Chapter 16 Drug Therapy to Decrease Pain, Fever, and Inflammation PDF

Chapter 16 Drug Therapy to Decrease Pain, Fever, and Inflammation  Chemical mediators found in most body Prostaglandins tissues oAssist in regulating many body functions oParticipate in the inflammatory response oAre formed...

Chapter 16 Drug Therapy to Decrease Pain, Fever, and Inflammation  Chemical mediators found in most body Prostaglandins tissues oAssist in regulating many body functions oParticipate in the inflammatory response oAre formed when cellular injury occurs oExert various and opposing effects on various body tissues 2 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #1 Prostaglandins are chemical mediators found in the central nervous system. 3 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #1 Rationale: Prostaglandins are chemical mediators found in most body tissues. 4 Copyright © 2025 Wolters Kluwer. All rights reserved.  Inhibit prostaglandin synthesis in CNS and NSAIDs’ PNS Mechanism of Action #1 Inhibit COX-1 and COX-2 enzymes oRequired for prostaglandin production Relieve pain by acting centrally and peripherally to block pain impulse transmission 5 Copyright © 2025 Wolters Kluwer. All rights reserved.  Relieve fever by decreasing hypothalamic NSAIDs’ response and resetting “thermostat” at a Mechanism of lower level. Action #2 Aspirin and nonselective NSAIDs also have antiplatelet effect. Acetaminophen is not an NSAID nor does it have anti-inflammatory properties or inhibit platelet aggregation. 6 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #2 Body temperature is controlled by a regulating center in the hypothalamus. 7 Copyright © 2025 Wolters Kluwer. All rights reserved.  True Answer to Question #2 Rationale: Body temperature is controlled by a regulating center in the hypothalamus. 8 Copyright © 2025 Wolters Kluwer. All rights reserved.  Act both centrally and peripherally to block Salicylates: the transmission of pain impulses Aspirin oReduce fever by acting on the hypothalamus oDiminish inflammation oSuppress platelet aggregation oLow dose indicated to manage Ischemic stroke, transient ischemic attack, angina, and acute myocardial infarction See Table 16.4. 9 Copyright © 2025 Wolters Kluwer. All rights reserved.  Does not cause nausea, vomiting, GI bleeding, Acetaminophen or interfere with blood clotting #1 Equal to ASA in analgesic and antipyretic effects oLacks anti-inflammatory activity Metabolized in the liver; small amount remains in the body as toxic metabolite 10 Copyright © 2025 Wolters Kluwer. All rights reserved.  Acute or chronic overdose can result in liver Acetaminophen damage or fatal liver necrosis. #2 Usual therapeutic doses may cause/increase liver damage in those who abuse alcohol. Available in tablet, liquid, rectal suppository. 11 Copyright © 2025 Wolters Kluwer. All rights reserved.  Prevention: maximum daily dose is 4 g (4,000 Acetaminophen mg) from all sources. Toxicity Overdose causes hepatotoxicity. Overdose may be accidental or intentional. Signs/symptoms are nonspecific. 24 to 48 hours after overdose, liver function tests begin to show increased levels. Later manifestations may include jaundice, vomiting, CNS stimulation with excitement, and delirium followed by coma and death. 12 Copyright © 2025 Wolters Kluwer. All rights reserved.  Gastric lavage and activated charcoal Acetaminophen oIf overdose detected within 4 hours after Toxicity ingestion Treatment Antidote oAcetylcysteine oOral or IV oMost beneficial if given within 8 hours after ingestion, may be helpful within 36 hours oDoes NOT reverse damage already sustained 13 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #3 Acetaminophen poisoning may occur with a single large dose or with chronic ingestion of excessive doses. 14 Copyright © 2025 Wolters Kluwer. All rights reserved.  True Answer to Question #3 Rationale: Acetaminophen poisoning may occur with a single large dose or with chronic ingestion of excessive doses. 15 Copyright © 2025 Wolters Kluwer. All rights reserved.  Propionic acid derivatives: ibuprofen Nonsteroidal Anti- oInhibits prostaglandin synthesis in both the central inflammatory and peripheral nervous systems Drugs Oxicam derivatives: meloxicam Acetic acid derivatives: indomethacin oStrong anti-inflammatory effects and more severe adverse effects than the propionic acid derivatives Selective COX-2 inhibitor: celecoxib oSelectively block production of prostaglandins associated with pain and inflammation without blocking those associated with protective effects on gastric mucosa, kidney function, and platelet aggregation 16 Copyright © 2025 Wolters Kluwer. All rights reserved.  Inflammatory disorders (Inflammation is the Indications for normal body response to tissue damage; it is NSAID Use #1 an attempt to remove the damaging agent and repair the damaged tissue.) oNSAIDs are widely used to prevent/treat mild to moderate pain and inflammation. Degenerative joint disease, osteoarthritis, rheumatoid arthritis, bursitis oAcetaminophen lacks anti-inflammatory properties but can be used as an analgesic. 17 Copyright © 2025 Wolters Kluwer. All rights reserved.  To relieve pain (the sensation of discomfort, Indications for hurt, or distress) NSAID Use #2 oNSAIDs and acetaminophen effective in treating mild to moderate pain Headache, minor trauma, minor surgery, other acute or chronic conditions Not recommended for visceral pain 18 Copyright © 2025 Wolters Kluwer. All rights reserved.  To reduce fever (elevation of body Indications for temperature above the normal range) NSAID Use #3 oNSAIDs and acetaminophen effective oASA not used with children because of risk of Reye syndrome To suppress platelet aggregation oRegular low-dose ASA effective for patients with history of ischemic stroke, TIA, angina, acute MI oReduces risk of death or recurrent event 19 Copyright © 2025 Wolters Kluwer. All rights reserved.  Increased risk of serious GI adverse events Contraindications oBleeding for NSAID Use #1 oUlceration oPerforation of stomach and intestines Contraindicated in the presence of oPeptic ulcer disease oGI or other bleeding disorders oAbnormal kidney function 20 Copyright © 2025 Wolters Kluwer. All rights reserved.  Hypersensitivity to ASA Contraindications Chronic alcohol abuse for NSAID Use #2 oGastric bleeding Children and adolescents oPresence of viral infections Due to its connection with Reye syndrome 21 Copyright © 2025 Wolters Kluwer. All rights reserved.  Pregnancy Contraindications oPotential for anemia from GI blood loss for NSAID Use #3 oPotential for postpartum hemorrhage Potential risks to the fetus oLow birth weight, kidney toxicity oPremature closure of ductus arteriosus oIntracranial hemorrhage, stillbirth 22 Copyright © 2025 Wolters Kluwer. All rights reserved.  Gout is characterized by an overproduction of Antigout uric acid or an inability to excrete uric acid. Medication oMitotic agent: colchicine For the treatment and prevention of gout Inhibits the migration of white blood cells into the body tissues containing urate crystals; decreases the inflammatory reaction to the urate crystals deposited in the tissues oUricosuric agents: allopurinol Used to reduce serum uric acid levels 23 Copyright © 2025 Wolters Kluwer. All rights reserved.