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ANTI-INFLAMMATORY AGENTS. ADAPTED FROM MATERIALS ORIGINALLY PREPARED BY AND USED WITH PERMISSION OF Ray Colucci, RN MSN. Anti-Inflammatory Agents. Non-Steroidal Anti-inflammatory Drugs [ NSAIDs ]. Quick Facts. NSAIDs One of most frequently prescribed drug categories - PowerPoint PPT Presentation
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ANTI-INFLAMMATORY AGENTS
ADAPTED FROM MATERIALS ORIGINALLY PREPARED BY AND USED WITH PERMISSION OF
Ray Colucci, RN MSN
Anti-Inflammatory Agents
Non-Steroidal Anti-inflammatory Drugs [ NSAIDs ]
Quick FactsNSAIDs
One of most frequently prescribed drug categories
> 70 million prescriptions / year
represent more than 5% of all prescriptions
> 70 different agents; 20 are commonly used
Use of Plants Containing Salicylates
common for > 1,000 years
North American Indians willow bark juice [antipyretic]
South African Hottentots similar mixture as an [anti-rheumatic]
Early Greek & Roman physicians willow & poplar [medicinal compounds]
gout / fever / sciatica / earaches
NSAIDs
Most common & first drug:
acetylsalicylic acid
– ASA
– aspirin
The Success of Aspirin
1899 economical procedure for manufacturing synthetic salicylic acid
rapidly became most widely used drug in the world
antipyretic, analgesic, antiinflammatory, & anti-rheumatic
Toxicity of Aspirin aspirin’s wide spread use produced
evidence of its major toxicologic potential gastrointestinal intolerance
bleeding
renal impairment
tinnitus, hearing loss– lead to development of NSAIDs
Specific NSAIDsSix structurally related groups:
acetic acids [6] carboxylic acids [6] propionic acids 7] enolic acids [2] fenamic acids [2] nonacidic compounds [1]
Acetic Acid NSAIDs
Diclofenac sodium [Voltaren]
Diclofenac potassium [Cataflam]
Etodolac [Lodine]
Indomethacin [Indocin]
Sulindac [Clinoril]
Tolmetin [Tolectin]
Carboxylic AcidsNSAIDs
Acetylated Aspirin [many]
Magnesium choline salicylate[Trilisate]
Diflunisal [Dolobid]
Nonacetylated Salicylamide [many]
Salsalate [Disalcid]
Sodium salicylate [many]
Other NSAIDs
Enolic AcidsPhenybutazone [Butazolidin]Piroxicam [Feldene]
Fenamic AcidsMeclofenamic Acid [Meclomen]Mefenamic Acid [Ponstel]
Nonacidic CompoundsNabumetone [Relafen]
Propionic Acid NSAIDs
Fenoprofen [Nalfon]
Flurbiprofen [Ansaid]
Ibuprofen [Motrin, others]
Ketoprofen [Orudis]
Ketorolac [Toradol]
Naproxen [Naprosyn]
Oxaprozin [DayPro]
MOA of NSAIDsArachidonic Acid Pathway
. Phospholipids
Arachidonic AcidPhospholipase
Prostaglandin Pathway Leukotriene Pathway
Prostacyclin Synthetase
Thromboxane Synthetase
Leukotrienes (A-E)
Prostacyclin
[PGI2]
Thromboxane[TXA2]
vasoconstrictionbronchosconstriction+vascular permeabilityInflammation[platelets]
+PLT aggregationvasoconstriction
[bv wall]-PLT aggregationvasodilationInflammation
cyclooxygenase lipooxygenase
NSAIDs
Treating Headaches & Pain [analgesics]
PROSTAGLANDINS cause HA by dilating
blood vessels in the brain
PROSTAGLANDINS sensitize one to pain by
sensitizing nerve endings to painful stimuli
NSAIDs blocks the bad effects of prostaglandins
NSAIDs
Treating Headaches & Pain [analgesics]
PROSTAGLANDINS cause HA by dilating
blood vessels in the brain
PROSTAGLANDINS sensitize one to pain by
sensitizing nerve endings to painful stimuli
NSAIDs blocks the bad effects of prostaglandins
NSAIDsRelief Inflammation [Anti-inflammatory]
inflammatory response mediated by host of endogenous compounds:
proteins of complement system histamine serotonin bradykinin leukotrienes prostaglandins
NSAIDsRelief Inflammation [Antiinflammatory]
NSAIDs relief inflammation by
inhibiting either
– the leukotriene pathway,
– the prostaglandin pathway,
– or both
NSAIDs: Indications
gout various bone, joint, and muscle pain osteoarthritis [OA] rheumatoid arthritis [RA] juvenile rheumatoid arthritis dysmenorrhea
NSAIDsPrimary Therapeutic Effects
Summary:
analgesic [mild to moderate]
anti-gout
anti-inflammatory
antipyretic
relief of vascular headaches
platelet inhibition
GOUT
Metabolic disease affecting mostly men which involves a defect in purine metabolism leading to an increase in uric acid which crystallizes in the small joints causing pain– purines are found highly concentrated in
sardines, venison, shell fish, organ meats,
Anti-gout Drugs
Colchicine– inhibits leukocyte activity (part of
inflammation) in joint synovial fluid– can stop an acute attack- usually after a
high purine meal.– Needs to be used in conjunction with
another anti-gout med which inhibits uric acid synthesis or promotes uric acid excretion
Anti-gout Meds
Allopurinol (zyloprim)– inhibits the formation of uric acid
Probenecid (benemid)– promotes the excretion of uric acid at the renal
tubule– inhibits the secretion of penicillin, OHAs, ASA,
and rifampin– Patients must increase fluids while on these
meds
Specific Agents
salicylates
more potent effects on platelet aggregation & thermal regulatory center in brain
more common for tx of fever & arterial and possibly venous thrombosis
NSAIDsSide Effects
Gastrointestinal
dyspepsia, heartburn, epigastric distress
GI bleeding mucosal lesions erosions or ulcerations
misoprostol (cytotec)
NSAIDsSide Effects
Renal
reductions in creatinine clearance
acute tubular necrosis [renal failure]
NSAIDsSide Effects
cardiovascular
moderate to severe
non-cardiogenic pulmonary edema– Fluid retention
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