Anti-inflammatory Drugs

Anti-inflammatory Drugs

Instructor: Rachel Feiman MSN, RN

Course: NUR2012

Learning Outcomes

  • Explain the indications for NSAID use: Understand the specific situations in which NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are prescribed.
  • Demonstrate a basic understanding of their mechanism of action in the body: Know how NSAIDs exert their pharmacological effects.
  • Recognize the potential risks of NSAID use: Be aware of adverse effects and complications associated with NSAIDs, and implement appropriate nursing interventions to ensure patient safety.
  • Identify key assessments and monitoring parameters: Monitor patients using NSAIDs for early signs of adverse effects.
  • Evaluate the risks and benefits of NSAID use: Analyze different patient populations, including contraindications and potential drug interactions.
  • Distinguish aspirin from other first-generation NSAIDs: Understand aspirin's unique pharmacological properties, therapeutic uses, and risk profile.

Overview of NSAIDs

  • Definition: Nonsteroidal anti-inflammatory drugs are medications that provide analgesic (pain relief), anti-inflammatory, and antipyretic (fever-reducing) effects.
  • Mechanism of Action:
    • Block Prostaglandin/Leukotriene Pathway: NSAIDs inhibit processes leading to the synthesis of these pro-inflammatory mediators.
    • Cyclooxygenase (COX) Inhibition:
    • COX-1: Involved in the regulation of homeostatic functions throughout the body, providing beneficial effects.
    • COX-2: Primarily involved in the inflammatory process.

Risks and Warnings for NSAIDs

  • Box Warning:
    • Increased risk of myocardial infarction (MI), stroke, and adverse gastrointestinal events with NSAID use.
  • Misoprostol: A synthetic prostaglandin analog approved by the FDA for preventing and treating NSAID-induced gastric ulcers.
  • Adverse Effects: Risk of Steven Johnson Syndrome (a serious skin condition).
  • Ceiling Effect: Increased dosages beyond a certain threshold increase the risk of adverse effects without a corresponding therapeutic benefit.

Salicylate - Aspirin

  • Classification: Aspirin is classified as an antiplatelet agent, differing from other NSAIDs as it does not block the leukotriene pathway.
  • Indications: Used for treating inflammatory disorders, mild to moderate pain, fever, and for prophylaxis against transient ischemic attacks (TIAs) and myocardial infarctions (MIs).
  • Nursing Considerations:
    • Prolongs bleeding time for up to 8 days.
    • Pregnancy Consideration: Special attention required due to risks.
  • Adverse Effects/Side Effects (AE/SE):
    • Gastrointestinal disturbances, bleeding, renal impairment, hepatotoxicity, and risk of Reye's Syndrome (a serious condition in children).
  • Dosage: 81 mg or 325 mg; lower doses recommended for patients with bleeding risks.

Salicylate Overdose (Salicylism)

  • Symptoms: Tinnitus, hyperventilation, mental confusion or lethargy, numbness.
  • Treatment: Gastric lavage and activated charcoal.

Propionic Acid Derivatives

  • Ibuprofen:
    • Indications: Management of mild to moderate pain, osteoarthritis, rheumatoid arthritis, musculoskeletal disorders, fever, and dysmenorrhea.
    • Side Effects/Adverse Effects (SE/AE): Risk of Steven Johnson Syndrome, myocardial infarction, and stroke.
    • Dosing: Maximum 3200 mg in 3-4 divided doses for adults.
Other Propionic Acid Derivatives
  • Naproxen: Noted for less gastrointestinal upset compared to ibuprofen.
  • Flurbiprofen, Fenoprofen, Ketoprofen: Other members of this class with similar indications.

Acetic Acid Derivatives

  • Ketorolac:
    • Indications: Utilized for moderate to severe pain.
    • Nursing Considerations: Patients with asthma should use caution; intended for short-term use not exceeding 5 days.
    • Adverse Effects/Side Effects (AE/SE): Potential for renal toxicity, gastrointestinal pain, and dyspepsia.
  • Indomethacin:
    • Indications: For mild to moderate acute pain via oral route, and also used for osteoarthritis, rheumatoid arthritis, gouty arthritis, and ankylosing spondylitis.
    • Special Use: Closure of patent ductus arteriosus, delivered intravenously.
    • AE/SE: Risk of tinnitus.
    • Nursing Consideration: Avoid after 30 weeks gestation to prevent premature closure of fetal ductus arteriosus.
  • Diclofenac: Available in both oral and topical forms.
    • Indications: For rheumatoid arthritis, osteoarthritis, mild to moderate pain; topical used for OA and acute pain associated with minor strains, sprains, and contusions.
    • AE/SE: Hepatotoxicity is a concern.
    • Nursing Consideration: Alerts to notify the provider for signs/symptoms of hepatotoxicity, rash, and signs of MI and stroke.

Cyclooxygenase 2 Inhibitors (COX-2 Inhibitor)

  • Celecoxib:
    • Indication: Used to manage moderate pain.
    • Mechanism: Developed to selectively inhibit COX-2.
    • Adverse Effects: Potential heart failure (HF).
    • Advertising Warning: Important differentiation made in commercial considerations of Celebrex.

Enolic Acid Derivatives

  • Indications: Treat mild to moderate pain as well as osteoarthritis, rheumatoid arthritis, and gouty arthritis.
  • Examples: Meloxicam, Piroxicam.

Nursing Considerations for Anti-inflammatory Drugs

  • Assessment Areas:
    • Evaluate pain levels, joint condition, and activities of daily living (ADLs).
    • Monitor laboratory values including complete blood count (CBC), blood urea nitrogen (BUN), creatinine (CR), and liver function tests (LFT).
    • Assessment of gastrointestinal status and complications.
  • Lifespan Considerations: Adjust care for specific populations including:
    • Children, pregnant patients, and the elderly to account for altered pharmacokinetics and risk profiles.