Drugs for pain, fever, & inflammation

Antiprostaglandin

 can be good or bad and is formed when theres a cellular injury

Antipyretic

works to get rid of fever(100.4); lowers body temp

pyrogen

fever causing

Hyperuricemia

too much uric acid in the blood…gout

NSAIDs

non-steroidal anti-inflammatory drugs

steroids are ___-_______….what does that mean?

anti-inflammatory; they tell your immune system to chill out

Prostagladin

chemical mediator and participates in the inflammatory response = PAIN

Cyclooxygenase

basically produces prostoglandens

what is inflammation?

its a normal body response to an invader or injury

what does histamine do during injury?

a vasodilator that improves blood flow aka swelling

what are the cardinal s/s of inflammation

pain, swelling, redness, heat

why do we experience malaise during inflammation process?

your tired because your metabolic demands increase. You fight off something better when you have a fever

whats a fever?

an increase in pyrogens (naturally found in the body)… body temp greater than 100.4

• other assoc s/s: dehydration, inflammation, infectious processes, drug use, etc

what drug class do (NSAIDS) ibruprofen, Advil/Motrin fall under?

Propionic acid derivatives

what drug class does ketorolac, Toradol fall under?

acetic acid derivative

what drug class does meloxicam, Mobic fall under?

Oxicam derivative

what drug class does acetaminophen, Tylenol fall under?

Nonnarcotic analgesic antipyretic

what drug class does allopurinol, Zyloprim fall under?

uricosuric

drug therapy for osteoarthritis?

produces inflammation and degeneration of joints; begins around age 30 and peak age 50-60

• acetaminophen (pain) and NSAIDS (anti-inflammatory)

ibuprofen

NSAID, rapidly absorbed in the GI tract and is metabolized in the liver but excreted in kidneys(nephrotoxic)

• relieves mild to moderate pain, treats inflammation and reduces fever

why cant you take NSAIDs if your are pregnant? What about older pop.?

they cross the placenta and into breastmilk; older adults kidneys don’t function as fast or as well as they used to so you have to be careful

What is the black box meaning/label for NSAIDs?

increase risk of CV events and GI bleeding

• anticoagulants, alcohol, and glucocorticoids increase risk of bleeding

• NSAIDs block COX-1 and COX-2

Do not take ibuprofen with ___? why?

aspirin because it decreases antiplatlet effects

patient edu NSAIDS

• Take with food or liquid to decrease gastric irritation

• Avoid alcohol

• Report signs of bleeding, severe stomach upset or weight gain & decreased urine output

what is one other drug found in the NSAID class?

naproxen, Aleve

• Used to treat mild to moderate pain, arthritis, and  dysmenorrhea

• Longer acting (two a day); More likely to have GI side effects

• be more conservative with older pop.

oxicam derivates: meloxicam, Mobic function?

Treatment of OA and RA(autoimmune);Inflammation, fever and pain

• metabolized by liver, excreted in feces/urine…Cox-1 and Cox-2 inhibitor

nursing assessment/implications: meloxicam, Mobic

• Caution in renal impairment

• AEs: respiratory, hematologic, GI

• Black Box: CV events and GI bleeding

• Patient with aspirin allergy contraindicated

patient teaching: meloxicam, Mobic

• Take with food—why??

• Report sore throat, dyspnea, edema, tarry stools

which NDAID affects the kidneys the most?

Acetic Acid Derivatives: Ketorolac (Toradol) **Potent Drug

purpose and assessment of Acetic Acid Derivatives: Ketorolac (Toradol) **Potent Drug

treats moderate to severe pain (only for short term use 5 days or less!)

• metabolized by liver (hepatic impairment), cant use if patient has advanced renal disease (renal impairment)

• avoid giving to older adults

patient teaching ..Acetic Acid Derivatives: Ketorolac (Toradol) **Potent Drug

• Take with food  to decrease GI irritation

• Report AEs such as chest pain, weakness, disorientation, jaundice-liver, edema-kidneys

• Report sore throat, fever, rash, weight gain, tarry stools(GI bleeding)

Non-Narcotic Analgesic Antipyretic: Acetaminophen (Tylenol)- strong antipyretic

• Reduce fever and decrease minor pain

• Aspirin & NSAID substitute (safe drug)

• Found in many combination products *

where is acetaminophen metabolized? interactions?

liver; interactions include warfin and alcohol

nursing assessment/implications for acetminophen

• Review History and LFTs– assess for allergy

• AEs:  HA, rash, renal dysfunction, hepatotoxicity 

4 gram max per 24 hours—less for alcohol use or someone with hepatic injury—leads to toxicity!

how do we treat acteminophen overdose

acetylcysteine (Antidote) or gastric lavage with oral activated charcoal

patient teaching for acetaminophen

• Children: Can alternate with ibuprofen for fever control, weight-based dosing

• Older adults use first for msk pain

• Can be used in pregnancy

gout

Arthritic condition characterized by an overproduction of uric acid or inability to excrete uric acid, resulting in hyperuricemia and urate crystal deposits in kidneys and joints.

• s/s: enlarged joints (typically 1), pain and swelling 10 days, tophi(little knobs)

what are the short term and long term antigout medication?

Colchicine (Short term) & Allopurinol (Long term)

• patient teach emphasis need to take long term drugs; diet alterations

what should I consider when altering a gout patients diet?

low purine diet to reduce uric acid; avoid red meat, seafood, and alcohol

uricosiuric agent? purpose?

allopurinol, management of gout—long term therapy

pharmacokinetics/MOA of allopurinol

absorbed in GI tract, slow excretion through kidneys

• inhibits conversion of purines to uric acid

nursing assessment/implications of allopurinol … adverse effects?

• Dosage adjusted by CrCl (creatine clearnace)

AEs: hypersensitivity reaction, hematologic and GI, renal and hepatic toxic

patient teaching: allopurinol

• Take after meals- prevents GI upset

• Increase fluid intake

• Report any rashes-allergy--hypersensitivity

• Report decreased urine output---why??? can be renal toxic