Exam 3 Patho: Medications for Inflammation

inflammation

body's defense mechanism

• contains injury or destroys the microorganism

chemical mediators of inflammation

histamines, leukotrienes, bradykinin, prostaglandins

anaphylaxis

life-threatening allergic response that may result in shock or death due to rapid release of inflammatory mediators throughout the body

acute inflammation

immediate onset, 8-10 days for symptoms to resolve

chronic inflammation

slower onset, continues for prolonged periods

• rheumatoid arthritis, seasonal allergies, lupus

inflammatory process

1. histamine and prostaglandins released

2. capillaries dilate and clotting begins

3. chemotactic factors attract phagocytic cells

4. phagocytes consume pathogens and cell debris

what do 1st Generation NSAIDS affect

COX 1 and 2

1st generation nsaids

Salicylates

• Aspirin (ASA)

Non-salicylates

• Ibuprofen (Motrin,Advil)

• Naproxen (Aleve)

Others

• Ketorolac (Toradol)

• Indomethacin (Indocin)

what do 2nd Generation NSAIDs affect

target COX 2 only

2nd generation nsaids

Celecoxib (Celebrex)

NSAIDs therapeutic uses

• Decreased inflammation (inhibits COX-2)

• Analgesia for mild to moderate pain

• Fever reduction

• Inhibition of platelet aggregation

aspirin classification

COX-1 and COX-2 inhibitor + Antiplatelet

aspirin therapeutic uses

• Suppresses inflammation

• Treats mild to moderate pain

• Reduces fever, relieves dysmenorrhea, and inhibits platelet aggregation

• *Prevention of heart attack and stroke

Salicylism

When salicylate levels are above therapeutic

Salicylism manifestations

• Tinnitus

• Sweating

• Headache

• Dizziness

Reye's syndrome

• Rare - when a child is given aspirin and has a viral illness.

Manifestations:

• Encephalopathy

• Fatty liver• 20-30% mortality rate

• Do not give to children under the age of 19

nsaids adverse drug reactions

•GI discomfort, ulcers

•Kidney dysfunction

•Increased bleeding

•Thromboembolic events (non-aspirin NSAIDs)

nsaids nursing interventions/client education

•Take with food or milk

•Avoid alcohol

•Monitor for signs of bleeding

•Monitor I&O and kidney function

•Stop taking 1 week before surgery

•Do not take aspirin if smells like vinegar

•Use acetaminophen for children or patients on anticoagulants

NSAIDs contraindications

•Teratogenic

•Bleeding disorders or on anticoagulants (heparin or warfarin)

•No aspirin for children

•Use cautiously in older adults

•Alcoholics or smokers

•Surgery within 1 week

nsaids drug interactions

•Anticoagulants

•Glucocorticoids

•Alcohol

•Other NSAIDS

Adrenal glands produce what

corticosteroids

Glucocorticoids

Cortisol (hydrocortisone) and Cortisone

Mineralcorticoids

aldosterone

glucocorticoids purpose

Provide symptomatic relief of inflammation and pain, by inhibiting synthesis of prostaglandins (decrease pain), decreasing capillary permeability (decrease swelling), decreasing lymphocyte production (decreases immune response)

glucocorticoids therapeutic uses

•Analgesia for pain, swelling, and joint stiffness

•Maintenance of joint function

•Slow/delay the worsening of a disease

•Short-term therapy

Glucocorticoids

•Increase glucose levels

•Promote breakdown of fats

•Decrease GI absorption of calcium

•Decrease formation of osteoblasts

•Maintain function of skeletal muscles

•Decrease production of prostaglandins

•Suppress inflammatory and immune responses

Mineralcorticosteroids

Maintains fluid and electrolyte balance by:

•Increasing renal reabsorption of sodium and water

fludrocortisone (Florinef)

given for orthostatic hypotension

glucocorticoids adverse drug reactions

•Increased risk for infection

•Osteoporosis (bone loss)

•Adrenal suppression

•Fluid retention

•GI discomfort, PUD

•Hyperglycemia

•Electrolyte imbalances

•Myopathy

•Cushing's Syndrome

•Cataracts

glucocorticoids nursing interventions/client education

•Monitor for signs of infection(vitals, labs)

•Take calcium and Vit D supplements

•Monitor for signs of fluid excess

•Monitor for GI bleeding

•Monitor blood glucose levels

•Monitor potassium levels and eat potassium-rich foods

•Do not abruptly stop taking - could cause Adrenal Crisis

glucocorticoids patient education

•Wear a medic alert bracelet

•Keep extra doses on hand

•Do not stop taking abruptly

•Avoid people with infections

•Adverse effects such as Cushing's Syndrome and Adrenal Crisis

•Take extra precautions for safety

•Increase potassium, calcium, and protein in diet

•Reduce sodium and carbs in diet

•Avoid alcohol

•Will need lifelong therapy if dx with Addison's Disease

adrenal function tests

•Blood tests - check ACTH, cortisol, and aldosterone levels

•24-hour Urinary Cortisol Test

•ACTH Challenge Test

Lab Tests for Inflammation

ESR - erythrocyte sedimentation rate

•Increased if inflammation is present

•> 100mm/hr

CRP - C-reactive protein

•Increased during inflammation

•1mg% = mild inflammation

•1-10mg% = mod inflammation

•>10mg% = severe inflammation

gout

Inflammatory disorder due to high levels of uric acid in the blood, leading to inflammation of the joints

•Hyperuricemia - deposit of urate acid crystals

Allopurinol classification

antihyperuricemic/antigout

allopurinol therapeutic uses

•Chronic gout treatment

•Promotes uric acid excretion

•Treatment/prevention of hyperuricemia from cancer/chemotherapy

allopurinol adverse drug reactions

•Hypersensitivity reactions

•Liver/kidney dysfunction

•GI upset

•CNS effects (drowsiness, HA, vertigo)

•Bone marrow suppression

•Cataracts >3 years of tx

allopurinol nursing interventions

•Monitor for rash or fever

•Monitor kidney & liver function

•Take w/meals

•Monitor CBC

•Check uric acid levels

•Increases bleeding with warfarin

allopurinol patient education

•Report rash, fever, abdominal pain or low urine output

•Report bleeding, bruising or sore throat

•Yearly eye exams

•Drink at last 3L of fluid per day