What is the goal of treatment for inflammation?
— To prevent or decrease the intensity of the inflammatory response
— To reduce fever
What is cyclooxygenase-1?
(COX-1)
- Present in all tissues
—— Reduces gastric acid secretion, promotes renal blood flow, promotes platelet aggregation.
—— Inhibition of COX-1 results in bleeding, gastric upset, reduced renal function.
What is Cyclooxygenase-2?
(COX-2)
- Formed only after tissue injury
—— Promotes inflammation, sensitizes pain receptors, mediates fever in brain.
- Inhibition of COX-2 results in suppression of inflammation
Ibuprofen mechanism of action, primary use, and side effects?
Mechanism of action: To inhibit prostaglandin synthesis
Primary use: For musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis, mild to moderate pain, reduction of fever, primary dysmenorrheal pain.
Side effects: Nausea, heartburn, epigastric pain, dizziness.
What are the effects of systemic corticosteroids?
— Effective in treating severe inflammation; can inhibit immune system to reduce inflammation
— Naturally released from adrenal cortex; suppress histamine and prostaglandins
— Serious side effects:
——Suppression of adrenal gland function, hyperglycemia, electrolyte imbalances, osteoporosis
—— Mood changes, cataracts, peptic ulcers
— Can mask infections
—— Existing infection grows rapidly and undetected
—— Contraindicated in active infections
What is the treatment with corticosteroids?
- used for short-term treatment of acute inflammation
- Long-term treatment
—— Keep dose as low as possible
—— Use alternate-day dosing
—— Cushing syndrome may result
—— Discontinue gradually
What does gout cause, what is primary and secondary gout, symptoms, cause?
— A form of acute arthritis caused by a buildup of uric acid (urate) crystals in the joints and other body tissues
— Primary gout: hereditary defect in uric acid metabolism
— Secondary gout due to:
——— Certain drugs: (thiazide diuretics, aspirin, alcohol)
——— Diseases that affect uric acid metabolism (diabetic ketoacidosis, kidney failure, leukemia)
— Symptoms of acute attacks:
——— Red, swollen tissue; in big toes, ankles, fingers, wrists, knees, elbows.
— Triggered by ingestion of alcohol, dehydration, injury, stress
— Attacks often occur at night
Pharmacotherapy of gout?
— Goal: Termination of acute attacks; prevention of future attacks
— NSAIDs for pain and inflammation; corticosteroids for severe pain and inflammation
— Prophylactic therapy:
——— Uricosurics increase excretion of uric acid by blocking reabsorption in the kidney
——— — Probenecid
———Drugs that inhibit formation of uric acid
———— Allopurinol (Zyloprim) or Febuxostat (Uloric)
——— Drugs that convert uric acid into a less toxic form
———— Rasburicase or pegloticase
Salicylates drugs, action, side effects, and nursing interventions?
Drugs: Acetylsalicylic acid (aspirin)
Action: Bind w/ COX-1 & COX-2 blocking inflammatory prostaglandins
Side effects: Epigastric pain, bleeding, heartburn
Nursing interventions: Assess for bleeding, Give w/ food, Do not give to anyone under age 19 - Reye’s syndrome
NSAIDs drugs, action, side effects, nursing interventions?
Drugs: Ibuprofen, meloxicam, Naproxen, Ketorlac
Action: Bind w/ COX-1 & COX-2 blocking inflammatory prostaglandins
Side effects: N & V
Nursing interventions: Assess for bleeding, Give w/ food, Risk of bleeding lower than aspirin, Renal impairment - give acetaminophen
Cox-2 inhibitors drugs, action, side effects, nursing interventions?
Drugs: Celecoxib
Action: Blocks COX-2 only (no effect on coagulation)
Side effects: No common
Nursing interventions: Monitor for GI bleeding, Monitor for thrombotic events, Monitor for fluid retention & edema, Monitor Hct/Hgb, LFT, BUN/Creatinine & electrolytes
Corticosteroids drugs, action, side effects, nursing interventions?
Drugs: Prednisone, betamethasone, hydrocortisone, dexamethasone.
Action: Inhibit the biosynthesis of prostaglandins
Use: Hyperglycemia, mood changes, cataracts, peptic ulcers, electrolyte imbalances, osteoporosis
Nursing interventions: Give w/ food, mask infection.
Classification of Meloxicam (Mobic)?
NSAID
Contraindications of Meloxicam?
GI bleeding
hepatic disease
Uses/action of meloxicam (mobic)?
Inhibits COX-1 & COX-2 necessary for synthesis of prostaglandins, part of the inflammatory response
Uses: Analgesic, anti-inflammatory, RA
Before/after giving meloxicam?
Before: Assess for bleeding (inhibition of COX-1 can interfere with coagulation)
After: Continue to assess for bleeding
Interactions with meloxicam?
ACE inhibitors
Diuretics
Aspirin
Anticoagulants
feverfew
garlic
Ginger
Ginkgo
Side effects of meloxicam?
None common
Nursing interventions for meloxicam?
Monitor for S/S of GI ulceration or bleeding
Kepatotoxicity
Skin rash
Weight gain
Edema
Monitor for S/S of CV thrombotic events
Monitor Hct/Hgb, CBC w/ diff, LFTs, electrolytes, BUN/creatinine within 3 months of beginning therapy & every 6-12 months thereafter
Take w/ milk or food
Classification of Ketorolac (Toradol)?
NSAID
Contraindications of Ketorolac?
Labor/delivery, surgery
Renal impairment
Hemorrhage
GI bleeding
Peptic ulcer
Uses/action of Ketorolac?
Inhibits COX-1 & COX-2, peripherally acting analgesic, inhibits platelet aggregation
Uses: Short-term management of pain, ocular itching
Interactions with Ketorolac?
Methotrexate
ACE inhibitors
Feverfew
Garlic, ginger, ginkgo
Side effects of Ketorolac?
Drowsiness
Nausea
