Anti-inflammatory and Antigout Drugs Chapter 44 PDF

Chapter 44: Anti-inflammatory and Antigout Drugs Copyright © 2017, Elsevier Inc. All rights reserved. Inflammation Protective Response Signs and Symptoms Stimulated by injury to Pain, fever, loss of function, tissues. redness, and swelling. Endogen...

Chapter 44: Anti-inflammatory and Antigout Drugs Copyright © 2017, Elsevier Inc. All rights reserved. Inflammation Protective Response Signs and Symptoms Stimulated by injury to Pain, fever, loss of function, tissues. redness, and swelling. Endogenous Compounds Proteins of the complement system, histamine, serotonin, bradykinin, leukotrienes, and prostaglandins. Nonsteroidal Antiinflammator y Drugs (NSAIDs) Large and chemically diverse group of drugs. Analgesic, antiinflammatory, antipyretic, and aspirin-platelet inhibition properties. Uses of NSAIDs Headaches Myalgia Postoperative Pain Relief of mild to moderate Relief of muscle pain. Alleviation of postoperative pain. headaches. Properties of NSAIDs Shared Properties Salicylates Antipyretic, analgesic, and antiinflammatory. Aspirin Diflunisal Salsalate Choline salicylate Acetic Acid Derivatives Diclofenac Sodium Indomethacin Ketorolac Voltaren Indocin Toradol Propionic Acid Derivatives Fenoprofen Flurbiprofen Ibuprofen Brand name: Nalfon Brand name: Ansaid Brand names: Motrin, Advil Ketoprofen Naproxen Brand name: Orudis KT Brand names: Naprosyn, Aleve Aspirin Benefits Cardiac Death First Sign Emergency Department Reduces cardiac death after MI. Administer at the first sign of MI. One of the first drugs given if no contraindications. NSAIDs: Mechanism of Action Inhibition 1 Leukotriene pathway, prostaglandin pathway, or both Blocking 2 Chemical activity of enzyme COX COX-1 3 Role in maintaining GI mucosa 4 COX-2 Aspirin Mechanism Irreversible Inhibitor Reduced Thromboxane A2 Other NSAIDs Aspirin irreversibly inhibits COX-1 Reduces formation of thromboxane Other NSAIDs lack these antiplatelet receptors in platelets. A2, promoting platelet aggregation. effects. NSAIDs: Contraindications Drug Allergy Type 2 Diabetes Bleeding Risk Known drug allergy. Contraindicated with glucosamine. Vitamin K deficiency Peptic ulcer disease NSAIDs: Adverse Effects GI Effects Renal Effects Range from heartburn to Can cause acute renal failure. severe GI bleeding. Cardiovascular Other Effects Effects Altered hemostasis, Increased risk of MI and hepatotoxicity, skin stroke. reactions, tinnitus, and hearing loss. Misoprostol (Cytotec) Adverse Effects GI Bleed Prevention Many adverse effects of Misoprostol prevents NSAIDs are secondary to gastrointestinal bleeding. inactivation of protective prostaglandins. Synthetic Mechanism of Action Prostaglandin Mechanism of action is Synthetic prostaglandin E1 unclear. analogue inhibits gastric acid secretion. NSAIDs and Renal Function 1 Renal Function 2 Disruption Renal function depends NSAIDs can disrupt on prostaglandins. prostaglandin function. 3 Compromised 4 Renal Toxicity Function Renal toxicity can occur NSAIDs can compromise in patients with existing renal function. dehydration, heart failure, liver dysfunction, or use of diuretics or ACE inhibitors. NSAIDs: Black Box Warning Cardiovascular Risk Aspirin Exception Increased risk of adverse cardiovascular thrombotic Aspirin is the only NSAID without this warning. events. Includes fatal MI and stroke. Aspirin Dosage Prophylactic Therapy Daily tablet (81 mg or 325 mg) for adults with high risk factors. Effective After MI Effective after myocardial infarction. Dosage Strength 81- and 325-mg strengths equally beneficial for preventing thrombotic events. Aspirin: Uses Headache Inflammation Systemic Lupus Antipyretic Neuralgia, myalgia, and Arthritis, pleurisy, and Antirheumatic effects Reduce fever arthralgia pericarditis Audience Response: Aspirin Indication Aspirin 325 mg daily indication. Thromboprevention. Aspirin: Reye's Syndrome Acute Condition Viral Trigger Potentially life-threatening Triggered by viral