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Chapter 44 - Pharm
Antiinflammatory, Antirheumatic & Related Drugs
| Question | Answer |
|---|---|
| Localized protective response stimulated by injury to tissues, which serves to destroy, diulute, or wall off both the injurious agent and teh injured tissue | Inflammation |
| General term for any of several disorders characterized by inflammation, degeneration, or metabolic derangement of tissue structures, especisally joints and related ligaments | Rheumatism |
| Rheumatic symptoms include | pain, stiffness and reduced ROM |
| Large - chemically diverse group of drugs that possess analgesic, antinflammatory, antirheumatic, and antipyretic activity are | NSAIDs |
| These drugs were produced to help yield the potential caused effects of aspirin such as GI intolerence, bleeding and renal impairment | NSAIDs |
| NSAIDs - Analgesic Method of Action | treat HA, pain and inflamation by blocking the chemical activity of COX enzymes and lipoxygenase |
| NSAIDs Antipyretic Method of Action | reduces fever by inhibiting prostaglandin E2 in the brain |
| NSAIDs categorized by seven related groups | Acetic acids, carboxylic acies (salicylates) - Acetylated & nonacetylated - Propionic acids, COX--2 inhibitors, Fenamic acids, Napthylalkanones (nonacidic), Oxicams |
| NSAIDs : Acetic Acids | diclofenac sodium (Voltaren) & indomethacin (Indocin) |
| NSAIDs : Propionic Acids | ibuprofen (Motrin, Advil) & ketorolac (Toradol) |
| NSADs : COX-2 Inhibitors | celecoxib (Celebrex) |
| NSAIDs : Oxicams | meloxicam (Mobic) & piroxicam (Feldene) |
| Indications for NSAIDs are | analgesia (mild-moderate), antigout effects, antinflammatory, antipyretic, relief of vascular headache, & platelet inhibitiohn (asiprin), Juvenile Rheumatoid arthritis, Dysmenorrhea, Acute Gout, Osteoarthritis, various bone, joint, and muscle pain |
| NSAIDs : Salicylates (aspirin) has | more potent effect on platelet aggregation and thermal regulatory center in the brain for analgesic, antipyretic antiinflammatory, antithrombotic effect, thromboembolic disorders |
| Condition that results from inappropriate uric acid metabolism, which deposists uric acid crystals in tissues and joints resulting in pain is called | Gout |
| NSAIDs : Antigout Drugs | allopurinol (Zyloprim) - reduces production of uric acid, Colchicine - redes inflammatory at the site of deposit (pulls out acid into bowels causing gas & diarrhea), and probenecid (Benemid) which increases excretion of the uric acid |
| NSAID's Adverse Effects | GI - Dyspepsia, heartburn, epigastric distress, Nausea, GI Bleeds, and mucosal lesions. Renal - reduces creatinine clearance & acute tubular necrosis with renal failure. Cardio - Non-cardio pulmonary edema |
| Salicylate Toxicity includes the following | tinnitus, hearing loss, hyperventilation, CNS effects. These effects arise when serum levels exceed 40-60mg/dL (it can also cause metabolic acidosis & respiratory alkalosis; this can cause an arrest and hard to convert patient back) |
| Interactions with NSAIDS include | anticoagulants, aspirin, corticosteroids, ulcerogenc drugs, protein bound drugs |
| What are the characteristics of Antirheumatoid Arthritis Drugs (DMARDS) | slow onset of action (several weeks), may take up to 3-6 months to see full effects, have much more toxic adverse effects than NSAIDs |
| DMARDS have the following actions | anti-inflammatory, antiarthritic, immunomodulating effects |
| Name some common Antirheumatoid Arthritis Drugs | auranofin, aurothioglucose, gold sodium thiomalate (weekly injection), & leflunomide |
| Nursing Implications for NSAIDs | history, allergies, contraindications (GI lesions & bleeding disorders such as Gerd or Coumadin), perform labs (Cardiac, renal, LFT, CBC, platelet count |
| Children under 18 should not take this drug because the risk of Reye's Syndrome (bleeding in the brain) | Salicylates |
| DMARDs generally cause GI distress therefore are better tolerated if | taken with food, milk, or antacids |
| DMARDs may not show therapeutic effects for up to | 3-4 weeks |
| Patient educations for patients on DMARDs should include | information on adverse effects, notify physician if effects become severe or bleeding/GI pain occurs, watch closely for bleeding in stools, do not chew or crush enteric-coated tablets |
| The nurse should expect what types of therapeutic effects from a patient using DMARDs | decrease in swelling, pain, stiffness, and tenderness of a joint or muscle |
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LILES
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