Antiinflammatory Agents and Nonsteroidal Antiinflammatory Drugs (NSAIDs) The nonnarcotic analgesics are a group of drugs used to relieve

pain The NONNARCOTIC ANALGESICS are: Salicylates nonsalicylates (acetaminophen), nonsteroidal anti-inflammatory drugs (NSAIDs) include aspirin (acetylsalicylic acid) analgesic (relieves pain), antipyretic (reduces elevated body temperature) anti-inflammatory effects. MECHANISM OF ACTION analgesic action of the salicylates is due to the inhibition of prostaglandins PROSTAGLANDINS are fatty acid derivatives found in almost every tissue of the bo dy and body fluid. increase the sensitivity of peripheral pain receptors.

USES The salicylate nonnarcotic analgesics are used for the following reasons: Relief of mild to moderate pain; Reduction of elevated body Treatment of inflammatory conditions, such as rheumatoid arthritis, osteoarthri tis, and rheumatic fever USES Reduction of the risk of myocardial infarction in those with unstable angina or previous myocardial infarction (aspirin only); Reduction of the risk of transient ischemic attacks or strokes in men who have had transient ischemia of the brain due to fibrin platelet emboli (aspirin only) ADVERSE REACTIONS Gastric upset, heartburn, nausea, vomiting, anorexia, and gastrointestinal blee ding allergic reactions : hives, rash, angioedema, bronchospasm with asthma-like symptoms, and anaphylactoid reactions SALICYLATE TOXICITY Salicylate toxicity produces a condition called SALICYLISM SALICYLISM Dizziness Tinnitus (a ringing sound in the ear) Impaired hearing Nausea SALICYLISM Vomiting Flushing Sweating Rapid deep breathing

Tachycardia Diarrhea SALICYLISM Mental confusion Lassitude Drowsiness Respiratory depression and coma (large doses) CONTRAINDICATIONS hypersensitivity to the salicylates or the NSAIDs Pregnancy: produce adverse maternal effects Anemia postpartum hemorrhage Prolonged gestation or labor

CONTRAINDICATIONS adverse fetal effects low birth weight intracranial hemorrhage in premature infants Stillbirths neonatal death

CONTRAINDICATIONS Children or teenagers with influenza or chickenpox (aspirin) Reye s syndrome a life threatening condition characterized by vomiting and lethargy, progressing to coma).

INTERACTIONS Food containing salicylate (curry powder, paprika, licorice, prunes, raisins, an d tea) may increase the risk of adverse reactions. Coadministration of the salicylates with activated charcoal decreases the absorp tion of the salicylates. Antacids may decrease the effects of the salicylates INTERACTIONS Coadministration with the carbonic anhydrase inhibitors increases the risk of s alicylism. Aspirin may increase the risk of bleeding during heparin administration. Coadministration with the NSAIDs may increase NSAID blood levels Acetaminophen (Tylenol, Datril, Panadol) Substitute for patients who are allergic to aspirin or who experience extreme ga stric upset when taking aspirin. drug of choice for treating children with fever and flu-like symptoms.

MECHANISM OF ACTION Acetaminophen is a nonsalicylate nonnarcotic analgesic whose mechanism of action is unknown. analgesic and antipyretic activity No antiinflammatory action USES mild to moderate pain reduce elevated body temperature (fever). aspirin allergy bleeding disorders, such as bleeding ulcer or hemophilia receiving anticoagulant therapy, minor surgical procedures ADVERSE REACTIONS usually occur with chronic use or when the recommended dosage is exceeded. Adverse reactions include skin eruptions urticaria (hives) hemolytic anemia pancytopenia (a reduction in all cellular components of the blood) ADVERSE REACTIONS Hypoglycemia jaundice (yellow discoloration of the skin) hepatotoxicity (damage to the liver) hepatic failure (seen in chronic alcoholics ACUTE ACETAMINOPHEN POISONING Acute acetaminophen poisoning or toxicity single 10- to 15-g dose Dosages of 20 to 25 g may be fatal the liver cells necrose or die The risk of liver failure increases patients who are chronic alcoholics. Acute hepatic and renal failure SIGNS OF ACUTE ACETAMINOPHEN POISONING Nausea Vomiting Confusion Liver tenderness Hypotension Arrhythmias Jaundice Acute hepatic and renal failure CONTRAINDICATIONS, PRECAUTIONS, AND INTERACTIONS Hypersensitivity chronic alcoholics used cautiously during pregnancy and lactation. Use with the barbiturates, hydantoins, isoniazid, and rifampin may increase the toxic effects and possibly decrease the therapeutic effects of acetaminophen have analgesic and antipyretic properties. exact mechanisms of actions are not known,

inhibiting prostaglandin (synthesis by inhibiting the action of the enzyme cyclo oxygenase, the enzyme responsible for prostaglandin synthesis. Prostaglandins sensitize pain receptors and increase the pain associated with other chemical me diators such as bradykinin and histamine act as pyrogens (fever-producing agents).

