ANTI-INFLAMMATORY

A. NON- STEROIDAL ANTI- INFLAMMATORY DRUGS (NSAID)

These are the medicines that is widely used to relieve pain, reduce inflammation, and bring down high temperature.
Side effect:
 GI bleeding
 Stomach ache
 Nausea
Caution:
 May increase the risk of myocardial infarction and stroke.
 Contraindication to post CABG patient.
 May cause photosensitivity.

I. IBUPROFEN
Classification Pharmacotherapeutic class: NSAID
Therapeutic class: Anti- inflammatory drugs
Actions Inhibit prostaglandin synthesis, produce anti- inflammatory, analgesic, and anti-pyretic effects.
Indications Used primarily in
 Osteoarthritis
 Migraine, fever
Clinically significant patent ductus arteriosus (PDA) – ibuprofen lysine
Side Effect Occasional: Nausea, Vomiting, Dizziness
Rare: Constipation, flatulence
Adverse Effect  CNS: Nervousness
 CV: edema
 EENT: tinnitus
 GI: heart burn
 GU: acute renal failure
 Hematologic: agranulocytosis
  Metabolic: hypoglycemia, hypokalemia
 Skin: pruritis

Contraindication and  Contraindication: hypersensitive to ibuprofen.

Caution  Patient with: Angioedema, bronchospastic reaction to aspirin; those with heart attack, stroke and post CABG surgery.

Nursing Baseline Assessment

Responsibilities
 Ask any hypersensitivity to NSAID or ibuprofen
 Obtain lab test results such as BUN, creatinine, ALT, AST, potassium and glucose level
 Question medical history as well as past surgeries

Intervention/ Evaluation
 Monitor BP, signs and symptoms of GI ulceration and aseptic meningitis
 Monitor patient’s rash, facial swelling, fever

Patient Teaching
 Take milk or meals to reduce adverse GI reactions.
 Report blood in vomit, urine, or stool, coffee ground vomit, black tarry tool as well as abnormal and trouble breathing.
 Avoid hazardous activities that require mental alertness.
 Wear sunscreen to avoid hypersensitivity to sunlight.

II. NAPROXEN
Classification Pharmacotherapeutic class: NSAID
Therapeutic class: NSAID
Actions Inhibit prostaglandin synthesis to produce anti- inflammatory, analgesic, and anti-pyretic effects.
Indications Used primarily for
 Acute gout
 Acute tendinitis, ankylosing spondylitis
 Juvenile arthritis
Side Effect  Headache
 Ringing of ears
  Rashes
Adverse Effect  CNS: vertigo
 CV: palpitation
 EENT: visual disturbances, tinnitus, auditory disturbances
 GI: dyspepsia
 Hematologic: increase bleeding time
 Respiratory: dyspnea
 Skin: Pruritis

Contraindications  Contraindication: hypersensitive to naproxen and those with aspirin- sensitive asthma, rhinitis, and nasal polyps.
 Contraindication: treatment of perioperative pain after CABG.

Nursing Baseline Assessment

Responsibilities  Ask any hypersensitivity to NSAID or ibuprofen
 Obtain lab test results such as BUN, creatinine, ALT, AST, potassium level.
 Question medical history as well as past surgeries.

 Intervention/ Evaluation
 Monitor CBC and normal hepatic function as well as the neurologic effects such as drowsiness and blurred vision.
 Evaluate symptoms and signs of heart attack and stroke.

Patient Teaching
 Take drug with milk or meals to reduce adverse GI reactions or drink a full glass of water.
 Naproxen and naproxen sodium should not be taken at the same time.
 Report signs and symptoms of GI bleeding.
 Avoid hazardous activities that require mental alertness.
 Wear sunscreen to avoid per sensitivity to sunlight.

III. DICLOFENAC
Classification Pharmacotherapeutic class: NSAID
Therapeutic class: NSAID
Actions Reversibly inhibits cyclooxygenase 1 and 2 enzymes. Has analgesic, anti- inflammatory and anti- pyretic properties.
Indications Used primarily in
 Osteoarthritis
  Analgesia
 Back pain

Side Effect  Nausea, Vomiting

 Headache
 Mild rash

Adverse Effect  CNS: anxiety

 CV: HF
 EENT: eye pain
 GI: bleeding
 GU: acute renal failure
 Hepatic: Jaundice
 Metabolic: hypoglycemia, hyperglycemia
 Respiratory: Asthma
 Musculoskeletal: back, leg, joint pain
 Skin: alopecia
Contraindication and  Contraindication: hypersensitive to ibuprofen and those with hepatic porphyria, history of asthma, urticaria, and any allergic
Caution reaction to aspirin
 Contraindication: treatment of pain after CABG surgery
 May increase heart attack and thrombotic events such as MI and stroke.
 May cause photosensitivity

Nursing Baseline Assessment

Responsibilities
 Ask any hypersensitivity to NSAID or ibuprofen
 Obtain lab test results such as BUN, creatinine, bilirubin, ALT, AST, and glucose level
 Question medical history as well as past surgeries
Intervention/ Evaluation
 Monitor BP, signs and symptoms of MI and stroke.
Patient Teaching
 Seek medical attention immediately if chest pain, shortness of breath occurs.
 Avoid drinking alcohol or aspirin.
  Wear sunscreen and protective clothing.
 Avoid hazardous activities that require alertness.

