Drug Name

Generic Name: baclofen

Brand Name: Apo-Baclofen (CAN), Gen-Baclofen (CAN), Lioresal, Lioresal
Intrathecal
Classification: Centrally acting skeletal muscle relaxant
Pregnancy Category C

Dosage & Route

 PO 5 mg 3 times/day for 3 days, increased to 10 mg 3 times/day for 3
days. May further increase if needed. Max: 100 mg/day. Intrathecal Test
dose: 25 or 50 mcg. Increase dose by 25 mcg not more often than 24 hrly
until 100 mcg/dose to determine appropriate dose. Responders w/
response lasting >8-12 hr, the test dose that was used to produce the
response can be given as a 24-hr infusion; if the response lasted ≤8-12 hr,
then a dose equivalent to twice the test dose is given. Adjust daily dosage
as required. Maintenance: 12 mcg-2 mg/day for spasticity of spinal origin;
22 mcg-1.4 mg/day for spasticity of cerebral origin.
Therapeutic actions
 Baclofen is an antispastic. It inhibits both monosynaptic and
polysynaptic reflexes at spinal level.
Indications
 Alleviation of signs and symptoms of spasticity resulting from MS,
particularly for the relief of flexor spasms and concomitant pain, clonus,
muscular rigidity (for patients with reversible spasticity to aid in restoring
residual function); treatment of central spasticity (via SynchroMed pump)
 Spinal cord injuries and other spinal cord diseases—may be of some
value
 Unlabeled uses: Trigeminal neuralgia (tic douloureux); may be beneficial
in reducing spasticity in cerebral palsy in children (intrathecal use)
Adverse effects
 Sedation, drowsiness, ataxia, dizziness, headache, confusion,
hallucinations, skin reactions, GI symptoms, enuresis.
 Potentially Fatal: Respiratory or CV depression, seizures.
Contraindications
 Hypersensitivity. Active peptic ulcer disease.
Nursing considerations
Assessment
 History: Hypersensitivity to baclofen, skeletal muscle spasm resulting
from rheumatic disorders, stroke, cerebral palsy, Parkinson’s disease,
seizure disorders, lactation, pregnancy
 Physical: Weight; T; skin color, lesions; orientation, affect, reflexes,
bilateral grip strength, visual examination; P, BP; bowel sounds, normal GI
output, liver evaluation; normal urinary output; LFTs, renal function tests,
blood and urine glucose
Interventions
 Patients given implantable device for intrathecal delivery need to learn
about the programmable delivery system, frequent checks; how to adjust
dose and programming.
 Give with caution to patients whose spasticity contributes to upright
posture or balance in locomotion or whenever spasticity is used to
increase function.
 BLACK BOX WARNING: Taper dosage gradually to prevent
hallucinations, possible psychosis, or other serious effects; abrupt
discontinuation can cause serious reactions.
Teaching points
 Take this drug exactly as prescribed. Do not stop taking this drug
without consulting your health care provider; abrupt discontinuation may
cause hallucinations or other serious effects.
 Avoid alcohol, sleep-inducing, or over-the-counter drugs because these
could cause dangerous effects.
 Do not take this drug during pregnancy. If you decide to become
pregnant or find that you are pregnant, consult your health care provider.
 You may experience these side effects: Drowsiness, dizziness,
confusion (avoid driving or engaging in activities that require alertness);
nausea (eat frequent small meals); insomnia, headache, painful or
frequent urination (effects reversible; will go away when the drug is
discontinued).
 Report frequent or painful urination, constipation, nausea, headache,
insomnia, or confusion that persists or is severe.

