Prototype- _________(upper limit- 3900 mg/day)

Other- ibuprofen, naproxen (first gen, OTC); celecoxib (second gen, prescription)

Action

Inhibit the COX enzyme (needed for biosynthesis of prostaglandins)- relieves inflammation and pain; Some antipyretic effect but NSAIDs more appropriate for reducing swelling, pain, and stiffness in joints

• Inhibition of COX-2 -> decrease inflammation and pain
• inhibition of COX-1 -> decreases protection of stomach lining; also prevents clotting (lead to GI irritation/bleeding + blood thinning)
• most NSAIDs block both COX 1 and 2, but celecoxib only block COX2 (pain)- would not benefit pts at risk for CVD

Contraindications:

renal/liver impairment, gout, ETOH abuse, anticoag therapy, GI bleeding hx, bone marrow suppression, head trauma, immunosuppression, pregnancy

Side/adverse effects:

• GI ulcers/bleeding/perforation
• vestibulocochlear effects- dizziness headache tinnitus
• metabolic acidosis, bronchospasm
• Steven Johnson syndrome
• GI distress- anorexia dyspepsia n/v, diarrhea, constipation, abd pain heartburn, flatulence

Considerations:

• Pt teaching- take w food, dont take w other NSAIDs (decreases blood level + effects of other NSAIDs), dont mix w warfarin,
• nursing care- discontinue drug 1 wk before surgery/dental procedure, observe for rash or allergic rxn, GI distress, dizziness (tinnitus)

Prototype: ________ (400-800 mg/dose; max- 3200 mg/day)

Action: COX enzyme inhibitor- inhibits prostaglandin synthesis (decreases inflammation and pain)

Contraindications: 

• Elderly, preg/lactating women, asthma 
• Heart surgery, cardiac disease/dysrhythmias
• dehydration 
• bone marrow suppression, anticoagulant therapy
• GI bleeding/ulceration- Crohns/UC, peptic ulcer
• ETOH abuse, liver/kidney dysfunction

Side effects: 

• less/milder GI effects- anorexia, n/v, diarrhea, abd pain, flatulence; can be ulceration w ibuprofen
• Vestibulocochlear effects- Headache, dizziness, blurred vision, tinnitus/hearing loss
• Allergic rxn- edema, pruritis/rash, anaphylaxis

•  

  • increases effects of warfarin, sulfonamides, many cephalosoporins, and phenytoin

  • effects can be decreased w aspirin 

  • hypoglycemia when taken w insulin or oral anti diabetics 

  • toxicity w Ca channel blockers

     

Considerations:

Pt teaching- 

Prototype: ____________ (COX 2 inhibitor)

Action: Only targets COX-2 (pain and inflammation)-> reduces pain and inflammation; for osteoarthritis or rheumatoid arthritis pain

Contraindications:

• Older adults
• NOT FOR CVD RISK PTS OR  CV problems- (increased clotting + risk of thrombosis, MI, and stroke)
• Liver problems
• Bleeders- peptic ulcer disease, GI bleeding/perforation, Crohn's/UC, anticoag therapy

Side/adverse effects:

• nausea, stomach pain, dizziness; NO ULCERS
• Adverse –
  • CV stuff - bleeding, peripheral edema, HTN, heart attack, stroke
  • rash
• Drug interactions
  • ↓ 's ACE inhibitors
  • ↑ bleeding w warfarin
  • celecoxib levels ↑ w antifungals ("azole")

Prototype: _____________

Action: anti-inflammatory; suppress/prevent inflammation at injury site- used to control arthritic flare ups as maintenance tx

Pt teaching- take once a day,

Considerations – if long term use, discontinue gradually- over 5-10 days (allows adrenal cortex time to compensate + avoid withdrawal)

• Start high and gradually taper down dose

Prototype:                         

Action:Blocks metabolism to inhibit synthesis of uric acid (tx underlying problem) & decreases uric acid + renal stone accumulation (need ↑ fluids)

• used as a prophylactic for prevention of gout- for gout pts w renal impairment/obstruction from kidney stones, blood disorder pts 

Side/adverse effects: gastric irritation, high liver enzymes, low renal fx, low blood cell ct

Pt teaching:

• Drink alot of fluids- to neutralize the urine + promote elimination
• Take w food to avoid GI distress
• NO ETOH or caffeine, NO purine foods, NO large doses of Vitamin C (contributes to kidney stones)
• keep up w lab work- blood ct, renal/liver fx tests

Prototype: __________

Action: ↓ uric acid synthesis, by inhibiting xanthine oxidase enzyme- treats the underlying cause

Contraindications: 

• Hepatic/renal disorder
• CV history- cardiac disease, stroke
• Cancer/chemotherapy

Side/adverse effects:

• gout exacerbation
• RISK FOR CV EVENTS!
• Low blood cell ct
• hepatic/renal impairment, hyperlipidemia,
• GI distress, cholecystitis
• weird taste, dry mouth
• bone/muscle pain, weakness
• Drug interactions- ↑ effect of theophylline (asthma med), azathioprine (immunosuppressive for kidney transplant)  

