McKenna's Pharmacology for Nursing, 2e

C H A P T E R 1 6  Anti-inflammatory, antiarthritis and related agents 245

the liver or extension of the therapeutic effects of the salicylate or the interacting drug (or both). Drugs such as anticoagulants, coumarin, heparin or thrombolytic agents may lead to increased anticoagulation and risk of bleeding as salicylates may displace these medicines from protein-binding sites and may cause hypopro- thrombinaemia. A list of interacting drugs in each drug monograph in a nursing drug guide should be consulted and the prescriber consulted before adding or removing a salicylate from any drug regimen. Prototype summary: Aspirin Indications: Treatment of mild to moderate pain, fever, inflammatory conditions; reduction of risk of transient ischaemic attack (TIA) or stroke; reduction of risk of myocardial infarction (MI). Actions: Inhibits the synthesis of prostaglandins; blocks the effects of pyrogens at the hypothalamus; inhibits platelet aggregation by blocking thromboxane A 2 . Pharmacokinetics: Route Onset Peak Duration Oral 5–30 mins 0.25–2 hours 3–6 hours T 1/2 : 15 minutes to 12 hours; metabolised in the liver and excreted in the urine. Adverse effects: Nausea, vomiting, heartburn, epigastric discomfort, occult blood loss, dizziness, tinnitus, acidosis. TEACHING FOR G.T. • Your doctor has prescribed aspirin to help relieve the signs and symptoms of your rheumatoid arthritis. Aspirin works as an anti-inflammatory drug. It works in the body to decrease inflammation and to relieve the signs and symptoms of inflammation, such as pain, swelling, heat, tenderness and redness. It does not cure your arthritis, but will help you to live with it more comfortably. • Take your aspirin exactly as prescribed, every day. It is important to take the drug every day so that the blood levels of the aspirin are high enough to be effective. Do not use any aspirin that has a vinegar odour. • Some of the following adverse effects may occur: • Nausea, vomiting, abdominal discomfort: Taking the drug with food or eating small, frequent meals may help. If these effects persist, consult with your healthcare provider. • Diarrhoea, constipation: These effects may decrease over time; ensure ready access to bathroom facilities

and consult with your healthcare provider for possible treatment. • Drowsiness, dizziness, blurred vision: Avoid driving or performing tasks that require alertness if you experience any of these problems. • Headache: If this becomes a problem, consult with your healthcare provider. Do not self-treat with more aspirin or other analgesics. • Tell any healthcare provider who is taking care of you that you are taking this drug. • Avoid using other over-the-counter preparations while you are taking this drug. If you feel that you need one of these drugs, consult with your healthcare provider for the most appropriate choice. Many of these drugs may also contain aspirin and could cause an overdose. • Report any of the following to your healthcare provider: fever, rash, GI pain, nausea, itching, black or tarry stools, or difficulty with breathing. • Keep this drug and all medications out of the reach of children. ■ ■ Assess for contraindications or cautions: history of allergy to any salicylate or tartrazine to avoid hypersensitivity reactions ; renal disease because these drugs are excreted through the urine; bleeding disorders because of the drug effects on blood clotting ; chickenpox or influenza in children to avoid the risk of Reye’s syndrome ; and pregnancy or breastfeeding to avoid adverse effects on the fetus or baby and risk of bleeding in the mother . ■ ■ Perform physical assessment to establish baseline status before beginning therapy and to monitor for any potential adverse effects . ■ ■ Assess for the presence of any skin lesions to monitor for dermatological effects . ■ ■ Monitor temperature to evaluate the drug’s effectiveness in lowering temperature . ■ ■ Evaluate central nervous system (CNS) status— orientation, reflexes, eighth cranial nerve function and affect— to assess CNS effects of the drug . ■ ■ Monitor pulse, blood pressure and perfusion to assess for bleeding effects of cardiovascular effects of the drug . ■ ■ Evaluate respirations and adventitious sounds to detect hypersensitivity reactions . ■ ■ Perform a liver evaluation and monitor bowel sounds to detect hypersensitivity reactions, Care considerations for people receiving salicylates Assessment: History and examination