Chapter 12 Anti-inflammatory Agents

Inflammation p 325 Tissue response to injury Characterized by Vasodilation Increased capillary permeability to plasma proteins Release of histamine Accumulation of leukocytes to the inflamed tissue Increased vascular permeability and leakage Erythema, warmth, swelling, tenderness

Agents used to treat inflammation p326 Nonsteroidal agents Steroidal agents

Nonsteroidal Anti-inflammatory Drugs p326 Table 12-1 p 327-330 Salicylates Acetylsalicylic acid (ASA) (aspirin) Anti-inflammatory effect in large dosages Inhibits platelet aggregation Most common adverse effect: GI intolerance and GI bleeding. NSAIDS: Celecoxib Diclofenac Etodolac Ibuprofen Naproxen

Uses of NSAIDs p330 Relief of mild to moderate pain caused by inflammation Bone, joint, and muscle pain Osteoarthritis Rheumatoid arthritis Dysmenorrhea Pt need to give NSAIDs a 2 week trial to reach full therapeutic effect

Gastrointestinal Side Effects of NSAIDs Dyspepsia Heartburn Epigastric distress Nausea Gastrointestinal bleeding Mucosal lesions

NSAIDs Contraindications Stomach ulcers G I bleeding Allergy to aspirin or sulfa  Pregnancy

Cardiovascular Side Effects of NSAIDs p326,330 Second-generation NSAIDs (Celebrex) Serious side effects: Cardiac arrhythmias Heart attack Stroke

Nursing Assessment NSAIDS Before beginning therapy, perform thorough assessment for: Gastrointestinal lesions or peptic ulcer disease Bleeding disorders Heart disorders

Therapeutic Effects NSAIDs Monitor for and document: Decrease in swelling Decrease in pain Decrease in joint tenderness

Client Education NSAIDS Monitor for: Unusual bleeding, abdominal pain, and cardiac problems Enteric-coated tablets should not be crushed or chewed Administration with food, milk, or antacids will reduce likelihood of GI upset

Corticosteroids p 344-345 A&P review: adrenal cortex hormones Anti-inflammatory glucocorticoids: cortisol Salt-retaining mineralocorticoids: aldosterone Corticosteroid agents mimic these adrenal hormones and have both glucocorticoid and mineralocorticoid properties

Corticosteroids p 335-339 Systemic use Local injection Topical use Dexamethasone Methylprednisone Prednisone Triamcinolone Local injection Hydrocortisone Prednisolone Topical use Betamethasone Dexamethasone Fluticasone Hydrocortisone Mometasone

Topical Corticosteroids p333 Treat local inflammatory disorders disorders of the skin dermatitis psoriasis Example: hydrocortisone cream Treat respiratory disease Asthma COPD Example: mometasone

Systemic Corticosteroids p333 Table 12-4 335-336 Treat systemic inflammatory disorders Bronchial asthma not well treated with inhaled corticosteroids Neoplastic diseases Autoimmune diseases Example of drug: prednisone

Systemic corticosteroids p334 Suppress inflammatory symptoms: Local heat, redness, swelling, tenderness Adverse effects: Fluid retention elevated glucose levels altered fat deposition wasting of muscle tissue in extremities immune system suppression

Systemic corticosteroids p335 Underlying cause of inflammation may remain and continue to progress Masking potential Systemic corticosteroids may cause: gastric ulceration suppression of the hypothalmic/pituitary/adrenal system hypertension changes in body fat deposits Immune system suppression is a result of decreased lymphocytes

Systemic corticosteroids p335 Observe pt for therapeutic and adverse effects Routinely assess vital signs Pt that have been on corticosteroid meds must not abruptly discontinue their medication. Physicians will taper off corticosteroid therapy. Abrupt discontinuation will result in adrenal insufficiency with a hypotensive crisis. It may take up to 2 years for a pt body to be able to secrete adequate adrenal hormones during times of stress. p348

Nursing considerations for pt on corticosteroids p344 Monitor for: GI bleeding Elevated blood glucose levels Weight gain Labile emotions Patients must carry identification and information about their meds Dietary modifications: Sodium restriction, Increased calcium intake, Take corticosteroids early in the day to avoid insomnia .

Nursing considerations cont. Teaching: Do not abruptly discontinue steroids S/S impending adrenal crisis Hypotension Restlessness weakness lethargy headache dehydration nausea vomiting diarrhea .