1. Chapter 12
Anti-inflammatory Agents

2. 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

3. Agents used to treat inflammation p326
Nonsteroidal agents
Steroidal agents

4. 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

5. 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

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

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

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

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

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

11. 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

12. 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

13. 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

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

15. 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

16. 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

17. 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

18. 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

19. 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 .

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