illnesses condition involving such as influenza. progressive neurologic deficits. Salicylate Therapy Neurologic Damage Triggered by salicylate Survivors may or may not therapy itself in the have permanent neurologic presence of a viral illness. damage. Salicylates Salicylic acid (aspirin) Inhibits platelet aggregation Antithrombotic effect: used in the treatment of MI and other thromboembolic disorders Reye's syndrome Salicylates - Tylenol Overdose Salicism Increased heart rate Hyperventilation & drowsiness seen in toxicity Tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion Mucomyst - acetylcysteine Audience Response: Salicylate Toxicity Patient admitted with salicylate toxicity. Nurse anticipates manifestations associated with salicylate toxicity. Acetic Acid Derivatives: Indomethacin Uses RA OA Acute bursitis or tendonitis Ankylosing spondylitis Acute gouty arthritis Pericarditis Treatment of preterm labor Administration Oral, rectal, intravenous use. Adverse Effects Biggest adverse effect is nausea and vomiting. Acetic Acid Derivatives: Ketorolac Antiinflammatory Analgesic Effects Indication Adverse Effects Activity Used for powerful Short-term use (up to 5 Renal impairment, Ketorolac (Toradol) has analgesic effects, days) for moderate to edema, GI pain, antiinflammatory comparable to morphine. severe acute pain. dyspepsia, and nausea. activity. Analgesic Choice Indocin is an acetic acid derivative. Audience Response: Ketorolac Duration Ketorolac (Toradol) is typically ordered for 5 days. This is due to the risk of severe renal and GI effects. Propionic Acid Derivatives 1 Ibuprofen 2 Naproxen Most commonly used Second most commonly NSAID. used NSAID. 3 Adverse Effect 4 Drug Interactions Profile Fewer drug interactions Naproxen has a better with ACE inhibitors. adverse effect profile than ibuprofen. COX-2 Inhibitor Celecoxib (Celebrex) Indications Adverse Effects First and only remaining COX-2 OA, RA, acute pain, ankylosing Headache, sinus irritation, diarrhea, inhibitor. spondylitis, and primary fatigue, dizziness, lower extremity dysmenorrhea. edema, and hypertension. NSAIDs: Adverse Effects GI Renal Dyspepsia, heartburn, Reductions in creatinine epigastric distress, nausea. clearance. GI bleeding and mucosal Acute tubular necrosis with lesions. renal failure. Cardiovascular Noncardiogenic pulmonary edema. Audience Response: Ibuprofen Monitoring Ibuprofen can cause renal toxicity. Monitor renal function studies. NSAIDs: Nursing Implications Contraindications Cautious Use Assess for conditions that Assess for conditions that may be contraindications to require cautious use. therapy. GI lesions or peptic ulcer disease Bleeding disorders Laboratory Studies Perform laboratory studies as indicated. Nursing Implications (Cont.) Salicylate Warning Do not give salicylates to children and teenagers. GI Distress Take with food, milk, or antacid to avoid irritation. Therapeutic Effects May not be seen for 3 to 4 weeks. Audience Response: Alcohol Interaction Increased chance for GI bleeding. Nursing Implications (Cont.) Adverse Effects Bleeding Educate patients about adverse effects. Watch for unusual bleeding, such as in the stool. Notify prescriber if effects are severe. Advise patients to not crush or chew enteric-coated tablets. Gout Gout Uric Acid Uric Acid Crystals Hyperuricemia Results from inappropriate Underexcretion or Deposited in tissues and High levels of uric acid in uric acid metabolism. overproduction of uric joints, causing pain. the blood. acid. Antigout Drugs Allopurinol (Zyloprim) Febuxostat (Uloric) Colchicine (Colcyrs) Probenecid (Benemid) Sulfinpyrazone (Anturane) Antigout Drugs: Indications 1 Allopurinol 2 Probenecid (Zyloprim) (Benemid) Prevents uric acid Inhibits uric acid production. reabsorption in kidneys. Antigout Drugs: Indications (Cont.) Colchicine Gout Management Adverse Effects Reduces inflammatory response to Short-term management or May cause leukopenia and bleeding. urate crystals. prevention of gout.