Chapter 12
Anti-inflammatory
Agents
Nonsteroidal Anti-inflammatory
Drugs



Group of frequently prescribed drugs
Treat pain
Common drug


Acetylsalicylic acid (ASA)
Hermann Kolbe
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Uses for NSAIDs






Analgesic (mild to moderate)
Antigout
Anti-inflammatory
Antipyretic
Relief of vascular headaches
Platelet inhibition
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How NSAIDs Work


Stop the activation of the arachidonic
acid pathway
Reduce:




Pain
Headache
Fever
Inflammation
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Analgesics

Reduce pain by blocking prostaglandins
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Antipyretics

Inhibit prostaglandin E2 in the brain
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Inflammation Relief

Inhibit either the:



Leukotriene pathway
Prostaglandin pathway
Or both pathways
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Pain Relief

Relief of mild to moderate pain





Bone, joint, and muscle pain
Osteoarthritis
Rheumatoid arthritis
Juvenile rheumatoid arthritis
Dysmenorrhea
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Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Common NSAIDs
Common drugs that are used:





Ibuprofen (Motrin, Advil)
Ketoprofen (Orudis)
Ketorolac (Toradol)
Naproxen (Naprosyn)
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Gastrointestinal Side Effects
First-generation NSAIDs




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Dyspepsia, heartburn, epigastric distress,
nausea
Gastrointestinal bleeding
Mucosal lesions (erosions or ulcerations)
(continues)
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(continued)
Gastrointestinal Side Effects
Second-generation NSAIDs


Called COX-2 inhibitors


More specific in their action
Reduce gastrointestinal distress
12 - 11
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Cardiovascular Side Effects

Second-generation NSAIDs

Serious side effects:





Cardiac arrhythmias
Heart attack
Stroke
Celecoxib (Celebrex) may be removed
Rofecoxib (Vioxx) removed from market by
the FDA
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Precautions

First and second generation

Do not take if you:






Have or had stomach ulcers and bleeding
Have had asthma
Have had an allergic response to aspirin or sulfa
Have severe kidney problems
Have severe liver problems
Are pregnant
12 - 13
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Renal Side Effects


Creatinine clearance reduced
Renal failure

Acute tubular necrosis
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Nursing Assessment
Before beginning therapy, perform
thorough assessment for:





Gastrointestinal lesions or peptic ulcer
disease
Bleeding disorders
Heart disorders
Perform lab studies

CBC, platelet count, cardiac, renal, and liver
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Medical History


Medication history
Serious drug interactions





Alcohol
Heparin and warfarin (Coumadin)
Phenytoin
Steroids
Sulfonamides
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Salicylates

Do not give salicylates to children under
age 12.


Reye’s syndrome
Give with food and milk.
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Client Education


Educate clients about precautions.
Watch for:


Unusual bleeding, abdominal pain, and
cardiac problems
Enteric-coated tablets should not be
crushed or chewed.
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Therapeutic Effects

Monitor for:



Decrease in swelling
Decrease in pain
Decrease in joint tenderness
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