McKenna's Pharmacology for Nursing, 2e

C H A P T E R 1 6  Anti-inflammatory, antiarthritis and related agents 255

Because leflunomide can cause severe liver dysfunc- tion if it is combined with other hepatotoxic drugs, this combination should be avoided. The absorption of penicillamine is decreased if it is taken with iron salts or antacids; if these are both being given, they should be separated by at least 2 hours. Anakinra and etanercept should not be used together because of an increased risk of serious infections.

■■ Chronic or excessive activity by the inflammatory response can lead to the release of lysosomal enzymes and tissue destruction. ■■ Anti-inflammatory drugs block various chemicals associated with the inflammatory reaction. Anti- inflammatory drugs may also have antipyretic (fever- blocking) and analgesic (pain-blocking) activities. ■■ Salicylates block prostaglandin activity. NSAIDs block prostaglandin synthesis. Paracetamol causes vasodilation and heat release, lowering fever and working to relieve pain. Gold salts prevent macrophage phagocytosis, lysosomal release and tissue damage. DMARDs alter the course of the inflammatory process and treat arthritis by aggressively affecting the process of inflammation. ■■ Salicylates can cause acidosis and eighth cranial nerve damage. NSAIDs are mostly associated with GI irritation and bleeding. Paracetamol can cause serious liver toxicity. The gold salts cause many systemic inflammatory reactions. Other antiarthritis drugs are associated with local injection-site irritation and increased susceptibility to infection; leflunomide is associated with severe hepatic toxicity. ■■ Many anti-inflammatory drugs are available OTC, and care must be taken to prevent abuse or overuse of these drugs.

Care considerations for people receiving antiarthritis agents

Care considerations for people receiving the drugs listed in this section are similar to those for people receiving NSAIDs and related agents. Details related to each individual drug can be found in the specific drug monograph in your drug guide.

KEY POINTS

■■ Gold salts prevent macrophage phagocytosis, lysosomal release and tissue damage because the gold salts are taken up by phagocytes, which then are not able to function in a normal way. ■■ Gold salts are deposited in the tissues and cause an assortment of inflammatory reactions, including stomatitis, glossitis, gingivitis, pharyngitis, laryngitis, colitis, diarrhoea and other GI inflammation; gold bronchitis and interstitial pneumonitis; bone marrow depression; vaginitis and nephrotic syndrome; dermatitis, pruritus and exfoliative dermatitis; and allergic reactions ranging from flushing, fainting and dizziness to anaphylactic shock. ■■ Drugs used to alter the inflammatory process involved in arthritis are called disease-modifying antirheumatic drugs (DMARDs) and can be associated with serious to potentially fatal infections. If used early in the disease, they can prevent or slow down the damage caused to the joints. ■■ The DMARDs can cause local irritation at the injection site, liver impairment and a variety of CNS problems, including demyelinating disorders. CHAPTER SUMMARY ■■ The inflammatory response, which is important for protecting the body from injury and invasion, produces many of the signs and symptoms associated with disease, including fever, aches and pains and lethargy.

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ONLINE RESOURCES

An extensive range of additional resources to enhance teaching and learning and to facilitate understanding of this chapter may be found online at the text’s accompanying website, located on thePoint at http://thepoint.lww.com. These include Watch and Learn videos, Concepts in Action animations, journal articles, review questions, case studies, discussion topics and quizzes.

WEB LINKS

Healthcare providers and students may want to consult the following Internet sources: www.arthritisaustralia.com.au Home page of Arthritis Australia. Information about arthritis and support services. www.arthritis.org.nz Home page of Arthritis New Zealand. Information about arthritis and support services.