ANTI-INFLAMMATORY AGENTS / NSAIDs o Assess for allergy prior to

(Non-steroid anti-inflammatory drugs) administration

o Assess for PT if on long term
 Anti-inflammatory drugs - block or alter the therapy
chemical reactions associated with the ACETAMINOPHEN (TYLENOL)
inflammatory response to stop one or more 
of the signs and symptoms of inflammation
 Aspirin & other NSAIDs relieve pain by 2. PROPRIONIC ACID DERIVATIVE
inhibiting the enzyme cyclooxygenase  Ibuprofen (Motrin), Naproxen
which is needed for biosynthesis of (Naprosyn), Ketoprofen (Orudis)
prostaglandins. o
 Non-narcotic analgesics 3. PARA-CHLOROBENZOIC ACID
o Aspirin, acetaminophen, ibuprofen &  Indomethacin (Indocin)
naproxen 4. PYRAZOLONE DERIVATIVES
o are not addictive and less potent than  Phenylbutazone (Butazolidin),
narcotic analgesics Oxyphenbutazone, Aminopyrine,
Dipyrone
EIGHT GROUPS OF NSAID’S 5. FENAMATES
1. Salicylates  Mefenamic Acid (Postel, Ponstan)
2. Para-chlorobenzoic Acid Derivatives / 6. OXICAMS
Indoles  Piroxicam (Feldene)
3. Pyrazolone Derivatives 7. PHENYLACETIC ACID DERIVATIVE
4. Proprionic Acid Derivatives  Diclofenac Sodium (Voltaren)
5. Fenamates  Ketorolac (Toradol) -1st injectable
6. Oxicams 8. COX – 2 INHIBITORS
7. Phenylacetic Acids  Celocoxib (Celebrex)
8. Selective COX – 2 Inhibitors  Valdecoxib (Bextra)
1. Salicylates (ASPIRIN) NURSING RESPONSIBILITIES
 Acetylsalicylic acid (ASA) 1. Check history for allergic reactions
 Oldest non-narcotic 2. Assess client for signs of GI stress and
 Analgesic, antipyretic, anti-inflammatory edema
and decreases platelet aggregation 3. Observe for any signs of bleeding,
(powerful) petechiae, tarry stool and bleeding time
 Should not be taken with other NSAID’s may be prolonged
 SIDE EFFECTS : gastric irritation, N/V, 4. Check laboratory findings (hematology)
dyspepsia, heart burn, epigastric 5. Take NSAID’s with meals, give w/ full
discomfort, rash, bruising, excessive glass of water
bleeding if taken 1st 2 days of 6. Avoid taking NSAID’s with Aspirin and
menstruation Aspirin with NSAID,s
 ADVERSE EFFECTS: > bleeding 7. Avoid alcoholic beverages
 Not to be used for children below 12 y/o 8. Advise the effect of drug may take
because of the danger of Reye’s several days to wks
Syndrome
 Salicylism – dizziness, tinnitus, OTHER RELATED DRUGS
difficulty hearing, N/V, diarrhea, mental  Acetaminophen
confusion & lassitude 20 – 25 g adult  Corticosteroids
dose, 4 g children  Disease Modifying Antirheumatic Drugs
 NR : > give with full glass of water, milk (DMARDs)
or with food
ACETAMINOPHEN (TYLENOL)  Uricosuric
 Antipyretic action results from inhibition  Can be taken with colchicine
of prostaglandins in CNS → peripheral  Inhibits excretion of weak organic acids
vasodilation, sweating, & dissipation of such as penicillin and some
heat cephalosporin
 Usual dose is 325 to 600 mg q4-6h po  Blocks renal / biliary transport and
or pr; max dose is 4 g per day transport of many other substances and
 AE : hepatotoxic, if > 50 - 200 ug/ml drugs in and out of CSF
 NR : monitor liver enzyme (SGOT / AST  S/E : headache, rash, kidney stone
& SGPT / AST )
 N-acetylcysteine (mucolytic) – antidote Osteoarthritis
for acetaminophen toxicity  More common in women
Gold standard of treatment is to use:  Degeneration of the cartilage in the
NSAIDs & corticosteroids joints
Rheumatoid arthritis
GLUCOCORTICOIDS (STEROIDS)  All ages
 this drugs have an anti-inflammatory  Autoimmune disease
action  High levels of rheumatoid
 it can be given intranasal spray, aerosol Gouty arthritis
inhalation, oral, IM, IV, topically on skin.  Common in men > 40 years old
o Prednisone  Results from deposits of uric acid and
o Prednisolone urate crystals in the joint
o Dexamethasone  Inflammatory response [usually affects
 Frequently used to control arthritic flare- single joint ie. Big toe (tophus)]
ups
 Long half-life (>24hrs), given once a day Common Adverse Reaction to Antigout
 When discontinuing, dosage should be drugs:
tapered.  blood dyscrasias
 Given in day time or morning w/c mimics  GI upset
the peak levels of diurnal rhythm  abdominal pain
 Most adverse reaction are seen within
2-4 weeks of therapy. NURSING RESPONSIBILITIES:
 Increase fluid intake
COLCHICINE  Alkalinize the urine (↓ Vit. C.)
 Anti-inflammatory gout drug  Avoid food rich in purine and uric acid
  the migration of leukocytes to the (wine, alcohol, organ meat, sardines ,
inflamed site by vasoconstriction. salmon)
 S/E: neuropathy – caution with elderly  Take acetaminophen instead of aspirin
to reduce acidity.
ALLOPURINOL (ZYLOPRIM)  Administer with food if given per orem
 Not an inflammatory drug  Cautiously used to elderly and those
 Uric acid inhibitors with cardiac, renal or gastric diseases
 S/E : fever & rash  With narrow margin of safety
 Drug interaction  Monitor blood level
o Amoxicillin or ampicillin -  risk of
rash formation DMARDs (Disease modifying anti-rheumatic
o  effect of coumadin and oral drugs)
hypoglycemics  Gold therapy
 Immunosuppressive agents
PROBENECID (BENEMID)  Antimalarials
Gold drug therapy
 known as Chrysotherapy Antimalarials
 Heavy metal therapy  To treat rheumatoid arthritis when other
 Alleviate symptoms slowly methods fail.
Orally – 3 – 6 months  Its use is unclear, usually in combination
Parenterally – 2 months with NSAIDs
Auranofin (Ridaura) – oral agent for  Effect takes place after 4 - 12 wks
long-term therapy  chloroquine HCl (Aralen)
 hydoxychloroquine SO4
Side effects: (Plaquenil SO4)
 May cause photosensitivity  - use  mefloquine HCl (Lariam)
sunblock  quinine SO4 ( Quinamm)
 To report metalic taste or pruritus–
possible gold toxicity
 Diarrhea – high fiber diet

Check for proteinurua, hematuria prior

to gold therapy
Observe patient 30 mins after gold
therapy

Etanercept
- for moderately severe arthritis
- Injectable form
Caution: numbness
tingling sensation
acute visual
changes

Sodium Hyaluronate
- given by injection to relieve from pain by the
cushioning & lubricating effect of the drug

Immunosuppressive Agent
 Used to treat refractory rheumatoid
arthritis ( arthritis that does not respond
to anti-inflam)
 Not the first or second choice of
treatment
 Primarily suppresses cancer growth and
proliferation
 Might be used to suppress the
inflammatory process when other
treatment fails
 Azathioprine ( Imuran)
 Cyclophosphamide
(Cytoxan)
 Methotrexate (Mexate)