karch 16 antiinflam la(1)

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Anti-Inflammatory, Antiarthritis, and Related Agents


Chapter 16


Inflammatory ResponseInflammatory Response

• Protects the body from injury and pathogens

• Used chemical mediators to produce a reaction that helps destroy pathogens and promotes healing




• Several different types of drugs

• Corticosteroids

• Block or alter the chemical reactions associated with the inflammatory response

• Over-the-counter (OTC)

• Adverse effects


SalicylatesSalicylates

• Can block the inflammatory response

• Have antipyretic properties (fever-blocking)

• Have analgesic (pain-blocking) properties

• Therapeutic actions and indications

• Pharmacokinetics

• Contraindications and cautions

• Adverse effects

• Clinically important drug-to-drug interactions


Common SalicylatesCommon Salicylates

• Aspirin (Bayer, etc.): Treats inflammatory conditions

• Balsalazide (Colazal): New drug treats ulcerative colitis

• Choline magnesium trisalicylate (Trilisate): Treats mild pain and fevers and arthritis

• Choline Salicylate (Arthropan): Treats mild pain and fevers as well as arthritis

• Mesalamine (Pentasa and others): Treats inflammation of the large intestine


Common Salicylates (cont.)Common Salicylates (cont.)

• Olsalazine (Dipentum): Converted to mesalamine in the colon; has the same direct anti-inflammatory effects

• Salsalate (Argesic and Others): Used to treat pain, fever, and inflammation

• Sodium Thiosalicylate (Rexolate): Treats episodes of acute gout and muscular pain, and rheumatic fever


Salicylates Salicylates • Actions /Indications

– Inhibit synthesis of prostaglandin, used to treat mild to moderate pain and fever


– Absorbed from the stomach, peak in 5-30 min., metabolized in the liver, excreted in the urine

• Contraindications

– Known allergy, bleeding abnormalities, impaired renal function

• Drug-to-Drug Interactions

– Interact with other drugs by interfering with absorption


Prototype Salicylates Prototype Salicylates


Nursing Considerations for Patients Receiving Salicylates

Nursing Considerations for Patients Receiving Salicylates

• Assessment: History and Examination

• Nursing Diagnoses

• Implementation With Rationale

• Evaluation


QuestionQuestion

Please answer the following statement as true or false.

A person who does not respond to one salicylate may respond to a different one.


AnswerAnswer

True.

Rationale: Salicylates are some of the oldest anti-inflammatory drugs used. They were extracted from willow bark, poplar trees, and other plants by ancient

peoples to treat fever, pain, and what we now call inflammation. They are generally available without

prescription and are relatively nontoxic when used as directed. A person who does not respond to one salicylate

may respond to a different one.


Nonsteroidal Anti-inflammatory and Related Agents

Nonsteroidal Anti-inflammatory and Related Agents

• Propionic Acids

– Fenoprofen

– Ibuprofen

• Acetic Acids

– Declofenac

– Etodolac

• Fenamates

– Mefenamic acid

• Cyclooxygenase-2 Inhibitors

– Celecoxib


NSAIDsNSAIDs

• Provide strong anti-inflammatory and analgesic effects

• Sold over the counter, which may lead to abuse

• Therapeutic actions and indications


• Contraindications and cautions

• Adverse effects

• Clinically important drug-to-drug interactions


Prototype NSAIDs Prototype NSAIDs


Acetaminophen Acetaminophen

• Actions /Indications

– Acts directly on the thermoregulatory cells of the hypothalamus

– Not sure of the mechanism of action related to analgesic effects

– Used to treat pain and fever

• Treat pain and fever associated with a variety of conditions, including influenza

• Prophylaxis of children receiving diphtheria–pertussis–tetanus (DPT) immunizations

• Relief of musculoskeletal pain associated with arthritis


Acetaminophen (cont.)Acetaminophen (cont.)


– Absorbed from GI tract

– Peak ½ to 2 hours

– Metabolized in the liver

– Excreted in the urine

– T ½ is about 2 hours


– Known allergy

– Use with caution in pregnancy and lactation


Acetaminophen (cont.)Acetaminophen (cont.)