Drug Name
Generic Name : diazepam
Brand Name: Apo-Diazepam (CAN), Diastat, Diazemuls (CAN), Diazepam
Intensol, Valium
Classification: Benzodiazepine, Anxiolytic, Antiepileptic, Skeletal
muscle relaxant (centrally acting)
 Pregnancy Category D
 Controlled Substance C-IV
Dosage & Route
Dosages
 Individualize dosage; increase dosage cautiously to avoid adverse
effects.
ADULTS
Oral
 Anxiety disorders, skeletal muscle spasm, seizure disorders: 2–10 mg
bid–qid.
 Alcohol withdrawal: 10 mg tid–qid first 24 hr; reduce to 5 mg tid–qid, as
needed.
Oral sustained-release
 Anxiety disorders: 15–30 mg/day.
 Alcohol withdrawal: 30 mg first 24 hr; reduce to 15 mg/day as needed.
Rectal
 0.2 mg/kg PR; treat no more than one episode q 5 days. May give a
second dose in 4–12 hr.
Parenteral
Usual dose is 2–20 mg IM or IV. Larger doses may be required for some
indications (tetanus). Injection may be repeated in 1 hr.

 Anxiety: 2–10 mg IM or IV; repeat in 3–4 hr if necessary.

 Alcohol withdrawal: 10 mg IM or IV initially, then 5–10 mg in 3–4 hr if
necessary.
 Endoscopic procedures: 10 mg or less, up to 20 mg IV just before
procedure or 5–10 mg IM 30 min prior to procedure. Reduce or omit
dosage of opioids.
 Muscle spasm: 5–10 mg IM or IV initially, then 5–10 mg in 3–4 hr if
necessary.
 Status epilepticus: 5–10 mg, preferably by slow IV. May repeat q 5–10
min up to total dose of 30 mg. If necessary, repeat therapy in 2–4 hr; other
drugs are preferable for long-term control.
 Preoperative: 10 mg IM.
 Cardioversion: 5–15 mg IV 5–10 min before procedure.
PEDIATRIC PATIENTS
Oral
 > 6 mo: 1–2.5 mg PO tid–qid initially. Gradually increase as needed and
tolerated. Can be given rectally if needed.
Rectal
 < 2 yr: Not recommended.
 2–5 yr: 0.5 mg/kg.
 6–11 yr: 0.3 mg/kg.
 >12 yr: Use adult dose; may give a second dose in 4–12 hr.
Parenteral
Maximum dose of 0.25 mg/kg IV administered over 3 min; may repeat after
15–30 min. If no relief of symptoms after three doses, adjunctive therapy is
recommended.

 Tetanus (> 1 mo): 1–2 mg IM or IV slowly q 3–4 hr as necessary.

