Antiinflammatory Agents and Nonsteroidal Antiinflammatory Drugs (NSAIDs

)

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs
• Large and chemically diverse group of drugs with the following properties:
– Analgesic

– Antiinflammatory
– Antipyretic

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Mechanism of Action
• Activation of the arachidonic acid pathway causes:
• pain

• headache
• fever

• inflammation

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Instructors may wish to use EIC Image #107: Arachidonic Acid Pathway

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Mechanism of Action
Analgesia—treatment of headaches and pain
• Block the undesirable effects of prostaglandins, which cause headaches

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Mechanism of Action
Antipyretic: reduce fever
• Inhibit prostaglandin E2 within the area of the brain that controls temperature

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Mechanism of Action
Relief of inflammation
• Inhibit the leukotriene pathway, the prostaglandin pathway, or both

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs
Six structurally related groups:
• Acetic acids
• Carboxylic acids • Propionic acids

• Enolic acids
• Fenamic acids • Nonacidic compounds

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Acetic Acid
• diclofenac sodium (Voltaren)
• diclofenac potassium (Cataflam) • etodolac (Lodine) • indomethacin (Indocin) • sulindac (Clinoril) • tolmetin (Tolectin)
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Carboxylic Acids
Acetylated
• aspirin (ASA) • choline magnesium salicylate (Trilisate) • diflunisal (Dolobid)

Nonacetylated
• salicylamide • salsalate (Disalcid) • sodium salicylate
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Propionic Acids
• fenoprofen (Nalfon)
• flurbiprofen (Ansaid) • ibuprofen (Motrin, others) • ketoprofen (Orudis) • ketorolac (Toradol)

• naproxen (Naprosyn)
• oxaprozin (Daypro)
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Other Agents
Enolic acids
• phenylbutazone (Butazolidin) • piroxicam (Feldene)

Fenamic acids
• meclofenamic acid (Meclomen) • mefenamic acid (Ponstel)

Nonacidic compounds
• nabumetone (Relafen)
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Other Agents
COX-2 Inhibitors
• celecoxib (Celebrex) • rofecoxib (Vioxx)

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Drug Effects
• Analgesic (mild to moderate)
• Antigout • Antiinflammatory • Antipyretic • Relief of vascular headaches • Platelet inhibition (ASA)
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Therapeutic Uses
• Relief of mild to moderate pain
• Acute gout • Various bone, joint, and muscle pain • Osteoarthritis • Rheumatoid arthritis

• Juvenile rheumatoid arthritis
• Dysmenorrhea • Fever
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Specific Agents
salicylates (aspirin)
• More potent effect on platelet aggregation and thermal regulatory center in the brain

– analgesic
– antipyretic – antiinflammatory • Antithrombotic effect: used in the treatment of MI and other thromboembolic disorders
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Specific Agents
phenylbutazone (Butazolidin)
• Greater effects on uric acid production and excretion, in addition to antiinflammatory effects

• More commonly used for treatment of gout

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Side Effects
Gastrointestinal
• dyspepsia, heartburn, epigastric distress, nausea **GI bleeding **mucosal lesions (erosions or ulcerations) • Misoprostol (Cytotec) can be used to reduce these dangerous effects.

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Side Effects
Renal
• reductions in creatinine clearance • acute tubular necrosis with renal failure

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Side Effects
Cardiovascular
• noncardiogenic pulmonary edema

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Salicylate Toxicity
• Adults: tinnitus and hearing loss
• Children: hyperventilation and CNS effects • Effects arise when serum levels exceed 300g/mL. • Metabolic acidosis and respiratory alkalosis may be present.

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Nursing Implications
• Before beginning therapy, assess for conditions that may be contraindications to therapy, especially:
– GI lesions or peptic ulcer disease – Bleeding disorders

• Assess also for conditions that require cautious use. • Perform lab studies as indicated (cardiac, renal, liver studies, CDC, platelet count).
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Nursing Implications
• Perform a medication history to assess for potential drug interactions. • Several serious drug interactions exist:
– alcohol – heparin

– phenytoin
– oral anticoagulants – steroids

– sulfonamides
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Nursing Implications
• Salicylates are NOT to be given to children under age 12 because of the risk of Reye’s syndrome.
• Because these agents generally cause GI distress, they are often better tolerated if taken with food, milk or an antacid to avoid GI irritation. • Explain to patients that therapeutic effects may not be seen for 3 to 4 weeks.
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Nursing Implications
• Educate patients about the various side effects of NSAIDs, and to notify their physician if these effects become severe or if bleeding or GI pain occur.
• Patients should watch closely for the occurrence of any unusual bleeding, such as in the stool. • Enteric-coated tablets should not be crushed or chewed.
Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

NSAIDs: Nursing Implications
• Monitor for therapeutic effects, which vary according to the condition being treated:
decrease in swelling, pain, stiffness, and tenderness of a joint or muscle area

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Sign up to vote on this title
UsefulNot useful