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Cyclooxygenase (COX) inhibitors (Body Systems (Stomach, CNS, Kidneys,…
Cyclooxygenase
(COX)
inhibitors
Uses
Reduce Fever
Suppress Inflammation
Relieve Pain
Adverse Effects
Body Systems
Stomach
CNS
Kidneys
Heart
BBW:
Increased CV risk
GI bleeding
Classification
Nonsteroidal
anti-inflammatory
drugs (NSAIDs)
First Generation NSAIDs
Non-selective
COX inhibitors
(inhibit COX-1 and COX-2)
Aspirin [ASA] (Ecotrin)
Uses
analgesic, antipyretic, anti-inflammatory
Suppress platelet aggregation
Cancer prevention
Adverse Effects:
(risk of serious harm)
GI effects
bleeding
renal impairment
Salicylism: Tinnitus, sweating, HA, dizziness
hypersensitivity reaction
Acute poisoning
resp. depression,
hyperthermia
dehydration
acidosis
Drug Interactions
Glucocorticoids [GI bleed risk]
Anticoagulents [bleeding risk]
Coumadin (Warfarin)
heparin
Ibuprofen [adverse fx amplified]
ACE inhibitors,
Angiotensin Receptor Blockers (ARBs)
renal prostaglandin inhibition, decreases effectiveness
NURSING IMPLICATIONS:
Aspirin
#
#
High Risk Patients:
pts w/ severe NSAID hypersensitivity
children w/ chickenpox or flu
PG women
peptic ulcer disease
bleeding disorders
taking anticoagulents, glucocorticoids, ACE inhibitors or ARBS
CAUTION WITH:
older adult pts
pts with heart failure, angina, MI history, hypertension, hypotensionhypovolemia, hepatic cirrhosis, renal dysfunction, asthma, hay fever, chronic urticaria, nasal polyps, history of alcoholism, heavy smoking
Teaching
take with food, milk or water
don't crush or chew enteric coated
disgard if smells like vinegar
don't consume with alcohol
notify prescriber if gastric irritation is severe or persistent
educate about manifestations of
Salicylism
:
(tinnitus, headache, dizziness) and advise
to notify prescriber if symptoms occur
Advise parents to use Acetaminophen for
children
instead of aspirin (risk of Reyes Syndrome)
Inform pts about signs of
liver damage
:
(jaundice, fatigue, nausea) and to notify
prescriber immediately
take aspirin at least 2 hrs before taking a different NSAID
don't use to alleviate vaccination associated fever and pain
Ibuprofen (Advil, Motrin, etc)
Uses
anti-inflammatory, analgesic, antipyretic
Well-tolerated
Low incidence of adverse effects
NURSING IMPLICATIONS:
Ibuprofen
Teaching
Adverse Effects
renal impairment
Hypertension & edema
increased risk of MI and stroke
Second Generation NSAIDs
Selective
COX inhibitors
(inhibits COX-2 only)
as effective as 1st gen
somewhat lower GI risk
Celecoxib (Celebrex)
Adverse Effects:
GI: dyspepsia, abdominal pain
Renal impairment
Extreme risk CV impact: stroke, MI
Drug Interactions:
Coumadin (Warfarin)
decreases effects of other drugs
Furosemide (Lasix)
ACE inhibitors
Increases levels of:
lithium (Lithobid)
celecoxib w/ fluconazole (Diflucan)
Uses
OA, RA, acute pain, dysmenorrhea
Last choice for LT use due to CV risks
NURSING IMPLICATIONS:
Celecoxib
Teaching
Dangerous in combination with:
lithium
celecoxib w/ fluconazole (Diflucan)
Coumadin (Warfarin)
Decreases effect of other drugs:
Furosemide (Lasix)
ACE inhibitors
contraindicated for pts w/ sulfa allergy
Drugs without
anti-inflammatory properties
Acedaminophen [APAP]
(Tylenol)
Uses
Analgesic, antipyretic ONLY
NOT antiinflammatory or
anti-rheumatic actions
NOT associated with
Reye Syndrome
Action: inhibits prostaglandin
synthesis in CNS
Drug Interactions
alcohol (ETOH)
Coumadin (warfarin)
Vaccines
Adverse Effects
Very few at normal doses
Stevens-Johnson syndrome (SJS)
acute generalized exanthematous pustulosis (AGEP)
Toxic epidermal necrolysis (TEN)
Hepatoxicity
Pts w/ liver failure
overdose: Hepatic necrosis
Early symptoms: N/V/D, sweating, abdominal pain
may result in liver failure --> coma, death
Treatment: Acetylcysteine (Mucomyst)
NURSING IMPLICATIONS:
Acetaminophen
Teaching
Dangerous in combination with:
alcohol
vaccination
Coumadin (Warfarin)
Overdose early symptoms:
#
PRN orders
MAX dosage: 4000 mg/day
Management of pain, fever ONLY
Past med history
Pts w/ liver failure
HIGH RISK PATIENTS:
consume alcohol daily
Coumadin (Warfarin)
Current conditions/probs
Drug interactions from other sources
(eg, Norco contains APAP)
MOA:
inhibit COX (enzyme that
converts arachidonic acid
into prostaglandins and
related compounds)
COX-1
Cytoprotective
("good" COX)
inhibition
causes:
Adverse
Renal Impairment
bleeding tendencies
Renal impairment
Benefit
Protection against MI and stroke
by reducing platelet aggregation
COX-2
Inflammatory
"bad" COX
inhibition
causes:
Benefit
suppression of inflammation
pain relief
fever reduction
protection against colorectal cancer
Adverse
renal impairment
Promotion of MI and stroke
by suppressing vasodilation