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Anti-inflammatory Drugs

Pathophysiology
Inflammation
Reaction to tissue injury
Caused by release of chemical
mediators
Leads to a vascular response
Fluid and WBCs migrate to injured site.
Chemical mediators
Histamines
Kinins
Prostaglandins

Inflammation

Inflammation
Chemical mediators
Histamine
Kinins
Prostaglandins

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Inflammation (Cont.)
Pathophysiology
Cardinal signs of inflammation
Cyclooxygenase (COX) enzyme
Converts arachidonic acid into
prostaglandins
Has two enzyme forms:
COX-1: protects stomach lining and
regulates blood platelets
COX-2: triggers inflammation and pain

Antiinflammatory Drugs
Anti-inflammatory drug groups

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Corticosteroids
Disease-modifying antirheumatic drugs
Antigout drugs

NSAIDs

Inhibit biosynthesis of prostaglandins

Analgesic effect
Antipyretic effect
Inhibit platelet aggregation
Mimic effects of corticosteroids

NSAIDs
Action

Inhibit COX enzyme

Inhibit prostaglandin synthesis

Uses

Reduce inflammation and pain

Not recommended for fever or
headaches
Except aspirin, ibuprofen

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NSAIDs (Cont.)
First-generation NSAIDs
Salicylates
Parachlorobenzoic acid
Indomethacin

Phenylacetic acids
Propionic acid derivatives
Ibuprofen

Fenamates
Oxicams

Second-generation NSAIDs
COX-2 inhibitors

Salicylates
Aspirin (acetylsalicylic acid) (ASA)
Action

Antiinflammatory,
antiplatelet,
antipyretic effects

Therapeutic serum salicylate level

15 to 30 mg/dL

Toxic serum salicylate level

Greater than 30 mg/dL

Salicylates (Cont.)
Drug-lab-food interactions
Drugs

Increased bleeding with anticoagulants

Hypoglycemia with oral antidiabetics
Increased gastric ulcer risk with
glucocorticoids

Lab

Increase PT, bleeding time, INR, uric acid

Decrease potassium, cholesterol, T3 and T4
levels

Foods containing salicylates

Prunes, raisins, licorice, certain spices

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Salicylates (Cont.)

Aspirin
Cautions
Side effects

Hypersensitivity
Salicylism (mild)
Severe salicylate poisoning

Nursing Process: Salicylates

Assessment
Nursing diagnosis
Planning
Nursing interventions

Patient teaching
Cultural considerations

Evaluation

Propionic Acid Derivatives (Cont.)

Ibuprofen
Drug interactions

Increased bleeding with warfarin, increased effects

with phenytoin, sulfonamides, warfarin
Decreased effect with aspirin

Side effects

Gastric distress (to be taken with food)

Tinnitus, dizziness, confusion, edema
Blood dyscrasias, dysrhythmias, nephrotoxicity

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Nursing Process: Ibuprofen

Assessment
Nursing diagnoses
Planning
Nursing interventions

Patient teaching
Cultural considerations

Evaluation

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by Saunders, an imprint of Elsevier Inc.

Selective COX-2 Inhibitors

Action

Selectively inhibits COX-2 enzyme without inhibition of

COX-1

Use

Decrease inflammation and pain

Drug agents
Celecoxib

Similar agents

Nabumetone (Relafen)

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Selective COX-2 Inhibitors (Cont.)

Caution

Avoid during third trimester of pregnancy.

Side effects

Headache, dizziness, sinusitis

GI distress
Peripheral edema

NSAIDs in older adults

Greater incidence of GI distress, ulceration

Reduced dose decreases risk of side effects.

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Corticosteroids
Prednisone, prednisolone, dexamethasone
Control inflammation by suppressing or preventing
many of the components of the inflammatory
process at the injured site
Not the drug of choice for arthritis because of
their numerous side effects
Frequently used to control arthritic flare-ups
Taper off

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by Saunders, an imprint of Elsevier Inc.

Disease-Modifying
Antirheumatic Drugs
Immunosuppressive agents
Immunomodulators
Antimalarials

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by Saunders, an imprint of Elsevier Inc.

Gout
Gout pathophysiology

Inflammatory disease of joints, tendons, and other

tissues
Usually occurs in great toe
Defect in purine metabolism leads to uric acid
accumulation.

