1. Drugs for Management of Fever & Inflammation
Brenda B. Rowe

2. Prostaglandin Synthesis
COX –1 enzyme – synthesizes prostaglandins involved in regulation of normal cell activity
COX –2 enzyme – produces prostaglandins at site of inflammation
Most NXAIDS are nonselective in targeting COX-1 & COX-2

3. Nonsteroidal Anti-inflammatory Agents (NSAIDS)
Salicylates
Acetylsalicylic acid (aspirin)
Has antipyretic, anti-inflammatory and antiplatelet effects
AE – GI (Give with milk or food)
Contraindications – peptic ulcer disease, gout, renal or hepatic impairment, bleeding disorders, children with varicella or flu like illness, pregnancy, lactating women

4. Teaching Points with aspirin
Watch for AEs
Avoid alcohol and smoking
Take as directed
Caution about OTC use with aspirin
Effects of long term aspirin use

5. Prostaglandin Synthetase Inhibitors
Subgroup of NSAIDS
Ibuprofen (Motrin, Advil)
Higher doses required for anti-inflammatory effect than analgesia
AEs – GI – Give with milk or food
Cautious use with many diseases

6. COX-2 Inhibitors Celecoxib (Celebrex)
Selective inhibit of COX-2 prostaglandin synthesis but not platelet aggregation
Anti-inflammatory, analgesic, & antipyretic
Tx osteoarthritis & dysmenorrheal
Contraindicated if have sulfa allergy
AE – GI - but not as likely

7. Para-Aminophenol derivative
Acetaminophen (Tylenol)
No anti-inflammatory effect
Tx fever & pain
Use with caution with pregnancy & lactation but safest antipyretic for children and pregnancy
AEs – hepatic, renal, hematologic & GI systems
Issues with self-administration

8. Antirheumatic drugs (DMARDS)
Auranofin (Ridaura)
Tx RA when patient have not responded to NSAIDS
Many contraindications & precautions
AEs – most significant is bone marrow suppression, most common is GI - diarrhea
Takes 8-12 weeks to get therapeutic response
Monitor CBC, platelets, renal & hepatic function

9. Antigout Drugs Colchicine
Decreases inflammatory response caused by hyperuricemia
Tx acute gout
AEs – GI
Many contraindications & precautions
Take at first sign of acute gout & d/c when symptoms resolve
Avoid alcohol & diet high in purines

10. Uricosuric Drugs Probenecid (Benemid) Reduces uric acid level
Tx chronic gout
AEs – serious is blood dyscrasias, common is headache, nausea, vomiting & anorexia – take with milk or food
Do not take during acute attack
Limit taking with vitamin C or cranberry juice

11. Sample Question
Which of the following drugs is a prototype drug for NSAIDS Prostaglandin Synthetese Inhibitor?
A. aspirin
B. acetaminophen (Tylenol)
C. ibuprofen (Motrin)
D. celecoxib (Celebrex)

12. Sample Question
What is the drug of choice for pregnant women & children with fever or mild to moderate pain?
A. aspirin
B. acetaminophen (Tylenol)
C. ibuprofin (Motrin)
D. codeine

13. Sample Question
Patients taking colchicine should be educated regarding limiting which of the following foods?
A. liver
B. cheese
C. beef
D. citrus fruits