 Tetanus (> 5 yr): 5–10 mg q 3–4 hr.
 Status epilepticus (> 1 mo–< 5 yr): 0.2–0.5 mg slowly IV q 2–5 min up to
a maximum of 5 mg.
 Status epilepticus (> 5 yr): 1 mg IV q 2–5 min up to a maximum of 10
mg; repeat in 2–4 hr if necessary.
GERIATRIC PATIENTS OR PATIENTS WITH DEBILITATING DISEASE
 2–2.5 mg PO daily–bid or 2–5 mg parenteral initially; reduce rectal
dose. Gradually increase as needed and tolerated; use cautiously.
Therapeutic actions
 Diazepam is a long-acting benzodiazepine with anticonvulsant,
anxiolytic, sedative, muscle relaxant and amnestic properties. It increases
neuronal membrane permeability to chloride ions by binding to
stereospecific benzodiazepine receptors on the postsynaptic GABA
neuron within the CNS and enhancing the GABA inhibitory effects resulting
in hyperpolarisation and stabilisation.
Indications
 Management of anxiety disorders or for short-term relief of symptoms
of anxiety
 Acute alcohol withdrawal; may be useful in symptomatic relief of acute
agitation, tremor, delirium tremens, hallucinosis
 Muscle relaxant: Adjunct for relief of reflex skeletal muscle spasm due
to local pathology (inflammation of muscles or joints) or secondary to
trauma; spasticity caused by upper motoneuron disorders (cerebral palsy
and paraplegia); athetosis, stiff-man syndrome
 Parenteral: Treatment of tetanus
 Antiepileptic: Adjunct in status epilepticus and severe recurrent
convulsive seizures (parenteral); adjunct in seizure disorders (oral)
 Preoperative (parenteral): Relief of anxiety and tension and to lessen
recall in patients prior to surgical procedures, cardioversion, and
endoscopic procedures
 Rectal: Management of selected, refractory patients with epilepsy who
require intermittent use to control bouts of increased seizure activity
 Unlabeled use: Treatment of panic attacks
Adverse effects
 Psychological and physical dependence with withdrawal syndrome;
fatigue, drowsiness, sedation, ataxia, vertigo, confusion, depression, GI
disturbances, changes in salivation, amnesia, jaundice, paradoxical
excitation, elevated liver enzyme values; muscle weakness, visual
disturbances, headache, slurring of speech and dysarthria; mental
 changes; incontinence, constipation; hypotension, tachycardia; changes in
libido; pain and thrombophloebitis at Inj site (IV).
 Potentially Fatal: Respiratory and CNS depression; coma.
Contraindications
 Hypersensitivity; preexisting CNS depression or coma, respiratory
depression; acute pulmonary insufficiency or sleep apnoea; severe hepatic
impairment; acute narrow angle glaucoma; children < 6 mth; pregnancy
and lactation.
Nursing considerations
Assessment
 History: Hypersensitivity to benzodiazepines; psychoses, acute narrow-
angle glaucoma, shock, coma, acute alcoholic intoxication; elderly or
debilitated patients; impaired liver or renal function; pregnancy, lactation
 Physical: Weight; skin color, lesions; orientation, affect, reflexes, sensory
nerve function, ophthalmologic examination; P, BP; R, adventitious sounds;
bowel sounds, normal output, liver evaluation; normal output; LFTs, renal
function tests, CBC
Interventions
 WARNING: Do not administer intra-arterially; may produce arteriospasm,
gangrene.
 Change from IV therapy to oral therapy as soon as possible.
 Do not use small veins (dorsum of hand or wrist) for IV injection.
 Reduce dose of opioid analgesics with IV diazepam; dose should be
reduced by at least one-third or eliminated.
 Carefully monitor P, BP, respiration during IV administration.
 WARNING: Maintain patients receiving parenteral benzodiazepines in
bed for 3 hr; do not permit ambulatory patients to operate a vehicle
following an injection.
 Monitor EEG in patients treated for status epilepticus; seizures may
recur after initial control, presumably because of short duration of drug
effect.
 Monitor liver and renal function, CBC during long-term therapy.
 Taper dosage gradually after long-term therapy, especially in epileptic
patients.
 Arrange for epileptic patients to wear medical alert ID indicating that
they are epileptics taking this medication.
 Discuss risk of fetal abnormalities with patients desiring to become
pregnant.
Teaching points
 Take this drug exactly as prescribed. Do not stop taking this drug (long-
term therapy, antiepileptic therapy) without consulting your health care
provider.
 Caregiver should learn to assess seizures, administer rectal form, and
monitor patient.
 Use of barrier contraceptives is advised while using this drug; if you
become or wish to become pregnant, consult with your health care
provider.
 It is advisable to wear a medical alert ID indicating your diagnosis and
treatment (as antiepileptic).
 You may experience these side effects: Drowsiness, dizziness (may
lessen; avoid driving or engaging in other dangerous activities); GI upset
(take drug with food); dreams, difficulty concentrating, fatigue,
nervousness, crying (reversible).
 Report severe dizziness, weakness, drowsiness that persists, rash or
skin lesions, palpitations, swelling of the ankles, visual or hearing
disturbances, difficulty voiding.
Drug Name
Generic Name: aspirin
Brand Name:Apo-ASA (CAN), Aspergum, Bayer, Easprin, Ecotrin, Empirin,
Entrophen (CAN), Genprin, Halfprin 81, 1/2 Halfprin, Heartline, Norwich,
Novasen (CAN), PMS-ASA (CAN), ZORprin, Alka-Seltzer, Ascriptin, Asprimox,
Bufferin, Buffex, Magnaprin
Classification: Antipyretic, Analgesic (nonopioid), Anti-
inflammatory, Antirheumatic, Antiplatelet, Salicylate, NSAID

