Antiinflammatory Drugs

Question 1

Facts

Answer 1

• Aka Prostaglandin Inhibitors
• Relieve pain, reduce elevated body temperature, and inhibit platelet aggregation

Question 2

NONSTEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS) Facts

Answer 2

• inhibit the COX enzyme
• Not suggested for use in alleviating mild headaches and mildly elevated temperature
• Ibuprofen and naproxen –only OTC NSAIDs

Question 3

7 groups of NSAIDs

Answer 3

A. 1st Generation
1. Salicylates
2. Parachlorobenzoic acid derivatives/ indoles
3. Phenylacetic acids
4. Propionic acid derivatives
5. Fenamates
6. Oxicams

B. 2nd generation
7. Selective COX-2 inhibitors

Question 4

Salicylates: Example_Aspirin

Answer 4

1. Facts
   - aka acetylsalicylic acid (ASA)
   - 250-500mg BID; max 1500mg/d for adults
   - for Mild to moderate pain
   - do not take durin the 3rd trimester
   - considered as an antiplatelet drug for patients with cardiac or cerebrovascular disorders
   - Should NOT be taken with other NSAIDs
2. Common Side effects
   - gastric distress (take with water, milk, or food)
3. can cause Reyes Syndrome
   - rare disorder that typically occurs after a viral illness
   - results in brain and liver damage

Question 5

Salicylates Nursing Interventions

Answer 5

• Monitor aspirin levels when taking high doses for chronic conditions
• Observe signs of bleeding
• Advise pt not to take with alcohol or highly protein-bound drugs
• Inform dentist before a dental visit if taking aspirin
• Discontinue 3-7 days before surgery
• Keep out of reach of children
• Call poison control center immediately if a child has taken a large or unknown amount of aspirin (or acetaminophen
• Do not administer for virus or flu symptoms due to risk of Reye’s syndrome
• Inform pt that aspirin can cause GI distress
• Inform pt with dysmenorrhea to take acetaminophen instead of aspirin
• Report side effects such as drowsiness, tinnitus, headaches, flushing dizziness, GI symptoms, visual changes, and seizures
• Take with food, at mealtime, or with plenty of fluids

Question 6

Para-Chlorobenzoic Acid

Answer 6

1. Indomethacin
   - used for rheumatoid arthritis, gouty arthritis an osteoarthritis
   - potent prostaglandin inhibitor
   - 90% protein-bound
   - very irritating to the stomach, should be taken with food
2. Sulindac and Tolmetin
   - Less severe adverse reaction
3. Adverse Reactions
   - sodium and water retention
   - increase blood pressure

Question 7

Phenylacetic Acid Derivatives

Answer 7

1. Diclofenac
   - Similar to the analgesic and anti-inflammatory effects of aspirin
   - minimal to no antipyretic effects
   - indicated for rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis
   - can be given PO, extended-release, and topical 1% gel preparations
2. Ketorolac
   - first injectable NSAID
   - greater analgesic property than anti-inflammatory
   - Recommended for short-term management of pain
   - IM 30-60mg q6h for adults
   - available in PO, IV, and intranasal preparations

Question 8

Fenamates

Answer 8

1. Meclofenamate sodium and Mefenamic acid
   - for acute and chronic arthritis
   - Side effects: gastric irritation (contraindicated to pts with history of peptic ulcer disease), edema, dizziness, tinnitus, and pruritus

Question 9

Oxicams

Answer 9

1. Piroxicam
   - for long-term arthritis condition (RA and OA)
   - lower incidence of ulceration and gastric distress
   - Advantage: long half-life; taken only once a day
   - Full clinical response after 1-2 weeks
   - Highly protein-bound
   - DO NOT take with aspirin or other NSAIDs

Question 10

Selective COX-2 Inhibitors

Answer 10

1. Celecoxib
   - Prototype drug
   - DOC for patients with severe arthritic conditions who need high doses of anti-inflammatory drug
2. Other drugs
   - Etoricoxib, Parecoxib
3. facts
   - have a gastroprotective property which cause gastric irritation

Question 11

CORTICOSTEROIDS (sone)

Answer 11

1. Facts
   - suppressing or preventing many of the components of the inflammatory process at the injured site
   - frequently used for arthritic flare up
   - Long half-life
   - administered once a day in a large prescribed dose
   - should be tapered over a period of 5 to 10 days
2. Examples
   - Prednisone
   - prednisolone
   - dexamethasone

Question 12

DISEASE-MODIFYING ANTIRHEUMATIC DRUGS (DMARDs)

Answer 12

*DOC when NSAIDs do not control immune-mediated arthritic disease sufficiently, however more toxic

1. Immunosuppressive agents
2. Immunomodulators
3. Antimalarials

Question 13

Immunosuppressive Agents

Answer 13

1. Facts
   - used to treat refractory rheumatoid arthritis
   - primarily used to suppress cancer growth and proliferation
   - might be used to suppress the inflammatory process of rheumatoid arthritis when other treatments fail
2. Examples
   - Azathioprine
   - Cyclophosphamide
   - Methotrexate

Question 14

Immunomodulators

Answer 14

1. Facts
   - Treat moderate to severe rheumatoid arthritis by disrupting the inflammatory process and delaying disease progression
   - Interleukin receptor (IL-1) agonists and Tumor necrosis factor(TNF) blockers
   - Predisposes patient to severe infections
   - Very expensive
2. Contraindicated
   - active infection

Question 15

IL-1 and TNF

Answer 15

proinflammatory cytokines that contribute to synovial inflammation and joint destruction

Question 16

Immunomodulators Examples

Answer 16

1. Anakinra
   - IL-1 receptor antagonist
   - Inhibits binding of IL-1 to interleukin receptors located in cartilage and bone
   - Subcutaneous injection, peak: 3-7hrs and t1/2: 6hrs
2. Infliximab, Etanercept Adalimumab, Leflunomide
   - Infliximab is a prototype drug
   - TNF blocker
   - Blocks TNF from attaching to TNF receptors on synovial cell surfaces