McKenna's Pharmacology for Nursing, 2e

C H A P T E R 1 6  Anti-inflammatory, antiarthritis and related agents 241

T he inflammatory response is designed to protect the body from injury and pathogens. It employs a variety of potent chemical mediators to produce the reaction that helps to destroy pathogens and promote healing. As the body reacts to these chemicals, it produces signs and symptoms of disease, such as swelling, fever, aches and pains. Occasionally, the inflammatory response becomes a chronic condition and can result in damage to the body, leading to increased inflammatory reac- tions. Anti-inflammatory agents generally block or alter the chemical reactions associated with the inflammatory response to stop one or more of the signs and symptoms of inflammation. ANTI-INFLAMMATORY, ANTIARTHRITIS AND RELATED AGENTS Several different types of drugs are used as anti-inflam- matory agents. Corticosteroids (discussed in Chapter 36) are used systemically to block the inflammatory and immune systems. Blocking these important protective processes may produce many adverse effects, includ- ing decreased resistance to infection and neoplasms. Corticosteroids also are used topically to produce a local anti-inflammatory effect without as many adverse Children are more susceptible to the GI and CNS effects of these drugs. Care must be taken to make sure that the child receives the correct dose of any anti-inflammatory agent.This can be a problem because many of these drugs are available in OTC pain, cold, flu and combination products. Parents need to be taught to read the label to find out the ingredients and the dose they are giving the child. Aspirin is the only salicylate in Australia and New Zealand recommended for children.The drug should not be used when any risk of Reye’s syndrome exists. Ibuprofen, naproxen, meloxicam and, in some cases, indomethacin are the NSAIDs approved for use in children. Paracetamol is the most used anti-inflammatory drug for children. Care must be taken to avoid overdose, which can cause severe hepatotoxicity. Children with arthritis may receive treatment with gold salts or etanercept; they must be monitored very closely for toxic effects. ADULTS Adults need to be cautioned about the presence of these drugs in many OTC products and taught to be aware of exactly what they are taking to avoid serious toxic effects. They should also be cautioned to report OTC drug use to their healthcare provider when they are receiving BOX 16.1 Anti-inflammatory agents CHILDREN

effects. Antihistamines (discussed in Chapter 54) are used to block the release of histamine in the initiation of the inflammatory response. In this chapter, discussion of anti-inflammatory agents focuses on drugs that have a direct effect on the inflammatory response, including salicylates, non-steroidal anti-inflammatory and related agents, and antiarthritis drugs. Because many anti-inflammatory drugs are avail- able over-the-counter (OTC), there is a potential for abuse and overdosing. In addition, individuals may take these drugs and block the signs and symptoms of a present illness, thus potentially causing the misdiag- nosis of a problem. In some situations, individuals may combine these drugs and unknowingly induce toxicity. All of these drugs have adverse effects that can be dan- gerous if toxic levels of the drug circulate in the body. See Box 16.1 for information on using these drugs with various age groups. SALICYLATES Salicylates (Table 16.1) are popular anti-inflammatory agents not only because of their ability to block the inflam- matory response, but also because of their antipyretic (fever-blocking) and analgesic (pain-blocking) properties. any other prescription drug to avoid possible drug–drug interactions and the masking of signs and symptoms of disease. PREGNANCY AND BREASTFEEDING Pregnant and breastfeeding women should not use these drugs unless the benefit clearly outweighs the potential risk to the fetus or neonate.The salicylates, NSAIDs and gold products have potentially severe adverse effects on the neonate and possibly the mother. Paracetamol can be used cautiously if a pain preparation or antipyretic is needed. Non-drug measures should be taken when at all possible to decrease the potential risk.These women also need to be urged to avoid OTC drugs unless they are suggested by their healthcare providers. OLDER ADULTS Older people may be more susceptible to the CNS and GI effects of some of these drugs. Dose adjustment is not needed for many of these agents. Geriatric warnings have been associated with naproxen, ketorolac and ketoprofen because of reports of increased toxicity when they are used by older people. These NSAIDs should be avoided if possible. Gold salts, used to treat arthritis, which is more common in older people, are particularly toxic for geriatric people. Accumulations in tissues can lead to increased renal, GI and even liver problems. If gold is used in this group, the dose should be reduced and the person monitored very closely for toxic effects.

Drug therapy across the lifespan