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Chapter 44

Chapter 44. Inflammation and Fever. Inflammation. Treatment Goals. Acute. Anti- inflammatory. Non- Pharmicologic. S & S. Chronic. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). Aspirin. Ibuprofen/like. Selective Cyclooxygenase-2- inhibitors. Salicylates. Indications. Analgesic.

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Chapter 44

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  1. Chapter 44 Inflammation and Fever

  2. Inflammation Treatment Goals Acute Anti- inflammatory Non- Pharmicologic S & S Chronic

  3. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Aspirin Ibuprofen/like Selective Cyclooxygenase-2- inhibitors

  4. Salicylates Indications Analgesic Anticoagulant Anti-inflammatory Antipyretic

  5. Aspirin Acetylsalicylic Acid NSAID Preg C & D Class Indications Pain and Inflammation Prevent Clots Stroke prevention Afib MI prophylaxis Coronary thrombosis Action Prostaglandin temperature vasodilation Drug Interactions • Methotrexate • Probenecid and sulfinpyrazone • Beta Blockers • Donquai, feverfew, garlic, ginger • horse chestnut, red clover • Caffeine • St. John’s wort

  6. ASA Contraindications Precautions Head trauma ICP GI bleed Hypoprothrombinemia Vit K deficiency CHF Flu – flu-like illness in kids Pregnancy Hypothyroid Immunosuppression Asthma,gout or anemia Renal and hepatic impairment G^PD deficiency Similar Drugs Choline and MangesiumTrisalicylate Magnesium Salicylate Aspirin Triad Allergy nasal polyps asthma

  7. ASA Adverse Effects Severe Adverse Effects

  8. ASA – Nursing Responsibilities

  9. Patient Family Teaching - ASA

  10. Ibuprofen and Ibuprofen-like Agents Inhibit COX Weak acids, GI damage Bound to albumin metabolized by liver Analgesic Anti-inflammatory Antipyritic Nephrotoxic

  11. Ibuprofen (Naproxen) NSAID Cat B & D Contraindications Allergy PUD, bleeding abnlCABG Severe Hepatic Impair Action Inhibits COX 1 & 2 Inhibits chemotaxis Decr. release of radicals Scavenger of radicals Precautions HTN, GI Bld, DM, Impaired Renal or Hepatic Functions CHF, stroke, MI Kids with asthma Indications RA- fever and pain Myalgia, HA, Dental pain Dysmenorrhea

  12. Ibuprofen Adverse Effects Drug Interactions Oral anticoagulants Digoxin, Lithium, Methotrexate NSAIDS, ETOH,Steroids Diuretic, BB, ACE Feverfew, garlic, Ginger, Ginko Serious Adverse Effects

  13. Ibuprofen-Nursing Responsibilities

  14. Ibuprophen-Patient Education

  15. Celebrex COX-2 Precautions 2nd Gen. NSAID Preg Cat. C Anti-Inflammatory *Poor CYP – metabolizers *Anticoagulants *Hx asthma, bone marrow suppression, VCA, PVD, elevate LFTs, CHF, KD Indications *Mild to mod pain – RA OA, dysmenorrhea, dental, HA, ankylosingspondylitis *Prophylaxis of adenomas/polyps Contraindications *Hepatic Insuff. *Adv. Renal *Anemia *Post-op CABG *Hx GI bld or PUD

  16. Celebrex COX-2 GI Neuro Derm U.Resp Adverse Effects Drug Interactions ~Oral Coagulation modifiers ~Lithium ~ETOH, Steroids, ASA, NSAIDs ~Diuretics or ACE ~Fluconazole Serious A.E. MI Stroke HTN Peripheral edema Renal Impair Hepatic Impair

  17. Celebrex – Nursing Responsibilities

  18. Celebrex – Patient Teaching

  19. Acetaminophen (Tylenol) Indications Mild to mod. pain OA of hip/knee Dysmenorrhea Dental HA/myalgia Fevers Relieve pain and feverNO NSAID PROPERTIES Non-opiod analgesicAntipyretic Preg. Cat. B Precautions Action Anemia G6PD deficiency Hepatic disease RA/OA Malnutrtion Bone marrow suppression Immunosuppression ~Inhibits COX ~Inhibits chem. mediators ~Heat-regulation. ctr in hypothalmus

  20. Acetaminophen (Tylenol) Adverse Effects Drug Interactions Well Tolerated ETOH Barbiturates, carbamazemine lamotrigine levels Warfarin Zidovudine Echinacea Serious Adverse Effects Hepatic Failure Poisoning Chronic use: Blood dyscrasias

  21. Tylenol – Nursing Responsibilities

  22. Tylenol – Patient Education

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