B. CORTECOSTEROIDS
These are the medicines have anti-inflammatory and immunosuppressive properties. More specifically, these are used in treating conditions such as
 Asthma
 Arthritis,
 Allergies
 Autoimmune diseases.
Common side effect:
 Weight gain
 Fluid retention
 High blood pressure

a. PREDNISONE
Classification  THERAPEUTIC CLASS: Corticosteroid (Glucocorticoid)
 PHARMACOLOGIC CLASS: Adrenocorticoids
Actions Decreases inflammation, mainly by:

 Stabilizing leukocyte lysosomal membranes

 Suppresses immune response
 Stimulates bone marrow
 Influences protein, fat, and carbohydrate metabolism
Indications Used primarily in

 Severe inflammation, disorders requiring immunosuppression, endocrine deficiency disorders

 Acute exacerbations of MS
Side Effect  Frequent: Increased Appetite and Weight Gain
 Occasional: Increased Blood Pressure
 Rare: Infections
Adverse Reactions  CNS: Pseudotumor cerebri
 CV: HF
 EENT: Cataracts
 GI: Pancreatitis
 GU: Menstrual irregularities
 Hematologic: Neutropenia
 Hepatic: Hepatomegaly
 Metabolic: Hypocalcemia
 Musculoskeletal: Tendon rupture
 Skin: Delayed wound healing
Contraindications and  Contraindications: Hypersensitive to prednisone and in those with systemic fungal infections, cerebral malaria, or active ocular
Cautions herpes simplex; and those receiving immunosuppressive doses together with live-virus vaccines.
 Cautions: HF, recent MI or HTN, DM, epilepsy.
 For pregnant: May pose risks to a developing fetus or infant through breast milk.
Nursing Responsibilities BASELINE ASSESSMENT

 Ask for hypersensitivity to other corticosteroids.

 Review the patient's current medications, including OTC drugs and herbal supplements, to check for potential drug interactions.
 Monitor baseline vital signs, especially blood pressure and ask medical history.
 Obtain lab results such as blood glucose and cholesterol levels.
 Assess the patient's risk factors for osteoporosis.

INTERVENTION/EVALUATION

 Monitor BP, sleep patterns, potassium level, IOP as well as the weight of the patient.
 Monitor for HPA axis suppression, cushingoid effects, and glucose level.
 Monitor bone density on long term therapy and bone growth as well as the growth in children.

PATIENT/FAMILY TEACHING

 Take drug with food or milk and to swallow delayed-release tablets whole.
 Warn and advise pt or family to report signs and symptoms of adrenal insufficiency and cushingoid effects.
 Consider exercise, physical therapy, and eye exam.
 b. PREDNISOLONE
Classification Pharmacologic class: Corticosteroid (intermediate-acting)
Therapeutic class: Anti-inflammatory, immunosuppressant
Pregnancy risk category C
Actions Decreases inflammation mainly
 by stabilizing leukocyte lysosomal membranes
 suppresses immune responses
 stimulate bone marrow and influences protein, fat, and carbohydrate metabolism

Indication Used primarily in treating

 Severe inflammation
 Uncontrolled asthma
 Nephrotic syndrome
Contraindication  Hypersensitivity to drug, other corticosteroids, alcohol, bisulfite
 Systemic fungal infections
 Live-virus vaccines (with immunosuppressive prednisolone dosages)

Caution:
 Pt with recent MI, HTN, Renal disease

Side Effect  Fluid retention including bloating of the face and swelling of the abdomen.
 Weight gain
 Acne

NS: heAdverse Effect nervousnes

Headache,
 CNS: Seizures
 CV: Arrythmias
 EENT: Cataracts
 GI: Pancreatis
 GU: Amenorrhea
 Metabolic: Hypokalemia
 Skin: Hirsutism
Nursing Responsibilities BASELINE ASSESSMENT
  Ask sensitivity to drugs.
 Assess signs and symptoms of depression, and psychosis.
 Obtain lab test such as glucose and cholesterol level.

