Drugs for inflammation and fever

Inflammation

A natural, nonstick defense mechanism
occurs in response to any injury or antigen
limit spread of injury or antigen
acute last 8 to 10 days
chronic last months or years

The signs of inflammation

Goals of treatment

To prevent or decrease the intensity of the inflammatory response
to reduce fever
used in many common diseases

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Drugs for treatment of mild to moderate inflammtion
all are analgesics and antipyretic's
inhibit prostaglandin synthesis

ibuprofen/advil/aleve

Class: NSAIDs
therapeutic action: anti-inflammatory, analgesic, antipyretic treatment of pain fever and inflammation
side effect: nausea, heartburn (dyspepsia), epigastric pain, dizziness, renal or hepatic impairment, thrombotic (MI/stroke) bleeding, ulceration preparation of the stomach/intestines and platelet function

NSAIDs

Admin alert: give one empty stomach, pt with asthma/allergies to ASA Poss hypersensitivity to IBU preg cat C/D at 30 wks
contradictions: . Operative pain with CABG surgery active peptic ulcers nasal polyps angioedema bronchial spasms due to ASA/NSAID, antihypertensives action may be reduced, NSAIDs,  Caution w/ HF & HTN

Lab test: increase bleeding time, AST, ALT levels. Decrease hemoglobin and hematocrit
herbal/food: feverfew, garlic, gender, ginkgo increase risk of bleeding

inter: avoid w/ anticoagulant, ASA (-) action of IBU, anti-HTN action (-), alcohol, corticosteroids- adverse G.I.

Cox-1 Inhinitor ASA

Tx: inflammation by inhibiting both COX-1  cyclooxygenase (enzyme responsible for the formation of prostaglandins
large doses needed to relieve severe inflammation
side effects: irritates digestive system, may cause bleeding,salicylism may occur (tinnitus, dizziness, headache, excessive respiration)
do not give in children and adolescents under 19 with flu symptoms, fever, chickenpox due to the risk of Reyes syndrome.
Drugs with aspirin: Pepto-Bismol, Alka-Seltzer, Bayer

COX-2 Inhibitors/ celecoxib(Celebrex)

TX: moderate to severe inflammation
No inhabitation of COX-1
do not affect blood coagulation or irritate digestive system

Systemic Corticosteroids

Effective in treating severe inflammation
naturally release from the adrenal cortex
suppress histamine and prostaglandins
can inhibit immune system to reduce inflammation

hydrocortisone, methylprednisolone, prednisone

Class: corticosteroids
therapeutic action: anti-inflammatory that suppresses histamine and prostaglandins and inhibits immune system to decrease inflammation (glucocorticoid)
admin alert: (IM) deep in muscle mass to avoid atrophy/abscesses, do not use in signs of systemic infection, must be tapered using for more than 10 days, preg cat C

corticosteroids

Side effects: suppression of adrenal gland function (hyperglycemia), cataracts, peptic ulcers, electrolyte imbalances, osteoporosis, mass infections Cushing's syndrome (moon face Buffalo shoulder, mood changes, HTN), obesity
Con: active viral, bacterial, fungal, protozoan infections should not take prednisone
inter: barbiturates increase prednisone metabolism (+ doses required) concurrent with amp B increase K+ loss, DM pts may have to adjust insulin or hypoglycemic drugs.

acetaminophen/ Tylenol

Class: antipyretic/analgesic
action: direct action at hypothalamus to dilation of peripheral blood vessels
admin: use appropriate does in children, never give to pt consuming alcohol due to drug-induced hepatitis city, watch OTC for Tylenol, Preg Cat B. 325mg per tab
Side: acute toxicity, renal failure, N&V, chills, and discomfort, hepatic necrosis, liver damage, Angioedema, difficulty breathing, itching, rash

Tylenol/Acetaminophen

Con: hypersensitivity to acetaminophen or phenacetin, chronic alcoholism
Inter: inhibits warfarin metabolism- anticoagulant toxic levels, high or long-term does may result in elevated were foreign levels and bleeding, alcohol or other hepatotoxic drugs not reprimanded due to liver failure from hepatic necrosis
labs: increase serum bilirubin, AST, ALT, 5– HIAA (urinary 5 hydroxyindole acetic acid & serum uric acid

Tylenol/acetaminophen

Herbal/food: Avoid taking herbs that have potential for liver toxicity, comfrey, coltsfoot, chaparral
tx of overdose: oral/IV of Acetadote (N-acetylcysteine) which protects the liver from toxic metabolites

Assessments prior to administration for inflammation and/or fever

History of hepatic, renal, respiratory, cardiovascular or neurologic disease pregnancy or breast-feeding.
History of allergies, current meds, OTC, herbs, caffeine, nicotine and alcohol use
all vital signs
labs: CBC, coagulation panels, bleeding time, electrolytes, coast, lipid profile, hepatic or renal function

Assessments throughout administration

Temp decreased wnl 100.4 and below, decreased pain, decreased redness/swelling, adverse effects, lab values, weight for corticosteroids 2 lbs w/in 24hr or 5lbs w/in 1 wk.

Symptoms of a G.I. bleed

Effects of steroids on blood glucose

why is it important to d/c steroids gradually

Dark/tarry stools, hematemesis, coffee ground emesis, blood in stools,

Increase blood sugars (Hyperglycemia)

Adrenal insufficiency/crisis with hypotension and tachycardia

Symptoms to report immediately to provider

G.I. bleed sx, ringing, buzzing, humming in ears, balance issues, dizziness, vertigo, nausea, signs/sx of infection, I pain, rainbow halos, diminished vision, inability to focus, fever above 100.4, seizures, tachycardia, increase BP, palpitations

Patient teaching for self administration

Rice (rest, ice, cool/wrap, elevate) check cost/BP, no alcohol with acetaminophen, good hygiene, immune suppression at the start of illness, avoid crowds.
Take with food/milk in G.I. irritation, increase fluids, do not abruptly stop corticosteroids, maintain eye exams, postmenopausal needs to add therapy