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.
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.
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.
Care considerations for
people receiving salicylates
Assessment: History and examination
■
■
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,
