Anti-Inflammatory Meds Exam 4

Nursing 6200 with Gilliam/stark at Medical College of Georgia

About this deck

By: Debbie Warren
Textbook:

Nutrition & Diet Therapy: Evidence-Based Applications

Pharmacology for Nursing Care, 7th Edition (Book & CD-ROM)
Created: 2010-04-15
Size: 30 flashcards
Views: 4

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Cyclooxygenase (COX)

Enzyme converts arachidonic acid into prostanoids: prostaglandins and related compounds
Found in all tissues
Multiple jobs
Two forms
Cox 1
Cox 2

COX 1 Inhibition

Gastric erosion and ulceration
Bleeding tendencies
Renal impairment
Reduced platelet aggregation -> protection against MI and stroke
Colon cancer protection

Cox 2 Inhibition

Suppression of inflammation
Alleviation of pain
Reduction of fever
Renal impairment

Dosage

age and condition dependent

Side effects

GI effects, GI bleeding, renal impairment, salicylism, Reye’s syndrome

First Generation NSAIDS

Aspirin
Non-aspirin NSAID

Multiple formulations

plain, buffered, enteric coated, suppositories

Second Generation NSAIDs

Celebrex

Characteristics

tinnitus, sweating, headache, dizziness, acid-base disturbance ? progression to stupor, coma, respiratory depression in poisoning

Aspirin - Adverse Effect

GI effects ? heartburn, nausea
GI bleeding
Occult loss
Gastric ulceration
Bleeding
Renal impairment
Hypersensitivity

Salicylism and Poisoning

Characteristics: tinnitus, sweating, headache, dizziness, acid-base disturbance progression to stupor, coma, respiratory depression in poisoning
Poisoning can be lethal in children
Levels ? symptoms can appear at levels 200 mcg/ml, but toxicity occurs > 400mcg/ml
If symptoms, withhold dose until symptoms subside, resume with small dosage.
Poisoning ? supportive treatment

Aspirin - Drug Interactions

Anticoagulants
Glucocorticoids
Alcohol
Ibuprofen
ACE inhibitors and ARBS

Non-Aspirin, 1 st Generation NSAID

Ibuprofen (Advil, Motrin)
Naproxen (Naprosyn)
Naproxen sodium (Aleve)

Uses

pain, inflammation and fever suppression

2 nd Generation NSAIDS

Selective inhibitors of COX 2
Celecoxib (Celebrex)
Uses: pain, inflammation and fever suppression
Differences in comparison to 1 st generations
Adverse effects: dyspepsia, abd. pain, ulcerations, cardiac events, renal

Routes

oral, rectal

Adult dosage

325-650 mg every 4-6 hours

Pediatric dose

weight based

Acetaminophen

Inhibition of prostaglandin synthesis in the CNS
Preferred use over NSAIDS for children
Routes: oral, rectal
Adult dosage: 325-650 mg every 4-6 hours
Pediatric dose: weight based
Adverse effects: rare, HPT
Overdose can cause severe liver injury!

Adverse effects

rare, HPT

Differences in comparison to 1 st generations

) less gastric ulceration
) don?t inhibit platelet aggregation

Chronic Pain Management

AHA recommendations
If drugs needed, lowest dose, shortest time
Stepwise approach
Non-drug measures
Drug therapy with acetaminophen or aspirin
Non-selective NSAIDS ? ibuprofen, naproxen
Selective COX 2 inhibitor (last choice for chronic pain management
In steps 2, 3, 4 - if client at risk for thrombosis, and not already taking aspirin use low-dose aspirin and a PPI

Nursing Implications

Take NSAIDS with food, milk or a glass of water
Don?t crush or chew enteric coated tablets
Education about adverse reactions
Check expiration dates on bottles
Watch for drug-drug interactions

Physiologic Effects

Metabolism
Carbohydrate, protein and fats
Cardiovascular
Vascular integrity
Effect on RBC, WBC
Effects during stress
Maintain B/P, glucose
Effects on Water and Electrolytes
Promote Na, H20 retention, K+ excretion
Neonatal respiratory system

Action

penetrate cell membrane ? activate cytoplasmic receptors ? travel to cell nucleus ?activity of genes that code for specific activities is regulated

Use

arthritis, allergic disorders, asthma, cancer, IBD, cancer, suppression of organ rejection, prevention of resp

Glucorticoids

Action: penetrate cell membrane activate cytoplasmic receptors travel to cell nucleus activity of genes that code for specific activities is regulated
Pharmacologic effects anti-inflammatory, immunosuppressive effects
Use: arthritis, allergic disorders, asthma, cancer, IBD, cancer, suppression of organ rejection, prevention of resp. distress in premature infants
Key Point

Adverse Effects

Osteoporosis
Increased risk of infection
Glucose intolerance
Fluid/electrolyte imbalances
Myopathy/muscle wasting
Growth retardation
Cataracts, glaucoma
Peptic ulcer disease
Cushing syndrome

Glucocorticoids

Common meds
Dexamethasone (Decadron)
Methylprednisolone (Medrol)
Prednisone (Deltasone)
Use in pregnancy/lactation
Drug interactions
Administration ? PO, IV, IM, Sub-Q, topical, intranasal, local injection, inhalation

Adrenal Suppression

High pharmacologic levels suppression
Long-term adrenal atrophy
Adrenal recovery period varies ? days to year, based on length of use not dose
At times of stress, increased dosages are required
Withdrawal slow