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NSAIDS & Tylenol

NSAIDS & Tylenol. Jane E. Smith, MHSA, RN, C, ONC. Objectives. Review the pathophysiology of the inflammatory response Discuss the mechanism of action for non-steroidal anti-inflammatory drugs and Tylenol

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NSAIDS & Tylenol

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  1. NSAIDS & Tylenol Jane E. Smith, MHSA, RN, C, ONC

  2. Objectives • Review the pathophysiology of the inflammatory response • Discuss the mechanism of action for non-steroidal anti-inflammatory drugs and Tylenol • Discuss the indications, side effects, and nursing implications related to NSAIDS and Tylenol • Identify key information to include in patient/family education

  3. NSAIDS and Tylenol

  4. Pain Management • Causes • Primary • Infection • Pathogenesis • The ABC’s • Ask • Believe • Choose • Deliver • Empower • Follow-up Wayne Heim/arthrw.jpg

  5. Inflammatory Response • Triggers • Provoking Factors • Physical & Chemical • Infectious Agents Art from: MayoClinic.com

  6. Injury  Release of Kinins & Histamines  Vasoconstriction  Vasodilatation  Capillary Permeability  Swelling  Pain and Impaired Function Evolution of Inflammation

  7. Tylenol • Properties • Indications • Dosage • Hepatotoxicity

  8. NSAIDs – How do they work?http://elfstrom.com/arthritis/NSAIDS/action.html

  9. Carboxylic acids Acetylated salicylates Nonacetylated salicylates Acetic acids Propionic acids Ibuprofen Naproxen Fenamates Meclomen Pyrazoles Oxicams Piroxicam (Feldene) NSAIDs – Many Categories (COX-1)

  10. Cyclooxygenase (COX – 2) Inhibitors

  11. Cox–1 and Cox–2 Drugs Indications • Rheumatoid Arthritis • Osteoarthritis • Juvenile Arthritis • Dysmenorrhea • Fever

  12. Cox–1 and Cox–2 Drugs Contraindications • Angioedema • Syndrome of nasal polyps • Bronchospasm reaction to ASA or other NSAIDs • Hypersensitivity

  13. Cox–1 and Cox–2 Drugs Drug to Drug Interactions • Antihypertensives, thiazide diuretics, lasix - NSAIDs  effectiveness of these meds • NSAIDs  digoxin and lithium levels • Sun exposure – photosensitivity

  14. Cox–1 and Cox–2 Drugs Side Effects • Gastrointestinal bleeds • Hematologic changes-  bleeding time, various anemias (prolongs INR, BUN & K+,  blood glucose levels) • Renal – acute renal failure

  15. Cox–1 and Cox–2 DrugsPatient/Family Education • Take medication with food • No ASA • No ETOH • Use sunscreen

  16. Efficacy of Cyclooxygenase-2-Specific Inhibitors • COX-2 specific agents superior to placebo and equivalent to conventional NSAIDs • COX-2 specific inhibitors offer advantages over conventional NSAIDs on the basis of decreased toxicity but not in terms of efficacy. • The role and guidelines for the use of COX-2 inhibitors should be based on toxicity and other issues. Cannon, G. W. & Breedveld, F. C. (2001) American Journal of Medicine

  17. Costs of NSAIDS vs. TylenolMcPhee, S. J., Pignone, M., & Schroeder, S.A. (2002)

  18. Key Points • NSAIDs are effective in the management of pain by interrupting prostaglandin synthesis. • Tylenol is an effective medication in the management of pain but it has no anti-inflammatory action. • COX-1 and COX-2 Inhibitors have similar efficacy in the management of pain. • NSAIDs have significant side effects and patient/family teaching is an integral component of the treatment plan.

  19. Reference List • Boh, L. E. (1999). Osteoarthritis. In J.T. DiPiro, R.L. Talbert, G.C. Yee, G.R. Matzke, B.G. Wells & L.M. Posey (Eds.). Pharmacotherapy: A pathophysiologic approach (4th ed.) (pp. 1441-1459). Stamford, CT: Appleton & Lange. • Cannon, G. W. & Breedveld, F. C. (2001, February). Efficacy of cyclooxygenase-2 – specific inhibitors. American Journal of Medicine, 110, Suppl 3A. Retrieved from: http://home.medconsult.com/das/article/body/1/jorg=journal&source=MI&sp=11895791. • Chyka, P. A. (1999). Clinical toxicology. In J.T. DiPiro, R.L. Talbert, G.C. Yee, G.R. Matzke, B.G. Wells & L.M. Posey (Eds.). Pharmacotherapy: A pathophysiologic approach (4th ed.) (pp. 70-90). Stamford, CT: Appleton & Lange. • Hellmann, D. B. & Stone, J. H. (2002). Arthritis & musculoskeletal disorders. In L. W. Tierney, Jr., S. J. McPhee, & M. A. Papadakis (Eds.), Current medical diagnosis & treatment (833-889). New York, NY: Lange Medical Books/McGraw-Hill. • McPhee, S. J., Pignone, M., & Schroeder, S. A. (2002). General approach to the patient ; health maintenance & disease prevention; & common symptoms. In L. W. Tierney, Jr., S. J. McPhee, & M. A. Papadakis (Eds.), Current medical diagnosis & treatment (1-31). New York, NY: Lange Medical Books/McGraw-Hill.

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