Pregnancy Category D
Dosage & Route
 Available in oral and suppository forms. Also available as chewable
tablets, gum; enteric coated, SR, and buffered preparations (SR aspirin is
not recommended for antipyresis, short-term analgesia, or children < 12
yr.)
ADULTS
 Minor aches and pains: 325–650 mg q 4 hr.
 Arthritis and rheumatic conditions: 3.2–6 g/day in divided doses.
 Acute rheumatic fever: 5–8 g/day; modify to maintain serum
salicylate level of 15–30 mg/dL.
 TIAs in men:1,300 mg/day in divided doses (650 mg bid or 325 mg
qid).
 MI prophylaxis: 75–325 mg/day.
PEDIATRIC PATIENTS
 Analgesic and antipyretic: 65 mg/kg per 24 hr in four to six divided
doses, not to exceed 3.6 g/day. Dosage recommendations by age:
Age (yr) Dosage(mg q 4 hr)

2–3 162

4–5 243

6–8 324

9–10 405

11 486

³ 12 648
 Juvenile rheumatoid arthritis: 60–110 mg/kg per 24 hr in divided
doses at 6- to 8-hr intervals. Maintain a serum level of 150–300 mcg/mL.
 Acute rheumatic fever: Initially, 100 mg/kg/day, then decrease to 75
mg/kg/day for 4–6 wk. Therapeutic serum salicylate level is 150–300
mg/dL.
 Kawasaki disease: 80–180 mg/kg/day; very high doses may be
needed during acute febrile period; after fever resolves, dosage may be
adjusted to 10 mg/kg/day.
Therapeutic actions
 Analgesic and antirheumatic effects are attributable to aspirin’s ability
to inhibit the synthesis of prostaglandins, important mediators of
inflammation. Antipyretic effects are not fully understood, but aspirin
probably acts in the thermoregulatory center of the hypothalamus to block
effects of endogenous pyrogen by inhibiting synthesis of the
prostaglandin intermediary. Inhibition of platelet aggregation is
attributable to the inhibition of platelet synthesis of thromboxane A2, a
potent vasoconstrictor and inducer of platelet aggregation. This effect
occurs at low doses and lasts for the life of the platelet (8 days). Higher
doses inhibit the synthesis of prostacyclin, a potent vasodilator and
inhibitor of platelet aggregation.
Indications
 Mild to moderate pain
 Fever
 Inflammatory conditions—rheumatic fever, rheumatoid arthritis,
osteoarthritis
 Reduction of risk of recurrent TIAs or stroke in males with history of TIA
due to fibrin platelet emboli
 Reduction of risk of death or nonfatal MI in patients with history of
infarction or unstable angina pectoris
 MI prophylaxis
 Unlabeled use: Prophylaxis against cataract formation with long-term
use
Adverse effects
 Acute aspirin toxicity: Respiratory alkalosis, hyperpnea, tachypnea,
hemorrhage, excitement, confusion, asterixis, pulmonary edema, seizures,
tetany, metabolic acidosis, fever, coma, CV collapse, renal and respiratory
failure (dose related, 20–25 g in adults, 4 g in children)
 Aspirin intolerance: Exacerbation of bronchospasm, rhinitis (with
nasal polyps, asthma, rhinitis)
 GI: Nausea, dyspepsia, heartburn, epigastric discomfort, anorexia,
hepatotoxicity
 Hematologic: Occult blood loss, hemostatic defects
 Hypersensitivity: Anaphylactoid reactions to anaphylactic shock
 Salicylism: Dizziness, tinnitus, difficulty hearing, nausea, vomiting,
diarrhea, mental confusion, lassitude (dose related)
Contraindications
 Contraindicated with allergy to salicylates or NSAIDs (more common
with nasal polyps, asthma, chronic urticaria); allergy to tartrazine (cross-
sensitivity to aspirin is common); hemophilia, bleeding ulcers,
