Inflammation – body defense mechanism that occurs in response to many different stimuli, including physical injury, exposure to toxic chemicals, extreme heat, invading microorganisms, or death of cells Histamine is the key mediator of inflammation- its stored in MAST CELLS. NSAIDS – they are all analgesics and antipyretics (for pain and for temperature) and anti-inflammatory uses. Prescribed for mild-mod inflammation NSAIDS work by blocking cyclooxygenase. Theres two types of COX. COX-1 and COX-2 COX -1 is the good kind, provides PROTECTIONS such as GI protection, increased platelet aggregation, renal protection, vasodilation, bronchodilation – SO IF THIS IS BLOCKED IT LEADS TO → GI IRRITATION. GI BLEED. CKD. KIDNEY FAILURE. VASOCONSTRICTION. PROLONGED BLEEDING. COX-2 formed only after tissue injury and promotes inflammation . has UNDESIRABLE EFFECTS such as inflammation, pain, fever, decreased platelet aggregation ( inflammatory responses/PROSTRAGLANDINS ) (Only COX-2 inhibitor that has been approved is Celebrex. Have few a/e as other NSAIDS but double the r/o HEART ATTACK. Celebrex usually used to tx anti-inflammatory indications and reduce number of colorectal polyps in adults w familial adenomatous polypsis (FAP) MOST NSAIDS ARE PREGNANCY CATEGORY D ASPIRIN- SALICYLATE ; COX INHIBITOR is a non selective COX inhibitor . blocks bothCOX-1 AND COX-2 prevents prostaglandin synthesis (no protective or inflammatory prostaglandins are made) -effects of platelet inhibition can last up to 10 days - dc med 1 week prior to sx to prevent complications . Do not use ASA w pts taking anticoagulants - increase r/o bleeding PREGNANCY CAT D s/e : brusing , bleeding gums, stomach pain ,HEARTBURN, nausea. a/e: GI or cerebral bleed, SALICYLISM: syndrome cause by high doses of ASA that cause tinnitus , dizziness, HA, excessive sweating, tachy, thirst severe bronchospasm, met acidosis REYES SYNDROME – do not give ASA to kids <19yrs old bc they can get reyes syndrome – can be fatal Reyes syndrome An acute condition that causes swelling in the brain (encephalopathy) and liver (hepatitis).
S/S of Reyes Syndrome : Altered mental state ,Repeated vomiting,Rash on palms of hands and feet,Diarrhea,Rapid breathing,Excessive sleepiness/lethargy,Decreased level of consciousness or loss of consciousness,Confusion,Personality changes,Irritability,Aggressiveness,Seizures,Hallucinations,Weakness of the arms and legs. Interactions: increase r/o gastric ulcers if taken w other NASIDs , Steroids, or ETOH. INTERACTS W THE 3G’S ( ginger , gingko, garlic) Contraindications for ASA : allergy to ASA, R/O bleeding d/t vitamin K deficiency, PEPTIC ULCER DISEASE, active bleeding , renal failure. Tx for ASA overdose : Gastric lavage , also commonly called stomach pumping , is an invasive procedure involving cleaning and removing stomach contents. A large tube is inserted through the mouth or nose into the stomach. Stomach contents are subsequently aspirated, and the stomach is later flushed with copious amounts of water or normal saline. During this procedure, the individual may be awake or under general anesthesia.
IBUPROFEN (Advil, Motrin, ETC) Analgesic, anti-inflammatory, anti-pyretic: NSAID MOA: inhibits prostaglandin synthesis , similar actions to ASA. Tx: pain associated w musculoskeletal disorders → RA, osteoarthritis , HA, dental pain, painful menstruation Admin: take on empty stomach , can take w food if GI upset (n/v) occur Pts w asthma or allergy to ASA → increased r/o allergy to ibuprofen PREGNANCY CAT C → CAT D at 30 weeks * s/e: mild- nausea, heartburn, epigastric pain, dizziness, dyspepsia, HA, drowziness a/e: GI ulceration with occult or gross bleeding – risk INCREASES if pt has HIGH DOSE/LONG TERM USE. CHRONIC USE → WILL LEAD TO RENAL IMPAIRMENT (CKD) which= increased r/o stoke /MI , REMEMBER : IBUPROFEN AFFECTS THE KIDNEYS ! ACETAMINOPHEN AFFECTS THE LIVER. BLACK BOX WARNING: NSAIDS may cause increase r/o serious thromboembolic events such as MI, CVA- fatal. Do not give NSAIDS to someone who is about to have a CABG sx bc pts with cardiovascular disease are at greater risk for MI, stroke (thrombotic events) . DO NOT give to someone w peptic ulcers b/c of increased r/o bleeding . Do not give to someone with significant renal or hepatic impairment, and again be careful w ur cardio patients. OLD AGE INCREASES R/O A/E Interacts w the 3g’s – garlic, ginger, gingko Meds that interact w ibuprofen: anticoagulants- , Diuretics/ace/beta blockers can be reduced when taken w ibuprofen Corticosteroids- can cause serious GI a/e Alcohol- can cause serious GI a/e S/S NSAID toxicity: Nausea and vomiting Rapid or deep breathing Ringing in the ears (tinnitus) Sweating.