• Adverse Reactions

– Headache, hemolytic anemia, renal dysfunction, skin rash and fever

– Hepatotoxicity usually associated with chronic use and overdose


– Oral anticoagulants increase bleeding


Prototype Summary: AcetaminophenPrototype Summary: Acetaminophen


Nursing Considerations for Patients Receiving NSAIDs and Related AgentsNursing Considerations for Patients

Receiving NSAIDs and Related Agents

• Assessment: History and Examination

– Contraindications or cautions

– Baseline status before beginning therapy and for any potential adverse effects


QuestionQuestion

When are NSAIDs contraindicated?

A. Allergy to penicillin

B. Allergy to sulfonamides

C. Allergy to antihistamines

D. Allergy to thiazines


AnswerAnswer

B. Allergy to sulfonamides

Rationale: The NSAIDs are contraindicated in the presence of allergy to any NSAID or salicylate/ Celecoxib is also contraindicated in the presence of allergy to sulfonamides.


Antiarthritis AgentsAntiarthritis Agents

• Potentially debilitating inflammatory process

• Antiarthritis drugs

• Prevent and suppress arthritis in selected patients with rheumatoid arthritis


Gold CompoundsGold Compounds• Indications/Action

– Absorbed by macrophages, which results in inhibition of phagocytosis

– Tissue destruction is decreased


– Absorptions varies based on site of administration

– Widely distributed throughout the body


– Known allergy

– Diabetes, CHF, renal or hepatic impairment


Gold Compounds (cont.)Gold Compounds (cont.)

• Adverse Reactions

– Stomatitis, glossitis, gingivitis, bone marrow depression, dermatitis


– Penicillamine, antimalarials, cytotoxic drugs, or immunosuppressive agents


Therapeutic Actions and IndicationsTherapeutic Actions and Indications

• Chrysotherapy

• Indicated to treat selected cases of:

– Rheumatoid arthritis

– Juvenile rheumatoid arthritis

– In patients whose disease has been unresponsive to standard therapy


PharmacokineticsPharmacokinetics

• Absorbed at varying rates

• Excreted in urine and feces

• Cross the placenta and cross into breast milk

• Barrier contraceptives


Contraindications and CautionsContraindications and Cautions

• Gold salts can be quite toxic

• Contraindicated in the presence of any known allergy to gold

Adverse Effects

– Variety of adverse effects are common with the use of gold salts


Clinically Important Drug–Drug Interactions

Clinically Important Drug–Drug Interactions

• Do not combine with:

– Penicillamine

– Antimalarials

– Cytotoxic drugs

– Immunosuppressive agents


Prototype Gold Compound Prototype Gold Compound


Disease Modifying Anti-Rheumatic Drugs Disease Modifying Anti-Rheumatic Drugs

• Available for treating arthritis that aggressively affect the process of inflammation

• Can be severe to life-threatening

• They alter the course of the inflammatory process, many rheumatologists are selecting to

• Antineoplastic drug methotrexate

• Therapeutic Actions and Indications

– Anakinra

– Leflunomide is slowly absorbed from the GI tract, reaching peak levels in 6-12 hours


Disease Modifying Anti-Rheumatic Drugs (cont.)

Disease Modifying Anti-Rheumatic Drugs (cont.)

• Anakinra

• Etanercept I

• Leflunomide is slowly absorbed from the GI tract, reaching peak levels in 6-12 hours.


Therapeutic Actions and Indications Therapeutic Actions and Indications

• Relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis

• Relief of mild to moderate pain

• Treatment of primary dysmenorrhea

• Fever reduction


Nursing Considerations for Patients Receiving Antiarthritis Agents

Nursing Considerations for Patients Receiving Antiarthritis Agents

• Similar to those for patients receiving NSAIDS and related agents


Drug Therapy Across the LifespanDrug Therapy Across the Lifespan

karch 16 antiinflam la(1)

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