hemorrhagic states, blood coagulation defects, hypoprothrombinemia,
vitamin K deficiency (increased risk of bleeding)
 Use cautiously with impaired renal function; chickenpox, influenza (risk
of Reye’s syndrome in children and teenagers); children with fever
accompanied by dehydration; surgery scheduled within 1 wk; pregnancy
(maternal anemia, antepartal and postpartal hemorrhage, prolonged
gestation, and prolonged labor have been reported; readily crosses the
placenta; possibly teratogenic; maternal ingestion of aspirin during late
pregnancy has been associated with the following adverse fetal effects:
low birth weight, increased intracranial hemorrhage, stillbirths, neonatal
death); lactation.
Nursing considerations
Assessment
 History: Allergy to salicylates or NSAIDs; allergy to tartrazine;
hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation
defects, hypoprothrombinemia, vitamin K deficiency; impaired hepatic
function; impaired renal function; chickenpox, influenza; children with fever
accompanied by dehydration; surgery scheduled within 1 wk; pregnancy;
lactation
 Physical: Skin color, lesions; T; eighth cranial nerve function,
orientation, reflexes, affect; P, BP, perfusion; R, adventitious sounds; liver
evaluation, bowel sounds; CBC, clotting times, urinalysis, stool guaiac,
LFTs, renal function tests
Interventions
 BLACK BOX WARNING: Do not use in children and teenagers to treat
chickenpox or flu symptoms without review for Reye’s syndrome, a rare
but fatal disorder.
 Give drug with food or after meals if GI upset occurs.
 Give drug with full glass of water to reduce risk of tablet or capsule
lodging in the esophagus.
 Do not crush, and ensure that patient does not chew SR preparations.
 Do not use aspirin that has a strong vinegar-like odor.
 WARNING: Institute emergency procedures if overdose occurs: Gastric
lavage, induction of emesis, activated charcoal, supportive therapy.
Teaching points
 Take extra precautions to keep this drug out of the reach of children;
this drug can be very dangerous for children.
 Use the drug only as suggested; avoid overdose. Avoid the use of other
over-the-counter drugs while taking this drug. Many of these drugs contain
aspirin, and serious overdose can occur.
 Take the drug with food or after meals if GI upset occurs.
 Do not cut, crush, or chew sustained-release products.
 Over-the-counter aspirins are equivalent. Price does not reflect
effectiveness.
 You may experience these side effects: Nausea, GI upset, heartburn
(take drug with food); easy bruising, gum bleeding (related to aspirin’s
effects on blood clotting).
 Report ringing in the ears; dizziness, confusion; abdominal pain; rapid or
difficult breathing; nausea, vomiting, bloody stools.
Drug Name
 Generic Name : ibuprofen
 Brand Name: Advil, Advil Liqui-Gels, Advil Migraine, Apo-
Ibuprofen (CAN), Children’s Advil, Children’s Motrin, Genpril,
Infants’ Motrin, Junior Strength Advil, Junior Strength Motrin,
Menadol, Midol, Midol Maximum Strength Cramp Formula,
Motrin, Motrin IB, Motrin Migraine Pain, Novo-Profen (CAN),
Nuprin, PediaCare Fever, Pediatric Advil Drops
 Classification: NSAID, Analgesic (nonopioid), Propionic acid
derivative
 Pregnancy Category B
 Pregnancy Category D (third trimester)
Dosage & Route
ADULTS
Do not exceed 3,200 mg/day.

 Mild to moderate pain: 400 mg q 4–6 hr PO.

