Chapter 13: Drugs for Inflammation, Arthritis, & Gout

Anti-inflammatory Drug

Primary purpose is to prevent or limit the tissue and blood vessel responses to injury or pathogen invasion.

Corticosteroids

Drugs built on the structure of cholesterol that are able to prevent or limit inflammation and allergy by slowing or stopping production of the mediators histamine and leukotriene.

disease-modifying antirheumatic drugs (DMARDs)

Reduces the progression and tissue destruction of the inflammatory disease process, especially rheumatoid arthritis, by inhibiting tumor necrosis factor (TNF).

Inflammation

Response to injury or infection caused by white blood cells (leukocytes) and their productions that result in a predictable set of tissue and blood vessel actions.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Not based on chemical structor of cholesterol but can prevent or limit the tissue and blood vessel responses to injury by slowing the production of one or more inflammatory mediators.

Acute inflammatory reactions

Common and can be helpful or protective.

Chronic Inflammatory reactions

Can cause tissue damage and distruction

All NSAIDS have the same

Mechanism of action

All NSAIDS increase

The risk of bleeding, especially in elderly patients and patients who take any type of anticoagulant.

NSAIDS (except aspirin) decrease the effectiveness of many

Antihypertensive drugs, especially ACE-Is, ARBs, beta-blockers, and most diuretics.

Patients who take corticosteroids must not

Suddenly stop taking drug

Corticosteroids have a

Wide range of side effects and adverse reactions.

Always ask a patient who is about to receive a DMARD about

If they have a current infection or have had TB, hepatitis, shingles, HIV, pneumocystis pneumonia, or any other type of opportunistic infection

Anti-inflammatory drugs do not prevent

Gout or the associated joint damage of gout.

The use of drugs for gout should be combined with

Patient teaching on weight loss and avoiding alcohol & high-purine foods.

NSAIDs slow the production of

Inflammatory mediators, limiting blood vessel response to injury.

Two main types of NSAIDs

Nonselective and Selective NSAIDs

Nonselective NSAIDs inhibit

Action of COX-1 and COX-2

Selective NSAIDS have

More inhibitory effects on COX-2 than COX-1.

NSAIDs are the first

Drugs used to treat inflammation based problems that are associated with pain & fever.

NSAIDs are available

Over-the-counter but can still potentially cause overdose. Larger doses most be prescribed by a doctor.

Nonselective NSAIDs (like aspirin) inhibit

Platelet clumping.

Common side effects of NSAIDs

Heartburn, nausea, vomiting, dizziness, headache, & increased risk for bleeding/bruising.

Adverse effects of NSAIDs

Hypertension from fluid retention, renal failure, upper or lower GI bleeding.

All NSAIDs increase

The risk of bleeding because they interfere with the platelet function.

If a patient is taking NSAIDs, what is important to remind them of?

Stop taking NSAIDs (specifically aspirin) prior to procedures due to the increased risk of bleeding.

Can NSAIDs be taken with Warfarin?

Increased risk of bleeding, hemorrhage, & stroke are likely.

If someone is taking NSAIDS, ensure

2-3 liters of water intake a day to ensure good blood flow because all drugs (except aspirin) cause kidney damage.

Patients who use NSAIDs with a diagnosis of diabetes need to

Check blood sugar levels more often due to risk of hypoglycemia for those taking oral antidiabetic drugs.

If a patient taking NSAIDs experiences

Ringing in the ears, abnormal bruising/bleeding, or any black tarry/bloody stools are noted, report to provider.

Common examples of NSAIDs

Ibuprofen (Advil), Naproxen (Aleve), Aspirin.

Contraindications of NSAIDs

History of ulcers or GI bleeding, kidney disease, pregnancy (3rd trimester), & using with anticoagulants (like warfarin)

Common Corticosteroids

PrednisONE, methylprednisolONE, hydrocortisONE, dexamethasONE, triamcinolONE, betamethasONE, & fluticasONE.

What are corticosteroids?

Synthetic drugs that resemble cortisol.

What do corticosteroids do?

Reduce inflammation and suppresses the immune system

How are corticosteroids administered?

Oral tablets, injections, inhalers, or topical creams.

Common side effects associated with corticosteroids

Weight gain, appetite increase, mood change, & increased risk for infection.