Therapeutic Classification
Analgesic, anti-inflammatory drug, antipyretic
Pharmacologic Classification
NSAID
Mechanism of Action
Inhibits COX-1 and COX-2, which block prostaglandin synthesis and modulate T-cell function.
- Inhibits inflammatory cell chemotaxis.
- Decreases the release of superoxide radicals.
- Increases scavenging of superoxide radicals at inflammatory sites.
Indications
- Relief of fever and mild to moderate pain associated with chronic symptomatic rheumatoid arthritis (RA) and osteoarthritis
- Also myalgia (muscle pain), headache, dental pain, and dysmenorrhea
Contraindications
- Allergy to aspirin or other NSAIDs
- PUD
- Bleeding abnormalities
- Perioperative pain related to coronary artery bypass graft (CABG)
- Severe hepatic impairment, also renal impairment
Precautions
- HTN
- History of GI bleeding
- DM
- Impaired renal or hepatic function
- Diminished respiratory function in children with asthma
pregnancy category?
Pregnancy Category B – 1st & 2nd trimesters
Pregnancy Category D – 3rd trimester
Drug interactions with oral anticoagulants?
Increased risk of bleeding.
Interactions with feverfew, gingko, garlic, ginger?
Increased risk of bleeding.
Drug interactions with diuretics, beta blockers, and ACE inhibitors?
Decreased antihypertensive action.
Drug interactions with digoxin, lithium, methotrexate?
Increased toxicity.
Adverse Effects
- Bleeding
- Anorexia
- Heartburn
- Nausea
- vomiting
- Constipation or diarrhea
- Dizziness, headache, drowsiness, and light-headedness
- Polyuria, azotemia, cystitis, hematuria
- Increased creatinine and blood urea nitrogen (BUN) levels
Serious Adverse Effects
- HTN
- CHF
- Peripheral edema
- Occult blood loss
- Aplastic anemia
- Leukopenia
- Decreased hemoglobin and hematocrit
- Increased aspartate transaminase (AST) & alanine transaminase (ALT)
- Renal impairment, including acute renal failure
Nursing Considerations
- Notify prescriber before therapy if the patient has a hx of PUD, bleeding abnormalities, and perioperative pain R/T CABG
- Monitor for cardiac responses and fluid retention
- Monitor BUN and creatinine levels
- Assess CBC and liver function studies; report abnormal values
Patient & Family Teaching
- Notify health care provider of blood in vomit; black, tarry stools; coffee-ground emesis; or GI discomfort
- Do not take products containing aspirin or other analgesics
- Do not drink alcohol
- Refrain from smoking
- Take with food or milk
- Immediately report unusual bruising
