Topic 11: Drugs that reduce Pain, Inflammation, and Fever

what does COX-1 enzyme do?

protects the stomach lining and regulates blood platelets

what does the COX-2 enzyme do?

triggers inflammation and pain

what are second-generation NSAIDs?

selective COX-2 inhibitors

what is the use of aspirin?

take care of fever, reduce platelet, pull inflammation away

what is the action of aspirin?

anti-inflammatory, antiplatlet, and antipyretic

what is the therapeutic serum level of aspirin (salicylate)?

15-30 mg/dL

what is a mild toxicity level for aspirin?

greater than 30 mg/dL

what is severe toxicity level for aspirin?

greater than 50 mg/dL

what are the drug interactions for aspirin?

increased gastric ulcer risk with glucocorticoids

what are some foods containing salicylates?

prunes, raisins, black licorice, curry and paprika

what are some side effects of salicylates?

tinnitus, black tarry stools, and bronchospasm (asthmatics)

what are the nursing considerations for aspirin?

have client take aspirin with food, instruct the client to discontinue aspirin 7 days before surgery to reduce the risk of bleeding

what is ibuprofen used for?

pain, osteoarthritis, and rheumatoid arthritis

what is the action of ibuprofen?

inhibits prostaglandin synthesis which reduces inflammation and pain

what are the side effects of ibuprofen?

CNS effects, gastric distress and bleeding, nephrotoxicity

what are the drug interactions with ibuprofen?

increased effects with sulfonamides and cephalosporins, don’t want to take with aspirin —> double down effect

what is the use of celecoxib (Celebrex)?

used to treat osteoarthritis

what is the action of celecoxib (Celebrex)?

selectively inhibits COX-2 enzyme without inhibiting COX-1

what are the side effects of celecoxib (Celebrex)?

CNS effects, sinusitis, increased risk for MI and stroke, hard on the stomach

what are the nursing considerations for celecoxib (Celebrex)?

typically given to older adults who cannot tolerate aspirin, increase fluid intake for adequate hydration

what is the action of corticosteroids?

they control inflammation by suppressing components of inflammatory process at injured site

what are corticosteroids used for?

athletic flare-ups

why are corticosteroids not the drug of choice for arthritis?

because of the numerous side effects

How do you discontinue the use of corticosteroids?

taper off over 5-10 days

what is the use of disease-modifying anti rheumatic drugs?

alleviate arthritis symptoms when other treatments fail (last resort)

what are immunomodulators?

drugs that disrupt the inflammatory process in all types of arthritis such as tumor necrosis factor (TNF)

what is the classification of infliximab?

immunomodulator: tumor necrosis factor blocker

what is the action of infliximab (Remicade)?

binds to TNF and blocks its from attaching to receptors

how is infliximab (Remicade) administered?

IV infusion given over at least 2 hours

what is gout?

defect in purine metabolism leading to accumulation of uric acid

what foods contain purine?

alcohol (beer), organ meats, sardines, salmon, and gravy

what is the use of colchicine?

it is an anti gout drug that alleviates gout symptoms

what are the side effects of colchicine?

GI distress

What is the use of allopurinol?

an anti-gout drug that inhibits the formation of uric acid

what are the side effects of allopurinol?

GI distress, anemia and bleeding

what are the nursing considerations for allopurinol?

asses serum uric acid for comparison later, instruct client to increase fluids to increase uric acid excretion, instruct client to avoid foods with purines, and instruct for yearly eye exams