The NSAIDs act to inhibit the activity of two related enzymes: 1. cycloo1xygenase-1 (COX-1) helps to maintain the stomach lining; and 2. cyclooxygenase-2 (COX-2) that triggers pain and inflammation. newer NSAIDs (celecoxib and rofecoxib) appear to work by specifically inhibiting the COX-2 enzyme, without inhibiting the COX-1 enzyme.

USES Osteoarthritis , rheumatoid arthritis, and other musculoskeletal disorders Mild to moderate pain relief dysmenorrhea Fever reduction ADVERSE REACTIONS Gastrointestinal tract nausea, vomiting, diarrhea, constipation, epigastric pain, indigestion,abdominal distress or discomfort, intestinal ulceration,stomatitis, jaundice, bloating, a norexia, and dry mouth ADVERSE REACTIONS Central Nervous System dizziness, anxiety, lightheadedness,vertigo, headache, drowsiness, insomnia, con fusion, depression, and psychic disturbances ADVERSE REACTIONS Cardiovascular congestive heart failure, decrease or increase in blood pressure, and cardiac ar rhythmias Renal hematuria, cystitis, elevated blood urea nitrogen, polyuria, dysuria, oligu ria, and acute renal failure in those with impaired renal function ADVERSE REACTIONS Special senses visual disturbances, blurred or diminished vision, diplopia, swollen or irritated eyes, photophobia, reversible loss of color vision, tinnitus, taste change, and rhinitis

CONTRAINDICATIONS, PRECAUTIONS, AND INTERACTIONS hypersensitivity used cautiously in patients withbleeding disorders, renal disease, cardiovascula r disease,or hepatic impairment and in the elderly. used with extreme caution during pregnancy, COMMON ADVERSE REACTIONS OF SELECTED NSAID s Celecoxib most common adverse reactions dyspepsia, abdominal pain, diarrhea, nausea, and headache. may compromise renal function. COMMON ADVERSE REACTIONS OF SELECTED NSAID s Ibuprofen used in children with juvenile arthritis and for fever reduction in children 6 m onths to 12 years. Common adverse reactions seen with ibuprofen include headache, dizziness, somnol ence, nausea, dyspepsia, gastrointestinal pain, and rash. COMMON ADVERSE REACTIONS OF SELECTED NSAID s Naproxen Common adverse reactions seen with naproxen include headache, vertigo (dizziness ), somnolence, insomnia, nausea, dyspepsia, gastrointestinal pain, and rash. NSAIDs: NURSING IMPLICATIONS Before beginning therapy, assess for conditions that may be contraindications to therapy, especially: GI lesions or peptic ulcer disease Bleeding disorders Assess also for conditions that require cautious use. Perform lab studies as indicated (cardiac, renal, liver studies, CDC, platelet c ount). NSAIDs: NURSING IMPLICATIONS Perform a medication history to assess for potential drug interactions. Several serious drug interactions exist: alcohol heparin phenytoin oral anticoagulants steroids sulfonamides NSAIDs: NURSING IMPLICATIONS Salicylates are NOT to be given to children under age 12 because of the risk of Reye s syndrome. Because these agents generally cause GI distress, they are often better tolerate d if taken with food, milk or an antacid to avoid GI irritation. Explain to patients that therapeutic effects may not be seen for 3 to 4 weeks. NSAIDs: NURSING IMPLICATIONS educate patients about the various side effects of NSAIDs, and to notify their p hysician if these effects become severe or if bleeding or GI pain occur. Patients should watch closely for the occurrence of any unusual bleeding, such as in the stool. Enteric-coated tablets should not be crushed or chewed.

NSAIDs: NURSING IMPLICATIONS Monitor for therapeutic effects, which vary according to the condition being tre ated: decrease in swelling, pain, stiffness, and tenderness of a joint or muscle area