Drug Therapy to Decrease Pain, Fever, & inflammation

Aspirin Class

Salicylate

Aspirin Usage

Relieves pain acting both centrally & peripherally blocking transmission of pain impulses.

Antipyretic

Diminish inflammation by preventing prostaglandins from increasing pain/edema

Inhibit platelet aggregation

Aspirin Adverse Effects

Nausea, dyspepsia, heartburn, epigastric discomfort

GI blood loss & hemorrhage (d/t decreased platelet aggregation)

Petechiae, bruising, acute toxicity

Aspirin Contraindications

Allergy / sensitivity to aspirin or salicylates

Known↑ risk of bleeding

Use cautiously with impaired renal function

Aspirin Highlights

BBW: Teens or children = Reye’s syndrome

Pregnancy Category D

Admin. with food = decreased GI irritation

Crushing = risk of toxicity

Acetaminophen Usage

Reduce fever & decrease minor pain

Lowers temp by acting on hypothalamus → ↑ vasodilation & sweating

Acetaminophen Class

Nonnarcotic Analgesic Antipyretic

Acetaminophen Adverse Effects

Hepatotoxicity

Renal failure

Acetaminophen Contraindications

Drug allergy

Use cautiously in liver or kidney impairment

Acetaminophen Highlights

Max dose: 4 g/day (adult)

Antidote: Acetylcysteine (Mucomyst)

Preferred for pain/fever in children

Give with food to ↓ GI upset

Ibuprofen Class

Propionic Acid Derivatives

Ibuprofen Usage

Mild to moderate pain

Reduces inflammation from rheumatoid and osteoarthritis

Reduces fever

Acute gout

Ibuprofen Adverse Effects

GI: Dry mouth, gingival hyperplasia, dyspepsia, heartburn, constipation, ulcers, occult blood loss

GU: Nephrotoxicity, ↑ BUN/creatinine, edema

Resp: Dyspnea, bronchospasm, hemoptysis, pharyngitis

Anaphylaxis

Ibuprofen Contraindications

Known allergies to NSAIDS/Salicylates

Caution in renal & hepatic impairment

Ibuprofen Highlights

Safe for children >6 months

BBW: Avoid for perioperative pain after CABG

Monitor for dyspepsia or GI bleeding

Caution with anticoagulants (↑ bleeding) and corticosteroids (↑ GI irritation)

Meloxicam Class

Oxicam derivatives

Meloxicam Usage

Osteo- & rheumatoid arthritis

Polyarticular juvenile RA

Meloxicam Adverse Effects

Resp: Dyspnea, hemoptysis, bronchospasm, rhinitis

Hematologic: Bleeding, platelet inhibition, ↓ H/H

GI: N/V, dyspepsia, diarrhea

CNS: Headache, dizziness, drowsiness, insomnia

Meloxicam Contraindications

Known aspirin allergy

Not for post-op CABG pt.

Meloxicam Highlights

BBW: ↑ risk of cardiovascular events & GI bleeding

↑ GI bleed risk with aspirin or anticoagulants

↑ lithium toxicity if given together

Give with food to ↓ GI irritation

Indomethacin Class

Acetic Acid Derivative

Indomethacin Usage

Pain with RA, osteoarthritis, bursitis, tendonitis, gouty arthritis

Patent ductus arteriosus (PDA) closure in infants

Indomethacin Adverse Effects

GI: Bleeding, ulcers, abdominal pain/distention, vomiting, transient ileus

CNS: Headache, dizziness, insomnia

Renal impairment

↓ clotting time

IV: Pulmonary hemorrhage

Indomethacin Contraindications

Salicylate allergy

History of GI bleeding

Postop CABG pt.

Severe renal impairment

Caution w/ renal or hepatic impairment

Indomethacin Highlights

Safety/efficacy not established in children

Beers Criteria: Avoid in geriatrics; if used, give lowest dose

Take after meals or with antacid to ↓ GI irritation

BBW: ↑ risk of CV thrombotic events (MI, CVA)

Celecoxib Class

Selective COX-2 Inhibitor

Celecoxib Usage

Treats Juvenile RA, RA, osteoarthritis, ankylosing spondylitis

Acute pain & primary dysmenorrhea

Reduces colorectal polyp formation

Celecoxib Adverse Effects

Headache, dizziness, insomnia, Ophthalmic changes

↑ Risk of MI or CVA

Rash, pruritus, sweating, dry mucous membranes

Dyspepsia, bleeding with prolonged/high doses

Anaphylaxis

Celecoxib Contraindication

Allergy to sulfonamides, NSAIDs, or aspirin

Significant renal impairment

Perioperative pain & postoperative CABG patients

Hepatic impairment – reduce dose by 50%

Celecoxib Highlights

Recommended for children ≥2 years for juvenile RA

BBW: Cardiac & vascular risks

↑ Bleeding risk with aspirin or anticoagulants

↑ Lithium toxicity if given together

Admin 2 hrs before/after antacids for proper absorption

Store in light-protected container

Colchicine Class

Mitotic Agent

Colchicine Usage

Treatment and prophylaxis of acute gout in adults

Colchicine Adverse Effects

GI: N/V, abdominal pain, dyspepsia

Hematologic: Bone marrow suppression, aplastic anemia

Hepatotoxicity

Peripheral neuropathy, alopecia, rash, muscle pain, weakness

Colchicine Contraindications

Known hypersensitivity

Avoid with cyclosporine or ranolazine

Caution in pregnancy, renal, or hepatic impairment

Older adults: reduce dose by 50% if ≥70 years

Colchicine Highlights

Avoid alcohol (ETOH) and grapefruit juice

Give with food to ↓ GI distress

May ↓ vitamin B12 absorption

Allopurinol Class

Uricosuric agents / xanthine oxidase inhibitor

Allopurinol Usage

Manage symptoms of primary & secondary gout

Acute and chronic tophaceous gout

Hyperuricemia from leukemia, lymphoma, or other malignancies

Allopurinol Adverse Effects

CNS: drowsiness, headache, vertigo

Hem: agranulocytosis, aplastic anemia, bone marrow depression

GI: N/V/D, abdominal pain, indigestions

Hepatotoxicity

Renal insufficiency

Allopurinol Contraindications

Allergy to allopurinol

Family hx or hx ofidiopathic hemochromatosis

Caution in hepatic impairment

Allopurinol Highlights

↑ Anticoagulant effects with warfarin or aspirin

Alcohol ↓ uric acid excretion

Admin after meals for better absorption

Encourage fluids to maintain ≥2000 mL urine/day

Monitor for ↓ urine output or cloudy urine → risk of uric acid kidney stones

Prednisone Class

Corticosteroid

Prednisone Usage

Suppresses inflammation & normal immune response.

Prednisone Adverse Effects

Adrenocortical insufficiency or excess

Cushingoid features: “moon face,” buffalo hump

CNS effects

Immunosuppression

Diabetes mellitus / hyperglycemia

Prednisone Contraindications

Immunosuppression or active untreated infections

Avoid live virus vaccines

Use cautiously with: kidney/liver disease, hypothyroidism, recent GI surgery, PUD, IBD, heart failure, diabetes mellitus

Prednisone Highlights

Taper dosage (do not stop abruptly)

Licorice increases the effects