Nursing Implications  Take allopurinol after a full meal  Drink 8-16 glasses water  Wait 3 hours to take an antacid  No dot use if breastfeeding  Avoid foods high in purine  Keep all follow up appointments