246
P A R T 3
Drugs acting on the immune system
■■
Salicylates block prostaglandin activity, which
decreases the inflammatory response and relieves the
signs and symptoms of inflammation.
■■
Salicylates can cause GI irritation, eighth cranial
nerve stimulation, and salicylism—ringing in the
ears, acidosis, nausea, vomiting, diarrhoea, mental
confusion and lassitude.
KEY POINTS
NON-STEROIDAL ANTI-INFLAMMATORY
AND RELATED AGENTS
Non-steroidal anti-inflammatory drugs
(NSAIDs) pro-
vide strong anti-inflammatory and analgesic effects
without the adverse effects associated with the cortico
steroids (Table 16.2). Paracetamol (
Dymadon, Panadol
)
is a related drug and a widely used agent. It has anti-
pyretic and analgesic properties but does not have
the anti-inflammatory effects of the salicylates or the
NSAIDs. It is discussed in this chapter because it is used
for many of the same reasons that NSAIDs are used,
and nurses and midwives need to understand the simi-
larities and differences of these drugs.
N
on
-
steroidal anti
-
inflammatory drugs
The NSAIDs are a drug class that has become one of the
most commonly used drug types in Australia and New
Zealand. Following unanticipated study results linking
drugs in this class to an increased risk of cardiovascu-
lar events and death as well as increased bleeding in the
GI tract, a black box warning was added to all of these
drugs pointing out the cardiovascular and GI risks asso-
ciated with taking them.
This group of drugs includes propionic acids, acetic
acids, fenamates, oxicam derivatives and cyclooxy
genase-2 inhibitors. The classes are defined by chemical
structural differences, but, clinically, the NSAIDs are
all-inclusive. See Table 16.2 for a list of these drugs by
group, as well as their specific indications. The choice of
NSAID depends on personal experience and the person’s
response to the drug. A person may have little response
to one NSAID and a huge response to another. It may
take several trials to determine the drug of choice for
any particular person (Box 16.4).
Therapeutic actions and indications
The anti-inflammatory, analgesic and antipyretic effects
of the NSAIDs are largely related to inhibition of prosta
glandin synthesis (see Figure 16.1). The NSAIDs block
two enzymes, known as cyclooxygenase-1 (COX-1)
and cyclooxygenase-2 (COX-2). COX-1 is present in
all tissues and seems to be involved in many body func-
tions, including blood clotting, protecting the stomach
lining, and maintaining sodium and water balance in
the kidney. COX-1 turns arachidonic acid into prosta
glandins as needed in a variety of tissues. COX-2 is
active at sites of trauma or injury when more prosta-
glandins are needed, but it does not seem to be involved
in the other tissue functions. By interfering with this
part of the inflammatory reaction, NSAIDs block
inflammation before all of the signs and symptoms can
develop. Most NSAIDs also block various other func-
tions of the prostaglandins, including protection of the
bleeding and gastrointestinal (GI) effects of the
drug
.
■
■
Monitor laboratory tests for full blood count
(FBC), liver and renal function tests, urinalysis,
stool guaiac
and clotting times
to detect bleeding
or other adverse effects of the drug and changes in
function that could interfere with drug metabolism
and excretion
.
Implementation with rationale
■
■
Administer with food if GI upset is severe; provide
small, frequent meals
to alleviate GI effects
.
■
■
Administer drug as indicated; check all drugs being
taken for possible salicylate ingredients; monitor
dose
to avoid toxic levels
.
■
■
Monitor for severe reactions
to avoid problems
and provide emergency procedures
(gastric lavage,
induction of vomiting, administration of charcoal)
if they occur.
■
■
Arrange for supportive care and comfort measures
(rest, environmental control)
to decrease body
temperature or to alleviate inflammation
.
■
■
Ensure that the person is well hydrated during
therapy
to decrease the risk of toxicity
.
■
■
Provide thorough teaching, including measures
to avoid adverse effects and warning signs of
problems, as well as proper administration,
to
increase knowledge about drug therapy and
to increase compliance with the drug regimen
.
■
■
Offer support and encouragement
to deal with the
drug regimen
.
Evaluation
■
■
Monitor response to the drug (improvement
in condition being treated, relief of signs and
symptoms of inflammation).
■
■
Monitor for adverse effects (GI upset, CNS
changes, bleeding).
■
■
Evaluate the effectiveness of the teaching plan
(person can name drug, dosage, adverse effects
to watch for, specific measures to avoid adverse
effects).
■
■
Monitor the effectiveness of comfort measures and
compliance with the drug regimen.
