Anti-Inflammatory, Antiarthritis,

and Related Agents

Chapter 16

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Inflammatory Response
Protects the body from injury and pathogens
Used chemical mediators to produce a reaction that helps
destroy pathogens and promotes healing

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Anti-Inflammatory, Antiarthritis, and

Related Agents
Several different types of drugs
Corticosteroids
Block or alter the chemical reactions associated with the
inflammatory response
Over-the-counter (OTC)
Adverse effects

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Salicylates
Can block the inflammatory response
Have antipyretic properties (fever-blocking)
Have analgesic (pain-blocking) properties
Therapeutic actions and indications
Pharmacokinetics
Contraindications and cautions
Adverse effects
Clinically important drug-to-drug interactions
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Common Salicylates
Aspirin (Bayer, etc.): Treats inflammatory conditions
Balsalazide (Colazal): New drug treats ulcerative colitis
Choline magnesium trisalicylate (Trilisate): Treats mild
pain and fevers and arthritis
Choline Salicylate (Arthropan): Treats mild pain and fevers
as well as arthritis
Mesalamine (Pentasa and others): Treats inflammation of
the large intestine

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Common Salicylates (cont.)

Olsalazine (Dipentum): Converted to mesalamine in
the colon; has the same direct anti-inflammatory effects
Salsalate (Argesic and Others): Used to treat pain,
fever, and inflammation
Sodium Thiosalicylate (Rexolate): Treats episodes of
acute gout and muscular pain, and rheumatic fever

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Salicylates
Actions /Indications
Inhibit synthesis of prostaglandin, used to treat mild to
moderate pain and fever
Pharmacokinetics
Absorbed from the stomach, peak in 5-30 min.,
metabolized in the liver, excreted in the urine
Contraindications
Known allergy, bleeding abnormalities, impaired renal
function
Drug-to-Drug Interactions
Interact with other drugs by interfering with absorption
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Prototype Salicylates

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Nursing Considerations for Patients

Receiving Salicylates
Assessment: History and Examination
Nursing Diagnoses
Implementation With Rationale
Evaluation

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Question
Please answer the following statement as true or false.

A person who does not respond to one salicylate may

respond to a different one.

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer

True.
Rationale: Salicylates are some of the oldest antiinflammatory drugs used. They were extracted from
willow bark, poplar trees, and other plants by ancient
peoples to treat fever, pain, and what we now call
inflammation. They are generally available without
prescription and are relatively nontoxic when used as
directed. A person who does not respond to one salicylate
may respond to a different one.

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Nonsteroidal Anti-inflammatory and

Related Agents
Propionic Acids
Fenoprofen
Ibuprofen

Acetic Acids
Declofenac

Fenamates
Mefenamic acid

Cyclooxygenase-2
Inhibitors
Celecoxib

Etodolac

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NSAIDs
Provide strong anti-inflammatory and analgesic effects
Sold over the counter, which may lead to abuse
Therapeutic actions and indications
Pharmacokinetics
Contraindications and cautions
Adverse effects
Clinically important drug-to-drug interactions

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Prototype NSAIDs

Copyright 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Acetaminophen
Actions /Indications
Acts directly on the thermoregulatory cells of the
hypothalamus
Not sure of the mechanism of action related to analgesic
effects
Used to treat pain and fever
Treat pain and fever associated with a variety of
conditions, including influenza
Prophylaxis of children receiving diphtheriapertussis
tetanus (DPT) immunizations
Relief of musculoskeletal pain associated with arthritis
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Acetaminophen (cont.)
Pharmacokinetics
Absorbed from GI tract
Peak to 2 hours
Metabolized in the liver
Excreted in the urine
T is about 2 hours
Contraindications
Known allergy
Use with caution in pregnancy and lactation
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Acetaminophen (cont.)
Adverse Reactions
Headache, hemolytic anemia, renal dysfunction,
skin rash and fever
Hepatotoxicity usually associated with chronic
use and overdose
Drug-to-Drug Interactions
Oral anticoagulants increase bleeding

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Prototype Summary: Acetaminophen

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Nursing Considerations for Patients

Receiving NSAIDs and Related Agents
Assessment: History and Examination
Contraindications or cautions
Baseline status before beginning therapy and for any
potential adverse effects

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Question
When are NSAIDs contraindicated?
A. Allergy to penicillin
B. Allergy to sulfonamides
C. Allergy to antihistamines
D. Allergy to thiazines

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Answer

B. Allergy to sulfonamides
Rationale: The NSAIDs are contraindicated in the presence
of allergy to any NSAID or salicylate/ Celecoxib is also
contraindicated in the presence of allergy to
sulfonamides.

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Antiarthritis Agents
Potentially debilitating inflammatory process
Antiarthritis drugs
Prevent and suppress arthritis in selected patients with
rheumatoid arthritis

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Gold Compounds
Indications/Action
Absorbed by macrophages, which results in inhibition of
phagocytosis
Tissue destruction is decreased
Pharmacokinetics
Absorptions varies based on site of administration
Widely distributed throughout the body
Contraindications
Known allergy
Diabetes, CHF, renal or hepatic impairment

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Gold Compounds (cont.)

Adverse Reactions
Stomatitis, glossitis, gingivitis, bone marrow
depression, dermatitis
Drug-to-Drug Interactions
Penicillamine, antimalarials, cytotoxic drugs, or
immunosuppressive agents

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Therapeutic Actions and Indications

Chrysotherapy
Indicated to treat selected cases of:
Rheumatoid arthritis
Juvenile rheumatoid arthritis
In patients whose disease has been unresponsive to
standard therapy

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Pharmacokinetics
Absorbed at varying rates
Excreted in urine and feces
Cross the placenta and cross into breast milk
Barrier contraceptives

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Contraindications and Cautions

Gold salts can be quite toxic
Contraindicated in the presence of any known allergy to
gold
Adverse Effects
Variety of adverse effects are common with the use
of gold salts

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Clinically Important DrugDrug

Interactions
Do not combine with:
Penicillamine
Antimalarials
Cytotoxic drugs
Immunosuppressive agents

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Prototype Gold Compound

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Disease Modifying Anti-Rheumatic Drugs

Available for treating arthritis that aggressively affect the
process of inflammation
Can be severe to life-threatening
They alter the course of the inflammatory process, many
rheumatologists are selecting to
Antineoplastic drug methotrexate
Therapeutic Actions and Indications
Anakinra
Leflunomide is slowly absorbed from the GI tract,
reaching peak levels in 6-12 hours
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Disease Modifying Anti-Rheumatic Drugs

(cont.)
Anakinra
Etanercept I
Leflunomide is slowly absorbed from the GI tract,
reaching peak levels in 6-12 hours.

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Therapeutic Actions and Indications

Relief of the signs and symptoms of rheumatoid arthritis
and osteoarthritis
Relief of mild to moderate pain
Treatment of primary dysmenorrhea
Fever reduction

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Nursing Considerations for Patients

Receiving Antiarthritis Agents
Similar to those for patients receiving NSAIDS and
related agents

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Drug Therapy Across the Lifespan

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