Methotrexate, Acetaminophen, ibuprofen

What is Acetaminophen?

para-aminophenol derivative

Acetaminophen Expected Pharmacological Action:

\-Cox inhibitor in the CNS

\-relieves pain and reduces fever

Acetaminophen Therapeutic use

\-For moderate to mild pain

\-fever reducer

Acetaminophen Complications

\-Overdose (liver damage)

\-Hypertension (daily use)

Acetaminophen Contraindications

Alcohol use disorder

Acetaminophen Percautions

\-Anemia \n -Immunosuppression

\-Hepatic or kidney disease

Acetaminophen Interactions

\-Alcohol increases the risk of liver injury (with high doses) \n -Warfarin increases risk of bleeding \n -Cholestyramine decreases absorption

Acetaminophen med admin

\-Admin: Orally, rectally, or IV \n - No more than 3 grams/day (2 grams wit alcoholic) \n - Children are dosed by weight \n - combo drug used with other meds

Acetaminophen Nursing interventions

\-Monitor for overdose/poisoning symptoms (abdominal discomfort, N&V, sweating, diarrhea) \n - Acetylcysteine (mucomyst) is the antidote for overdose \n -Monitor B/P if taking daily

Acetaminophen education

* Do not exceed 3 grams/day
* Report any abdominal discomfort, N&V, sweating, diarrhea
* Have B/P checked regularly

Acetaminophen evaluation of effectiveness

* decrease in fever
* decrease in pain

What is Ibuprofen

\-NSAID

\-(Cox 1 and Cox 2 inhibitor)

Ibuprofen Expected Pharmacological Action

Inhibits cyclooxygenase (Cox) enzyme

Ibuprofen therapeutic use

Decreases pain and fever

Ibuprofen complication

\n -GI upset, heartburn, nausea, ulcerations \n -Bleeding (less with non-ASA NSAIDs) \n -Kidney dysfunction \n - Stroke (Thromboembolic event)

Ibuprofen contraindications

\-Pregnancy risk D \n -Peptic ulcer disease \n -Bleeding disorders \n -Children or adolescents with a virus

Ibuprofen percautions

\-Older adults \n -Smoking \n -Alcohol disorder \n -H-pylori \n -Heart failure \n -Advanced kidney dysfunction \n -hypertension

Ibuprofen interactions

\-anticoagulants, glucocorticoids and alcohol: increase risk of bleeding \n -ACE inhibitors & ARBs increase risk of kidney failure \n -Decreases antihypertensive effects of ACEs \n -Risk of lithobid and methotrexate toxicity increases

Ibuprofen med admin

\-admin: Oral, IV

\-Make sure swallow enteric coated or sustained release, do not crush or chew \n -Monitor for therapeutic effects

Ibuprofen nursing interventions

\-Monitor for signs of bleeding

\-Test and treat H-pylori infection \n -Recommend a proton pump inhibitor \n -Monitor I&O, BUN & creatinine \n -Monitor for salicylism (tennitis) \n -Monitor for signs of embolic event

Ibuprofen client education

\-Take with food or milk \n -Avoid alcohol \n -Report persistent GI irritation or GI bleeding \n -Report changes in urine output, weight gain or fluid retention \n -Report symptoms of embolic events

Ibuprofen effectiveness evaluation

* decrease inflammation
* decrease pain
* decrease fever

What is Methotrexate

DMARD1 (disease-modifying antirheumatic drugs)

Methotrexate expected pharmacological action

immunosuppression is primary effect

Methotrexate therapeutic use

\-decrease joint inflammation & joint damage

\-can slow or stop RA,

\-treat cancer in larger doses

Methotrexate complications

\-Liver damage \n -Renal problems \n -Bone marrow suppression \n -Increase risk of infection \n -GI ulceration \n -Pulmonary fibrosis \n -Pregnancy Category X

Methotrexate contraindications

\n -Active bacterial or viral infections \n -Peptic ulcer disease

\-Ulcerative colitis

Methotrexate percautions

\-Liver insufficiency \n - Hepatitis \n -Renal insufficiency \n -Women who are pregnant

Methotrexate interactions

\-May decrease digitalis levels \n -Combined with NSAIDs/salicytates/sulfonamides may cause toxicity \n -Alcohol increases risk of hepatotoxicity

Methotrexate med admin

\-Give once a week (oral, SQ, IM) \n -Weakly folic acid supplement (to decrease risk of toxicity) \n -Initially give with NSAIDs, may stop when optimal therapeutic effects achieved \n -Slow onset of therapeutic affects

Methotrexate nursing interventions

\-Decrease platelets, WBC, RBC \n -Watch for Signs and Symptoms of infection \n -Watch liver function-labs, jaundice \n -Watch for GI bleeding \n -Watch for respiratory distress, decreased O2

Methotrexate client education

\-Drink 8-12 oz H2O daily \n -Report: yellow skin/eyes, S&S of infection, oral ulcerations, abnormal bleeding or bruising, blood in vomitus or stool, difficulty breathing or SOB \n -Avoid pregnancy during or 6 month postpartum \n -Avoid alcohol

Methotrexate effectiveness evaluation

Decreased joint inflammation, able to move joints more