Pt teaching:

• Drink alot of fluids- to neutralize the urine + promote elimination
• Take w food to avoid GI distress
• NO ETOH or caffeine, NO purine foods (organ meats, legume, salmon, sardines), NO large doses of Vit C (contributes to kidney stones)
• keep up w lab work- blood ct, renal/liver fx tests

Prototype: ________________

• (adults-325-650 mg q4-6 hrs, max 4 g/day; extended release- 650-1300 mg q 8hrs, max 3900 mg/day)
• Therapeutic level- 10 to 20 mcg/mL

Action: weakly inhibits prostaglandin synthesis (COX inhibition) used to decrease pain/fever- action in hypothalamus; for mild to mod pain

• NOT AN NSAID, NO ANTI-INFLAMMATORY EFFECT, NO ANTIPLATELET EFFECT, OR GASTRIC ULCERATION

Contraindications: 

• Older adults, Renal/hepatic disease, ETOH abuse, malnutrition
• HTN, diabetes mellitus
• hypovolemia 

Side/adverse effects:

• CNS effects- anxiety, insomnia, headache 
• lesser GI effect- n/v, constipation
• peripheral edema, rash, fatigue
• Toxic effects 
  • renal/hepatotoxicity, oliguria
  • tinnitus/hearing loss
  • e- imbalances
  • blood dyscrasias/low blood cell ct- agranulocytosis, hemolytic anemia, thrombocytopenia, leukopenia
• Drug interactions:
  • ↑ effect w caffeine
  • ↓ effect w oral contraceptives, antacids, anticholinergics, seizure drugs (carbamazepine, phenytoin)

Considerations: Acetylcysteine is the antidote

Pt teaching: 

• DO NOT exceed 4 g a day- or 2 g if taken frequently
• Keep out of reach of children- call Poison Control Center first
• no ETOH ingestion
• check labels on OTC meds to avoid OD
• don't use w warfarin (risk of warfarin toxicity)

Prototype: ____________

Action: tumor necrosis factor (TNF) blocker, delays inflammatory process- used for RA, Crohn's/UC, psoriasis

Contraindications:

• active infx- should be discontinued when an infx occurs
• hepatic dysfunction
• immunosuppression- bone marrow suppression corticosteroid therapy, leukopenia
• diabetes mellitus
• COPD, heart failure,
• CNS dysfunction- multiple sclerosis, seizures
• Drug interactions- may down effects of vaccines, concurrent immunosuppressives may up risk for infx

Side effects:

• GI effects
• susceptibility to severe infx
• low blood cell ct
• Bronchospasm
• Rash

Considerations:

• Admin IV over at least 2 hrs
• Should be discontinued when an infx occurs

Pt teaching: avoid sick ppl

Action: suppress or prevent inflammation at injury site- used to control arthritic flare ups (not a maiantenance drug due to many side effects)

Considerations/pt teaching:

admin once a day in large doses(due to long 1/2 life), discontinuation must be gradual- taper over 5-10 days to prevent s/s from returning + avoid withdrawal

Prototype: ___________

Others: meripidine (synthetic narcotic, better for GI procedures and  pregnancy, not for LT use), hydromorphone (6x more potent than morphine)

Action: act on opioid receptors in the brain to suppress pain impulses - for acute severe pain; Schedule II- has potential for physical and psych dependence, but effective for pain rt cancer, childbirth and MI 

• also suppresses respirations and coughing by acting on resp and cough centers in the medulla

Contraindications:

• head injury (dont want to depress CNS even more), increased ICP
• shock, hypovolemia, dysrhythmias
• resp depression, sleep apnea
• constipation/ileus
• ETOH abuse- ETOH ups sedative effects 

Side effects/adverse reactions:

• Orthostatic hypotension- drowsiness, dizziness
• miosis (constriction from OD), blurred vision
• urinary retention, constipation
• Psychological dependence, euphoria
• Respiratory depression- check pt's RR + chest excursion
• Drug interactions- ↑ effects of ETOH, sedatives, antipsychotic drugs, muscle relaxants

Nursing considerations: 

• If 2 hrs post-op, check RR q 10 mins, once back on unit/ICU- 15 mins, once stable q 30 mins
• If pt in resp depression (<10 breaths/min), check VS, call PCP
• Naloxone (Narcan) is the antidote- must always be available to reverse effects when giving opioids
• Watch for drug diversion by hospital staff
• Pt teaching- report any low RR or difficulty breathing, blurred vision, headaches, urinary retention

Prototype: ___________

Action: Knocks morphine off mu receptor- reverses effects of opioids; antidote for opioid OD

Side effects:

• opens all the orifices of the body- sweating flushing agitation dyspnea hypo/hypertension tachycardia
• elevated PTT/bleeding
• Reversal of analgesia (withdrawal), anger/agitation
• n/v, dyspnea

Considerations:

• administered via an IM or IV route
• monitor VS and bleeding continuously