INTERVENTION/ EVALUATION
 Monitor weight, blood pressure, and electrolyte levels.
 Watch for cushingoid effects (moon face, central obesity, buffalo hump, hair thinning, high blood pressure, frequent infections).
 Adjust to lowest effective dose

PATIENT TEACHING
 Take oral dose with food or milk to reduce GI upset.
 Explain that drug increases risk of infection. Report immediately to doctor.
 Inform patient that he may need higher dosage during periods of stress.
 Tell patient to avoid vaccinations, OTC drugs, and herbs during therapy.

c. DEXAMETHASONE
Classification  THERAPEUTIC CLASS: Corticosteroid
 PHARMACOLOGIC CLASS: Glucocorticoid

Actions Decrease inflammation mainly by:

 Stabilizing leukocyte lysosomal membranes
 Suppresses immune response
 Stimulates bone marrow
Indications Used primarily in
 Cerebral edema
 Inflammatory conditions
 Shock
 Adrenocortical insufficiency
Side Effect  More common side effects that can occur with dexamethasone oral tablets include:
 nausea
 vomiting
  stomach upset
 swelling (edema)
 headache, dizziness
 mood changes such as depression, shifts in mood, or personality changes
 trouble falling asleep
 anxiety
 low potassium levels (causing symptoms such as tiredness)
 high blood glucose, high blood pressure
Adverse Effect  CNS: Pseudotumor celebri
 CV: HF
 EENT: Cataracts
 GI: Pancreatis
 Metabolic: Hypokalemia
 Musculoskeletal: Osteoporosis
 SKIN: Hirsutism
 Other: Susceptibility to infection
Contraindication and Contraindication:
Caution
 Hypersensitivity to patient with dexamethasone or its ingredients
 Systemic fungal infection
 Those receiving immunosuppressive dose together with live virus vaccines.
Caution: Patient with
 GI ulcer
 Diabetes mellitus
 Cirrhosis
Nursing Responsibilities Baseline Assessment
 Question for hypersensitivity to any Corticosteroids.
 Obtain lab results such as cholesterol and glucose level.
 Obtain medical history as listed in precautions.
Intervention/Evaluation
 Give once- daily dose in the morning or adjust to lowest effective dose.
 Monitor glucose level.
  Reduce dosage after long term therapy.
Patient/Family Teaching
 Instruct patient to take drug with food or milk.
 Teach patient sign and symptoms of early adrenal insufficiency.
 Avoid alcohol, limit caffeine.
 Report fever, sore throat, muscle aches, sudden weight gain, edema, exposure to measles/chicken pox.

C. ANTIGOUT

These medicines primarily used to prevent and treat gout, reduce the uric acid to build-up in the blood and to reduce inflammation.

Common side effects:

 Dizziness
 Rashes
 Nausea.
 Vomiting.
 Cramping.
 Abdominal pain and discomfort.

I. COLCHICINE
Classification ➢ Therapeutic class: Antigout drugs
➢ Pharmacologic class: Colchicum autumnale alkaloids

Actions  Reducing lactic acid produced by leukocytes

 Reducing uric acid deposits and phagocytosis, thereby decreasing the inflammatory process.
 Reducing inflammation and pain associated with gout and FMF.
Indications  Prevention of acute gout
 Treatment of Fever, Pericarditis, FMF.
Side Effect  Black tarry tool
 Numbness in fingers
 Sore throat
Adverse Effect  CNS: Fatigue
 EENT: Pharyngeal pain
 GI: Diarrhea
  Hematologic: Aplastic anemia
 Other: Gout
Contraindication and Contraindication: Serious CV, renal, hepatic impairment, and patient with hypersensitive colchicine
Caution
Nursing Responsibilities BASELINE ASSESMENT
 Obtain medical history and any current medications.
 Obtain CBC results.
 Assess vital signs.
INTERVENTION/EVALUATION
 Monitor pt with prolonged drug use for neuromuscular toxicity.
 Administer colchicine with allopurinol for gout prophylaxis.
PATIENT/FAMILY TEACHING
 Drug can be taken without food.
 Avoid grapefruit.
 Report all adverse reactions such as muscle pain, bleeding, nausea, vomiting.

II. ALLOPURINOL
Classification Pharmacotherapeutic class: Anti- gout drugs
Therapeutic class: Xanthine oxidase inhibitors
Actions Reduces uric acid production by inhibiting xanthine oxidase
Indications Gout or Hyperuricemia
 hyperuricemia caused by malignancies
 to prevent uric acid nephropathy during cancer chemotherapy
 recurrent calcium oxalate calculi

Side Effect  Nausea

 Diarrhea
 Drowsiness
Adverse Effect  GI: Abdominal pain
 GU: Renal failure
 Musculoskeletal: Acute gout attack
 Skin: Rash
Contraindication and Contraindicated in patients hypersensitive to drug and pt positive for HLA- B
Caution
Nursing Responsibilities BASELINE ASSESMENT
 Ask hypersensitivity to allopurinol.
 Obtain medical history and any current medications.
 Obtain laboratory results such as ALP, ALT, eosinophil count, and WBC count.
INTERVENTION/EVALUATION
 Monitor uric acid level to evaluate drug’s effectiveness.
 Monitor fluid intake and output.
 Monitor CBC, hepatic, and renal function.
PATIENT/FAMILY TEACHING
 Tell patient to take drugs with or immediately after meal.
 Patient who is HLA- B should not take this drug.
 Reduce dietary intake of animal protein, sugar, sodium for patient treating recurrent calcium oxilate stones.
 Avoid alcohol.