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ANTI- INFLAMMATORY DRUGS/ VACCINES & SERA

INFLAMMATION:
* Inflammation (from Latin: unctionion) is part of the complex biological response of
body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants,
and is a protective response involving immune cells, blood vessels, and
molecular mediators.

Inflammation is characterized by five cardinal signs:

1. rubor (redness),
2. calor (increased heat),
3. tumor (swelling),
4. dolor (pain), and.
5. funtio laesa (loss of function).

ANTI-INFLAMMATORY AGENTS
Inflammatory Response
* Protects the body from injury and pathogens
* Uses chemical mediators to produce the reaction that helps destroy pathogens
and promote healing

Anti-inflammatory Agents
* Block or alter the chemical reactions associated with the inflammatory response
* Anti-inflammatory agents have additional properties such as relief of pain
(analgesics), reduction of elevated body temperature (antipyretic), and inhibition
of platelet aggregation (anticoagulant).
* Aspirin is the oldest anti-inflammatory drug

Types of Anti-inflammatory Agents

* Corticosteroids: used systemically to block the inflammatory and immune
systems
* Antihistamines: block the release of histamine in the initiation of the inflammatory
response

NSAIDs (Nonsteroidal Anti-inflammatory drug)

* Provide strong anti-inflammatory and analgesic effects
* Sold over the counter, which may lead to abuse

Seven Types of NSAIDs

1. Salicylates: Aspirin (ASA- acetylsalicylic acid)
2. Parachlorobenzoic acid or derivatives or indoles: Indomethacin, Sulindac,
Tolmetin
3. Propionic acids: Fenoprofen, Ibuprofen,
4. Phenylacetic acids : Diclofenac, Etodolac, Keterolac, Diclofenac (Voltaren)

Celia Cruz-Fajardo, M.D. Antiinflammatory / Vaccines Sera

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5. Fenamates: Mefenamic acid, Meclofenamate sodium monohydrate

6. Oxicams: Piroxicam
7. Cyclooxygenase-2 inhibitors : Celecoxib

NSAIDs Indications
* Relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis
* Relief of mild to moderate pain
* Treatment of primary dysmenorrhea
* Fever reduction

Side Effects
* Gastric irritation

Contraindications to NSAIDs
* Presence of allergy to any NSAID or salicylate
* Cardiovascular dysfunction or hypertension
* Peptic ulcer or known GI bleeding
* Pregnancy and lactation
* Caution with renal or hepatic dysfunction

Nursing Interventions
* Observe for bleeding
* Report if client has GI discomfort
* Monitor vital signs and check for peripheral edema especially in the morning

Salicylates
* Can block the inflammatory response
* Have antipyretic (fever-blocking) properties
* Have analgesic (pain-blocking) properties

Common Salicylates
* Aspirin (Bayer,etc.): treats inflammatory conditions
* Balsalazide (Colazal): new drug that treats ulcerative colitis
* Choline magnesium trisalicylate (Trilisate): treats mild pain and fevers as well as
arthritis
* Choline salicylate (Arthropan): treats mild pain and fevers as well as arthritis
* Mesalamine (Pentasa, etc.): treats inflammation of the large intestine
* Olsalazine (Dipentum): converted to mesalamine in the colon; has the same
direct anti-inflammatory effects
* Salsalate (Argesic, etc.): treats pain, fever, and inflammation
* Sodium thiosalicylate (Rexolate): treats episodes of acute gout and muscular
pain as well as rheumatic fever

Salicylates

Celia Cruz-Fajardo, M.D. Antiinflammatory / Vaccines Sera

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* Action/indication: Inhibit synthesis of prostaglandin; used to treat mild to

moderate pain and fever
* Pharmacokinetics: Absorbed from the stomach, peak in 5 to 30 min., metabolized
in the liver, and excreted in the urine
* Contraindications: Known allergy, bleeding abnormalities, and impaired renal
function
* Drug-to-drug interactions : Interact with other drugs by interfering with absorption
* Adverse Effects
› GI irritation : Nausea, dyspepsia, and heartburn
› Clotting system : Blood loss and bleeding abnormalities
› Eighth cranial nerve stimulation
› Salicylism : Ringing in the ears, Acidosis, Nausea, vomiting, and
diarrhea & Mental confusion and lassitude