CORTICOSTEROIDS: natural hormones released by adrenal cortex that have effects on every cell in the body. Effective to tx SEVERE inflammation- dosages are many times higher than the amount naturally present in the blood. Used to tx- neoplasia(tumor) , asthma, arthritis, corticosteroid deficiency. MOA: also inhibit prostaglandin biosynthesis; They suppress the immune system (that’s why theyre contraindicated in patients with active infections) They can suppress histamine release, inhibit phagocyte and lymphocyte actions. CORTICOSTEROIDS ARE THE MOST EFFECTIVE MEDICATIONS AVAILABLE FOR THE TX OF SEVERE INFLAMMATORY DISORDERS. PREDNISONE (deltasone) Anti-inflammatory/ corticosteroid MOA: synthetic corticosteroid that inhibits the synthesis of prostaglandins. When used for inflammation- limit to 4-10 day use Long term need- alternate day dosing used s/e: Will increase ur BS( CUSHINGS SYNDROME-a disorder resulting from abnormally high levels of the hormone cortisol. This causes obesity, fatty deposits in the midsection, face, between the shoulders, and upper back, bones that easily fracture[osteoporosis] *-) - increased BS, this is NORMAL , increased WBC, NA+ retention → edema , yeast infections, sleep problems, hyperactivity( short term), can cause mood changes, depression , euphoria, fluid retention due to na+ retention, vision issues d/t increase of intraocular pressure and increase r/o glaucoma/cataracts . ALSO MONITOR FOR OSTEOPOROSIS , BONE PROBLEMS, FX’S . increase risk d/t cushings syndrome. can cause gastric ulcers- admin anti-ulcer med for ppx such as omeprazole Careful use w people that have GI problems- peptic ulcer disease, ulcerative colitis, diverticultis Do not give to people w active viral, bacterial, fungal, protozoan infection DO NOT STOP TAKING MED ABRUPTLY- NEEDS TAPERING Licorice can potentiate effect of corticosteroid- increase effects. CORTICOSTEROIDS ARE USUALLY AVOIDED FOR PATIENTS W ACTIVE INFECTION BC OF THEIR KNOWN IMMUNOSUPPRESIVE EFFECTS AND THE CONCERN OF LONG TERM COMPLICATIONS.
ANTIPYRETICS Tx underlying cause of fever High fever can break down body tissues, reduce mental acuity, lead to delirium/coma. Can be fatal (RARE) Drug induced fever caused by : abx(penicillin or amphotericin B ) , SSRIS(paroxetine/paxil), antipsychotic drugs(Chlorpromazine-thorazine), anesthetics , immunomudulators, cytotoxic drugs, drugs that cause neutropenia(NSAIDS, phenothiazines, antithyroid drugs, antipsychotic meds ) ACETAMINOPHEN (Tylenol) Antipyretic and analgesic; centrally acting COX inhibitor . MOA: works on hypothalamus - reduces fever and dilates peripheral blood vessels to promote sweating and dissipation of heat (COOLS THE BODY OFF/BREAKS THE FEVER) Admin: do not give to ALCOHOLICS !!! INCREASED R/O HEPATOTOXICITY , Remember IBUPROFEN affects KIDNEY TYLENOL affects LIVER Actions: has NO anti-inflammatory properties . Wont work for arthritic pain or pain caused by swelling following injury. Primary use: for fever and relief of mild-mod pain when ASA is contraindicated. May be prescribed w opiods for severe pain No effect on platelets ad does not cause cardiotoxicity , Main most serious risk is HEPATOTOXICITY. DOES NOT CAUSE GI BLEEDING unlike NSAIDS Tyl poisoning s/s : anorexia, nausea, vomit, dizziness, lethargy, diaphoresis, chills, abd pain, diarrhea. BLACK BOX WARNING: potential to cause SEVERE AND EVEN FATAL LIVER INJURY. May cause serious allergic reactions w s/s of angioedema , diff breathing, itching/rash. TYL inhibits warfarin metabolism – can cause medication to accumulate → TOXICITY aeb → increased BLEEDING. Teach patients to avoid alcohol Antidote: oral or IV admin of N-acetylcysteine (acetadote) – drug protects the liver from toxic metabolites of Tylenol.