Purine-containing foods: organ meats, sardines, salmon, gravy,

herring, liver, meat soups, and alcohol (especially beer)

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Antigout Drugs
Colchicine

Inhibit migration of leukocytes to inflamed site

Side effects
GI distress

Taken with food to avoid GI distress

Contraindications
Severe renal, cardiac, or GI problem

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by Saunders, an imprint of Elsevier Inc.

Antigout Drugs (Cont.)

Uric acid inhibitors

Allopurinol (Zyloprim)
Action
Decreases production of uric acid
Prophylactic to prevent gout attacks

Nursing interventions

Monitor CBC, liver enzymes, renal function.

Tell patient to get yearly eye examinations for visual changes.
Advise patient to avoid alcohol, caffeine, and thiazide diuretics
that increase uric acid level.
Advise patient to increase fluid intake to increase uric acid
excretion.

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by Saunders, an imprint of Elsevier Inc.

Nursing Process: Allopurinol

Assessment
Nursing diagnoses
Planning
Nursing interventions

Patient teaching
Cultural considerations

Evaluation

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by Saunders, an imprint of Elsevier Inc.

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Antigout Drugs (Cont.)

Uricosurics

Probenecid (Benemid)
Sulfinpyrazone (Anturane)
Action

Increase uric acid excretion by blocking reabsorption of uric

acid

Side effects

Gastric irritation; patient should take with food.

Nursing interventions

Use caution when giving with other highly protein-bound

drugs.
Patient should increase fluid intake to increase uric acid
excretion.

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by Saunders, an imprint of Elsevier Inc.

Case Study
A 35-year-old woman diagnosed with rheumatoid
arthritis has been prescribed infliximab (Remicade).
The nurse identifies infliximab as which type of
medication?
A.
B.
C.
D.

Immunosuppressive
Immunomodulator
Antimalarial
Steroid

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by Saunders, an imprint of Elsevier Inc.

Case Study
The nurse identifies Infliximab (Remicade) as
useful in the treatment of rheumatoid arthritis as
well as
A. Crohns disease.
B. asthma.
C. peptic ulcer disease.
D. multiple sclerosis.

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Case Study
The patient asks the nurse how the infliximab
(Remicade) will be administered. The nurse
should respond that this medication is
administered
A. orally.
B. subcutaneously.
C. intramuscularly.
D. intravenously.

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Practice Question #1
A patient with gout is prescribed colchicine. It is
most important for the nurse to give which
instruction to the patient?
A. Increase vitamin C intake.
B. Avoid alcohol and caffeine.
C. Increase foods high in purines.
D. Take colchicine 2 hours before meals.

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by Saunders, an imprint of Elsevier Inc.

Practice Question #2
A patient has been advised to take ibuprofen
(Motrin). When teaching the patient about Motrin,
which instruction should the nurse include? (Select
all that apply.)
A. Avoid taking aspirin with Motrin.
B. Take with food to reduce GI upset.
C. Monitor for bleeding gums, nosebleeds, black tarry
stools.
D. Take herbs, such as ginkgo and garlic, with Motrin.
E. Take NSAIDs 2 days before menstruation to decrease
discomfort.
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Practice Question #3
An older adult patient takes tolmetin (Tolectin) for
arthritis pain. Which statement made by the patient
is of most concern to the nurse?
A.
B.
C.
D.

I feel like I am coming down with a cold.

My stomach aches and burns.
I have a bad headache.
I feel dizzy when I get up fast.

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by Saunders, an imprint of Elsevier Inc.

Practice Question #4
A patient is ordered to receive low-dose aspirin
(ASA) to prevent a heart attack. Which assessment,
if found in the patient, is the highest priority for the
nurse?
A.
B.
C.
D.

Otitis externa
Multiple bruises
Dry mouth
Aches in the joints

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Practice Question #5
A 65-year-old man has been diagnosed with chronic
gout. The nurse anticipates that the patient will be
treated with
A.
B.
C.
D.

allopurinol (Zyloprim).
colchicine.
adalimumab (Humira).
infliximab (Remicade).

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Practice Question #6
Which herb is associated with the development of
bleeding if taken with nonsteroidal
antiinflammatory drugs?
A.
B.
C.
D.

Garlic
Echinacea
St. Johns wort
Cinnamon

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