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Chapter 71:Cyclooxygenase Inhibitors: Nonsteroidal Antiinflammatory Drugs and Acetaminophen

Terms in this set (28)

Cyclooxygenase Inhibitors
Uses
-Suppress inflammation
-Relieve pain
-Reduce fever
Adverse effects
-Gastric ulceration
-Bleeding
-Renal impairment
Cyclooxygenase Inhibitors Adverse Effects
1.Gastric ulceration
2. Bleeding
3. Renal impairment
1.Cyclooxygenase Inhibitors: Mechanism of Action

2. Inhibition of COX-1
1. Inhibit cyclooxygenase (COX), the enzyme that converts arachidonic acid into prostanoids (prostaglandins and related compounds)

2.Gastric ulceration
Bleeding
Renal impairment
Inhibition of COX-1: Beneficial effects
Protection against myocardial infarction (MI) and stroke
Inhibition of COX-2 ("bad COX"): Largely beneficial effects:
1. Suppression of inflammation
2. Alleviation of pain and reduction of fever
3. Protection against colorectal cancer
Classification of Cyclooxygenase Inhibitors
1.Drugs with antiinflammatory properties
Nonsteroidal antiinflammatory drugs (NSAIDs)
-Aspirin, celecoxib, ibuprofen, and naproxen
2.Drugs without antiinflammatory properties
-Acetaminophen
First-Generation NSAIDs
(Aspirin, Ibuprofen(Advil,Moltrin))
1. Inhibit COX-1 and COX-2
2.Used to treat inflammatory disorders (rheumatoid arthritis, osteoarthritis, bursitis)
-Alleviate mild to moderate pain
-Suppress fever
-Relieve dysmenorrhea
3.Suppress inflammation but pose risk of serious harm
Asprin
1. Nonselective inhibitor of cyclooxygenase
2. Therapeutic uses
-Analgesic, antipyretic, antiinflammatory
-Suppression of platelet aggregation
Protects in thrombotic disorders
-Dysmenorrhea
-Cancer prevention
-Prevention of Alzheimer's disease
Asprin Adverse Effects:
-Gastrointestinal (GI) effects
-Bleeding
-Renal impairment
-Salicylism: Tinnitus (ringing in the ears), sweating, headache, and dizziness
-Reye's syndrome
-Pregnancy
-Anemia, postpartum hemorrhage; may prolong labor
-Hypersensitivity reaction
Aspirin Drug Interactions:
Anticoagulants: Warfarin and heparin
Glucocorticoids
Alcohol
Ibuprofen
ACE inhibitors and ARBs

-Acute poisoning
-Immediate threats to life: Respiratory depression, hyperthermia, dehydration, and acidosis. Treatment is largely supportive
Aspirin Drug Interactions:Anticoagulants: Warfarin and heparin
Asprin most important interactions are with anti coagulants. Because they SUPPRESSES platelet function and decrease prothrombin production, asprin can INTENSIFY the effects of WARFIN and HEAPRIN (Anticoagulants)
Aspirin Drug Interactions:Gluccocortticoids
Gluccocortticoids: risk of ulcers is greatly increased when drugs are combined.
Aspirin Drug Interactions: Alcohol
Alcohol: Combination of asprin and alchol increase the risk of gastric bleeding.
Aspirin: Ibuprofen/Naproxen
Ibuprofen/naproxen: mixed with asprin can reduce the antiplatelet effects of asprin
Aspirin Drug Interactions:Ace Inhibitors
Ace Inhibitiors: Combing the two can increase the risk of acute renal failure
Aspirin Drug Interactions Acute poisoning:
Asprin overdose
• Immediate threats to life: Respiratory depression, hyperthermia, dehydration, and acidosis. Treatment is largely supportive.
Ibuprofen [Advil, Motrin]
➢ Inhibits cyclooxygenase and has antiinflammatory, analgesic, and antipyretic actions
➢ Indications/USE: Fever, mild to moderate pain, arthritis
➢ Generally well tolerated
➢ Low incidence of adverse effects
➢ SAFETY ALERT: All first-generation NSAIDs are associated with an increased risk of GI bleeding that can lead to hospitalization or death
Second-Generation NSAIDS
-Celecoxib [Celebrex]
-Tyenol{Achetaminophen}
1.Supressed inflammation and pain,
lower risk for GI and side effects.

