Anti-inflammatory Agents

Anti-inflammatory Agents

Inflammatory Response

  • Protects the body from injury and pathogens
  • Uses chemical mediators to produce the reaction that helps destroy pathogens and promote healing

Anti-inflammatory Agents

  • Block or alter the chemical reactions associated with the inflammatory response

Types of Anti-inflammatory Agents

  • Corticosteroids: used systemically to block the inflammatory and immune systems
  • Antihistamines: block the release of histamine in the initiation of the inflammatory response

Salicylates

  • Can block the inflammatory response
  • Have antipyretic (fever-blocking) properties
  • Have analgesic (pain-blocking) properties

NSAIDs

  • Provide strong anti-inflammatory and analgesic effects
  • Sold over the counter, which may lead to abuse

Common Salicylates

  • Aspirin (Bayer,etc.): treats inflammatory conditions
  • Balsalazide (Colazal): new drug that treats ulcerative colitis
  • Choline magnesium trisalicylate (Trilisate): treats mild pain and fevers as well as arthritis
  • Choline salicylate (Arthropan): treats mild pain and fevers as well as arthritis
  • Mesalamine (Pentasa, etc.): treats inflammation of the large intestine
  • Olsalazine (Dipentum): converted to mesalamine in the colon; has the same direct anti-inflammatory effects
  • Salsalate (Argesic, etc.): treats pain, fever, and inflammation
  • Sodium thiosalicylate (Rexolate): treats episodes of acute gout and muscular pain as well as rheumatic fever

Salicylates

  • Action/indication
    • Inhibit synthesis of prostaglandin; used to treat mild to moderate pain and fever
  • Pharmacokinetics
    • Absorbed from the stomach, peak in 5 to 30 min., metabolized in the liver, and excreted in the urine
  • Contraindications
    • Known allergy, bleeding abnormalities, and impaired renal function
  • Drug-to-drug interactions
    • Interact with other drugs by interfering with absorption

Salicylates—Adverse Effects

  • GI irritation
    • Nausea, dyspepsia, and heartburn
  • Clotting system
    • Blood loss and bleeding abnormalities
  • Eighth cranial nerve stimulation
  • Salicylism
    • Ringing in the ears
    • Acidosis
    • Nausea, vomiting, and diarrhea
    • Mental confusion and lassitude

Types of NSAIDs

  • Propionic acids
    • Fenoprofen
    • Ibuprofen
  • Acetic acids
    • Diclofenac
    • Etodolac
  • Fenamates
    • Mefenamic acid
  • Cyclooxygenase-2 inhibitors
    • Celecoxib

NSAIDs Indications

  • Relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis
  • Relief of mild to moderate pain
  • Treatment of primary dysmenorrhea
  • Fever reduction

Contraindications to NSAIDs

  • Presence of allergy to any NSAID or salicylate
  • Cardiovascular dysfunction or hypertension
  • Peptic ulcer or known GI bleeding
  • Pregnancy and lactation
  • Caution with renal or hepatic dysfunction

Other Anti-inflammatory Agents

  • Acetaminophen (Tylenol)
  • Gold compounds
  • Antiarthritic drugs

Acetaminophen

  • Action/indications
    • Acts directly on the thermoregulatory cells of the hypothalamus
    • Mechanism of action related to analgesic effects is not certain
    • Used to treat pain and fever
      • Treatment of pain and fever associated with a variety of conditions, including influenza
      • Prophylaxis of children receiving diphtheria–pertussis–tetanus (DPT) immunizations
      • Relief of musculoskeletal pain associated with arthritis
  • Pharmacokinetics
    • Absorbed from the GI tract
    • Peaks in ½ to 2 hours
    • Metabolized in the liver
    • Excreted in the urine
    • T½ is about 2 hours
  • Contraindications
    • Known allergy
    • Use with caution in pregnancy and lactation
  • Adverse reactions
      • Headache, hemolytic anemia, renal dysfunction, skin rash, fever, and hepatotoxicity
    • Drug-to-drug interactions
      • Oral anticoagulants increase bleeding

Gold Compounds

  • Action
    • Absorbed by macrophages, which results in inhibition of phagocytosis
  • Indication
    • Tissue destruction is decreased
  • Pharmacokinetics
    • Absorption varies based on the site of administration
    • Widely distributed throughout the body
  • Contraindications
      • Known allergy
      • Diabetes, CHF, and renal or hepatic impairment
    • Adverse reactions
      • Stomatitis, glossitis, gingivitis, bone marrow depression, and dermatitis
    • Drug-to-drug interactions
      • Penicillamine, antimalarials, cytotoxic drugs, and immunosuppressive agents

Other Antiarthritis Drugs

  • Etanercept (Enbrel)
  • Leflunomide (Arava)
  • Penicillamine (Depen)
  • Hyaluronidase derivative (Synvisc)
  • Sodium hyaluronate (Hyalgan)
  • Anakinra (Kineret)

Use of Anti-inflammatory Agents Across the Lifespan

Use of Anti-inflammatory Agents Across the Lifespan

Use of Anti-inflammatory Agents Across the Lifespan

 

 

Prototype Salicylates

Prototype Salicylates

Prototype Salicylates

 

 

Prototype NSAIDs

Prototype NSAIDs

Prototype NSAIDs

 

 

Prototype Acetaminophen

Prototype Acetaminophen

Prototype Acetaminophen

 

 

Prototype Gold Compound

Prototype Gold Compound

Prototype Gold Compound

 

 

Nursing Considerations for Salicylates

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for NSAIDs

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
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