 Osteoarthritis or rheumatoid arthritis: 1,200–3,200 mg/day PO (300 mg
qid or 400, 600, 800 mg tid or qid; individualize dosage. Therapeutic
response may occur in a few days, but often takes 2 wk).
 Primary dysmenorrhea: 400 mg q 4 hr PO.
 OTC use: 200–400 mg q 4–6 hr PO while symptoms persist; do not
exceed 1,200 mg/day. Do not take for more than 10 days for pain or 3
days for fever, unless so directed by health care provider.
PEDIATRIC PATIENTS
 Juvenile arthritis: 30–40 mg/kg/day PO in three to four divided doses;
20 mg/kg/day for milder disease.
 Fever (6 mo–12 yr): 5–10 mg/kg PO q 6–8 hr; do not exceed 40
mg/kg/day.
Therapeutic actions
 Ibuprofen exhibits anti-inflammatory, analgesic and antipyretic
activities. Its analgesic effect is independent of anti-inflammatory activity
and has both central and peripheral effects. It potently inhibits the enzyme
cyclooxygenase resulting in the blockage of prostaglandin synthesis. It
also prevents formation of thromboxane A2 by platelet aggregation.
Indications
 Relief of signs and symptoms of rheumatoid arthritis and osteoarthritis
 Relief of mild to moderate pain
 Treatment of primary dysmenorrhea
 Fever reduction
 Unlabeled uses: Prophylactic for migraine; abortive treatment for
migraine
Adverse effects
 Oral: Dyspepsia, vomiting, abdominal pain, heartburn, nausea, diarrhoea,
epigastric pain, oedema, fluid retention, dizziness, rash, tinnitus.
Parenteral: Intraventricular haemorrhage, skin irritation, hypocalcaemia,
 hypoglycaemia, GI disorders, anaemia, apnoea, respiratory infection,
sepsis.
 Potentially Fatal: Severe CV thrombotic events. Severe GI bleeding,
ulceration and perforation.
Contraindications
 Active peptic ulcer; hypersensitivity. Neonates with congenital heart
disease, suspected necrotising enterocolitis and active bleeding
(parenteral).
Nursing considerations
Assessment
 History: Allergy to ibuprofen, salicylates or other NSAIDs; CV
dysfunction, hypertension; peptic ulceration, GI bleeding; impaired hepatic
or renal function; pregnancy; lactation
 Physical: Skin color, lesions; T; orientation, reflexes, ophthalmologic
evaluation, audiometric evaluation, peripheral sensation; P, BP, edema; R,
adventitious sounds; liver evaluation, bowel sounds; CBC, clotting times,
urinalysis, LFTs, renal function tests, serum electrolytes, stool guaiac
Interventions
 BLACK BOX WARNING: Be aware that patient may be at increased risk
of CV event, GI bleeding, monitor accordingly.
 Administer drug with food or after meals if GI upset occurs.
 Arrange for periodic ophthalmologic examination during long-term
therapy.
 Discontinue drug if eye changes, symptoms of hepatic impairment, or
renal impairment occur.
 WARNING: Institute emergency procedures if overdose occurs: Gastric
lavage, induction of emesis, and supportive therapy.
Teaching points
 Use drug only as suggested; avoid overdose. Take the drug with food or
after meals if GI upset occurs. Do not exceed the prescribed dosage.
 Avoid over-the-counter drugs. Many of these drugs contain similar
medications, and serious overdosage can occur.
 You may experience these side effects: Nausea, GI upset, dyspepsia
(take drug with food); diarrhea or constipation; drowsiness, dizziness,
vertigo, insomnia (use caution when driving or operating dangerous
machinery).
 Report sore throat, fever, rash, itching, weight gain, swelling in ankles or
fingers, changes in vision, black or tarry stools.
Drug Name
Generic Name :celecoxib
Brand Name: Celebrex
Classification: NSAID, Analgesic (nonopioid), Specific COX-2 enzyme blocker
Pregnancy Category C (first and second trimester)
Pregnancy Category D (third trimester)
Dosage & Route
Oral
 Osteoarthritis
 Adult: 200 mg as a single dose or in 2 divided doses. May
increase to 200 mg bid if necessary.