2. Can Impair renal function and cause hypertention and edema. Increased risk of MI and stroke

3. Just as effective as traditional NSAIDs in suppressing inflammation and pain
Somewhat lower risk for GI side effects
Can impair renal function and cause hypertension and edema
Increased risk of MI and stroke
Celecoxib [Celebrex]
1.Second-generation COX-2 inhibitor: Fewer adverse effects than first-generation drugs
2.Because of cardiovascular risks, last-choice drug for long-term management of pain
Uses
-Osteoarthritis
-Rheumatoid arthritis
-Acute pain
-Dysmenorrhea
Celecoxib :Adverse Effects:
Dyspepsia, Abdominal pain, Renal impairment, Sulfonamide allergy, Cardiovascular impact (stroke, MI, and other serious events)Use in pregnancy
Celecoxib:Drug interactions
Warfarin: Celecoxib may increase Anticoagulant effects of warfarin: the risk of bleeding is increased, May decrease diuretic effect of furosemide, May decrease antihypertensive effect of ACE inhibitors, May increase levels of lithium, Celecoxib levels may be increased by fluconazole
Acetaminophen {Tylenol}:
• Therapeutic uses: Analgesic, antipyretic
- Does not have any antiinflammatory or antirheumatic actions
- Not associated with Reye's syndrome
Acetaminophen {Tylenol}:Action:
Adverse affects:
1. Inhibition of Cox 2 only.
2. Very few at normal doses
Stevens-Johnson syndrome (SJS), acute generalized exanthematous pustulosis (AGEP), and toxic epidermal necrolysis (TEN)
3.Hepatotoxicity: With overdose or in patients with liver failure

4.Overdose: Hepatic necrosis: Signs and symptoms of hepatic failure, coma, death: Early symptoms: Nausea and vomiting, diarrhea, sweating, abdominal pain Treatment for overdose: Acetylcysteine (Mucomyst)
Acetaminophen:DrugInteraction
Alcohol: acetaminophen dosage to less than 2000 mg/day to prevent hepatic injury.
Warfin and vaccines

• Most COX inhibitors, especially COX-2 inhibitors, increase the risk for MI and stroke
AHA Statement on COX Inhibitors
1.Most COX inhibitors, especially COX-2 inhibitors, increase the risk for MI and stroke
2. American Heart Association (AHA) recommends a stepped-care approach
A patient is prescribed celecoxib [Celebrex] and warfarin [Coumadin]. The nurse should monitor the patient for what?

A. Renal toxicity
B. Bleeding
C. Stroke symptoms
D. Dysrhythmias
Answer: B
Rationale: Celecoxib may increase the anticoagulant effects of warfarin; the risk of bleeding is increased.
A patient drinks five to six alcoholic beverages per day and takes acetaminophen [Tylenol] for pain relief. The nurse should caution the patient to do what?

A. Limit intake of acetaminophen to less than 2000 mg/day
B. Avoid taking acetaminophen for pain
C. Take acetaminophen with food to reduce the risk of liver
damage
D. Avoid taking any pain reliever other than acetaminophen
Answer: A
Rationale: Patients who drink three or more alcoholic beverages per day should limit their acetaminophen dosage to less than 2000 mg/day to prevent hepatic injury.
Nonaspirin NSAIDs differ from aspirin in all but which way?

A. They cause reversible inhibition of COX, so their effects decline as soon as their blood levels decline.
B. They can suppress platelet aggregation, but they are not used to prevent MI and stroke.
C. They increase the risk of MI and stroke and therefore should be used in the lowest effective dosage for the shortest possible time.
D. They are safe to use in children with chickenpox or influenza.
Answer: D
Rationale: As with aspirin, these drugs should not be given to children with chickenpox or influenza, owing to the possibility of precipitating Reye's syndrome. All other statements are true.
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