Other Anti-inflammatory Agents

* Acetaminophen (Tylenol)
* Gold compounds
* Antiarthritic drugs

Acetaminophen
* Action/indications
› Acts directly on the thermoregulatory cells of the hypothalamus
› Mechanism of action related to analgesic effects is not certain
› Used to treat pain and fever
1. Treatment of pain and fever associated with a variety of conditions, including
influenza
2. Prophylaxis of children receiving diphtheria–pertussis–tetanus (DPT)
immunizations
3. Relief of musculoskeletal pain associated with arthritis

* Pharmacokinetics
› Absorbed from the GI tract
› Peaks in 1⁄2 to 2 hours
› Metabolized in the liver
› Excreted in the urine
› T1⁄2 is about 2 hours

* Contraindications : Known allergy; Use with caution in pregnancy and lactation

* Adverse reactions : Headache, hemolytic anemia, renal dysfunction, skin rash,
fever, and hepatotoxicity
* Drug-to-drug interactions : Oral anticoagulants increase bleeding

Gold Compounds (DMARD-Disease Modifying Antirheumatic Drugs

* Action : Absorbed by macrophages, which results in inhibition of phagocytosis

Celia Cruz-Fajardo, M.D. Antiinflammatory / Vaccines Sera

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* Indication : Tissue destruction is decreased

* Pharmacokinetics : Absorption varies based on the site of administration; Widely
distributed throughout the body
* Contraindications : Known allergy; Diabetes, CHF, and renal or hepatic
impairment
* Adverse reactions : Stomatitis, glossitis, gingivitis, bone marrow depression, and
dermatitis
* Drug-to-drug interactions : Penicillamine, antimalarials, cytotoxic drugs, and
immunosuppressive agents

VACCINES AND SERA

Biologicals—Actions
* Stimulate the production of antibodies
* Provide preformed antibodies to facilitate an immune reaction
* React specifically with the toxins produced by an invading pathogen

Types of Immunity
1. Active immunity : The body recognizes a foreign protein and begins producing
antibodies to react with it
2. Passive immunity : Occurs when preformed antibodies are injected into the
system and react with a specific antigen

Immunization
* Definition
› The process of artificially stimulating active immunity
› Exposes the body to weakened or less toxic proteins associated with specific
disease-causing organisms

* Goal
› To cause an immune response without having the patient suffer the full course
of a disease

Childhood Vaccinations
* Diphtheria, pertussis, and tetanus
* Haemophilus B
* Hepatitis B and hepatitis A
* Chickenpox
* Polio
* Measles, mumps, and rubella

VACCINES

Indications
* Stimulate active immunity in people who are at risk

Celia Cruz-Fajardo, M.D. Antiinflammatory / Vaccines Sera

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* The vaccine needed depends on the exposure the person will have to pathogens
* Vaccines are thought to provide lifelong immunity

Contraindications
* In the presence of immune deficiency
* During pregnancy
* Known allergies to any of the components of the vaccine
* Patients who receive immune globulin or who have received blood or blood
products within the last 3 months
* Caution with history of febrile convulsions or cerebral injury, conditions in which
high fever would be dangerous, and during acute infection

Adverse Effects
* Fever
* Rash
* Malaise
* Chills
* Fretfulness
* Drowsiness
* Anorexia
* Vomiting
* Irritability
* Pain, redness, and swelling at the injection site

IMMUNE SERA
* Definition : Sera that contain antibodies to specific bacteria or viruses

* Types : Antitoxin and antivenom

› Immune sera have antibodies to specific toxins that might be released by
invading pathogens, or to venom from spider or snake bites

Immune Sera and Antitoxins

Indications
* Provide passive immunity to a specific antigen or disease
* Used as prophylaxis against specific disease after exposure
* May lessen the severity of a disease

Contraindications
* History of severe reaction to any immune sera
* Use with caution:
› Pregnancy

Celia Cruz-Fajardo, M.D. Antiinflammatory / Vaccines Sera

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› Coagulation defects
› Previous exposure to the immune sera
› Rash
› Nausea
› Vomiting
› Chills
› Fever

* Allergic reaction
› Chest tightness, decreased blood pressure, and difficulty breathing

* Local reaction

* Swelling, tenderness, pain, and muscle stiffness at the injection site

Celia Cruz-Fajardo, M.D. Antiinflammatory / Vaccines Sera