 Hepatic impairment: Child-Pugh category B: Reduce dose by
50%. Child-Pugh category C: Avoid use.
 Rheumatoid arthritis
 Adult: 100-200 mg bid.
 Elderly: 100 mg bid.
 Hepatic impairment: Child-Pugh category B: Reduce dose by
50%. Child-Pugh category C: Avoid use.
 Dysmenorrhea
 Adult: Initially, 400 mg followed by 200 mg if necessary on the
1st day. Maintenance: 200 mg bid.
 Hepatic impairment: Child-Pugh category B: Reduce dose by
50%. Child-Pugh category C: Avoid use.
 Pain
 Adult: Initially, 400 mg followed by 200 mg if necessary on the
1st day. Maintenance: 200 mg bid.
 Hepatic impairment: Child-Pugh category B: Reduce dose by
50%. Child-Pugh category C: Avoid use.
 Familial adenomatous polyposis
 Adult: 400 mg bid.
 Hepatic impairment: Child-Pugh category B: Reduce dose by
50%. Child-Pugh category C: Avoid use.
Therapeutic actions
 Celecoxib has COX-2 specific inhibitory activity. It inhibits the
conversion of arachidonic acid to prostaglandins while having no effect on
the formation of prostaglandins that mediate the normal homeostasis in
the GI tract, kidneys and platelets catalyzed by COX-1.
 Absorption: Absorbed from the GI tract (oral); peak plasma
concentrations after 3 hr.
 Distribution: Protein-binding: 97%.
 Metabolism: Hepatic; converted to inactive metabolites.
 Excretion: Feces and urine (as metabolites and unchanged
drug); 11 hr (elimination half-life).
Indications
 Acute and long-term treatment of signs and symptoms of rheumatoid
arthritis and osteoarthritis
 Reduction of the number of colorectal polyps in familial adenomatous
polyposis (FAP)
 Management of acute pain
 Treatment of primary dysmenorrhea
 Relief of signs and symptoms of anklylosing spondylitis
 Relief of signs and symptoms of juvenile rheumatoid arthritis
Adverse effects
 Abdominal pain, diarrhea, nausea, edema, dizziness, headache,
insomnia, upper respiratory tract infections; rash.
 Potentially Fatal: Serious skin reactions such as exfoliative dermatitis,
Stevens-Johnson syndrome, and toxic epidermal necrolysis.
Contraindications
 Hypersensitivity including those in whom attacks of angioedema,
rhinitis and urticaria have been precipitated by aspirin, NSAIDs or
 sulfonamides. Severe hepatic impairment; severe heart failure;
inflammatory bowel disease; peptic ulcer; renal impairment (CrCl <30
ml/min); pregnancy and lactation.
Nursing considerations
CLINICAL ALERT! Name confusion has occurred between Celebrex
(celecoxib), Celexa (citalopram), Xanax (alprazolam), and Cerebyx
(fosphenytoin); use caution.
Assessment
 History: Renal impairment, impaired hearing, allergies, hepatic and CV
conditions, lactation, pregnancy
 Physical: Skin color and lesions; orientation, reflexes, ophthalmologic
and audiometric evaluation, peripheral sensation; P, edema; R, adventitious
sounds; liver evaluation; CBC, LFTs, renal function tests; serum
electrolytes
Interventions
 BLACK BOX WARNING: Be aware that patient may be at increased risk
for CV events, GI bleeding; monitor accordingly.
 Administer drug with food or after meals if GI upset occurs.
 Establish safety measures if CNS, visual disturbances occur.
 Arrange for periodic ophthalmologic examination during long-term
therapy.
 WARNING: If overdose occurs, institute emergency procedures—
gastric lavage, induction of emesis, supportive therapy.
 Provide further comfort measures to reduce pain (eg, positioning,
environmental control) and to reduce inflammation (eg, warmth,
positioning, and rest).
Teaching points
 Take drug with food or meals if GI upset occurs.
 Take only the prescribed dosage; do not increase dosage.
 You may experience these side effects: Dizziness, drowsiness (avoid
driving or the use of dangerous machinery while taking this drug).
 Report sore throat, fever, rash, itching, weight gain, swelling in ankles or
fingers; changes in vision.