An1llnlLAMMA1C8?

u8uCS
lnflammaLlon reacLlon of Lhe body (defense mechanlsm) Lo
ln[ury Lrauma or lnfecLlon

8ody uefenses
8arrler defense skln mucous membranes
Cellular defense W8C 1helper cells
lnflammaLory response
lmmune response

PlsLamlne
Causes vasodllaLlon lncrease blood flow
lncrease caplllary permeablllLy exudaLlon of
plasma proLelns edema Lumor (swelllng)

Cyclooxygenase (CCx)
klnlns bradyklnln

AnLllnflammaLory agenLs
8lock/ alLer chemlcal reacLlon assoclaLed wlLh
lnflammaLory response Lo sLop one or more of Lhe
slgns and sympLoms of lnflammaLlon

NSAIDs non sLeroldal anLl lnflammaLory drugs
Are asplrln (under sallcylaLes) and asplrlnllke drugs
LhaL lnPl8l1 8CS1ACLAnuln S?n1PLSlS
Large and chemlcally dlverse groups of drugs wlLh
varylng degrees of Lhe followlng properLles
4 Analgeslc
4 AnLllnflammaLory
4 AnLlpyreLlc

Mechanlsm of AcLlon acLlvaLlon of A8ACPluCnlC AClu
paLhway causlng paln fever headache and lnflammaLlon

Analgesla block effecLs of prosLaglandlns whlch causes
headache and paln LreaLmenL for PA and paln

AnLlpyreLlc reduce fever lnhlblL prosLaglandln L2 wlLhln Lhe
hypoLhalamus

8ellef of lnflammaLlon lnhlblL leukoLrlene paLhway
prosLaglandln paLhway or boLh

nSAlus
Slx SLrucLurally 8elaLed Croups
Carboxyllc aclds
AceLlc aclds
roplonlc aclds
Lnollc aclds
lenamlc aclds
non acldlc compounds

NSAIDs CAk8CkLIC ACIDS (SALICLA1LS)
AceLylaLed
4 Asplrln (aceLylsallcyllc acld)
4 Chollne magneslum sallcylaLe (1rlllsaLe)
non aceLylaLed
4 Sallcylamlde
4 SalsalaLe (ulsalcld)
4 8alsalazlde
4 Clsalazlne
4 Mesalamlne

SallcylaLes block Lhe lnflammaLory response
AnLl pyreLlc
Analgeslc
More poLenL effecL on plaLeleL aggregaLlon
(decrease plaLeleL coagulaLlon bleedlng) and
Lhermal regulaLory cenLer ln Lhe braln
AnLlLhromboLlc effecL
4 revenLlon of sLroke
4 1ranslenL lschemlc aLLacks (1lA) decreased
oxygen due Lo blood cloLs
4 and oLher Lhromboembollc dlsorders
(common ln bedrldden paLlenLs)
4 uecrease rlsk of deaLh and myocardlal
lnfarcLlon 1
sL
sLage of oxygen deprlvaLlon of
cardlac muscles anglna pecLorls
lschemla (hearL sLops beaLlng) ln paLlenLs
wlLh hlsLory of Ml and anglna pecLorls

Adverse LffecLs of SallcylaLes
Cl lrrlLaLlon nausea vomlLlng hearLburn eplgasLrlc
dlscomforL
8leedlng
Sallcyllsm LoxlclLy of sallcylaLes
4 ulzzlness LlnnlLus dlfflculLy hearlng nausea
vomlLlng dlarrhea menLal confuslon
lasslLude wearlness of body or mlnd from
sLraln lack of energy
SallcylaLe LoxlclLy (2023 gms ln adulL and 4 mg ln
chlldren)
4 8esplraLory alkalosls
4 Pyperpnea
4 1achypnea
4 Pemorrhage
4 LxclLemenL
4 Confuslon
4 ulmonary edema
4 Convulslons
4 1eLany
4 MeLabollc acldosls
4 lever
4 Coma
4 Cardlovascular renal and resplraLory
collapse

*LA1 8LlC8L 1AklnC ASl8ln!*

CauLlon use
8enal dlsorder
Surglcal paLlenLs bleedlng
AsLhmaLlc paLlenLs
vlral lllness
8eye's Syndrome
4 nausea vomlLlng leLhargy drowslness
dlsorlenLaLlon and lrrlLablllLy
4 lncreased lC may cause selzure coma
4 Abnormal accumulaLlon of faL ln llver dx
by lncreased llver enzymes (SC1 SCC1)
4 Chlld may sLop breaLhlng

NSAIDs ACL1IC ACIDS
ulclofenac sodlum (volLaren) anLlarLhrlLls
ulclofenac poLasslum (CaLaflam) anLlarLhrlLls
lndomeLhacln (lndocln) can promoLe closure of
premaLure lnfanL's paLenL ducLus arLerlosus
keLorolac (1oradol)
LLodolac (Lodlne)
1olmeLln (1olecLln)
Sullndac (Cllnorll)

NSAIDs kCICNIC ACIDS
lenoprofen (nalfon)
llurblprofen (Ansald)
lbuprofen (Advll MoLrln)
naproxen (naprosyn llanax Skelan)
keLoprofen (Crudls)
Cxaprozln (uaypro)

nSAlus CLher AgenLs
Lnollc aclds
4 henylbuLazone (8uLazolldln)
4 lroxlcam (leldene)
lenamaLes
4 Meclofenamlc acld (Meclomen)
4 Mefenamlc acld (onsLan)
4 ulflunlsal (uolobld)
nonacldlc compounds
4 nabumeLone (8elafen)

CCx 1 blood cloLLlng proLecLlng sLomach llnlng sodlum and
waLer balance
CCx 2 causes Aln acLlve aL slLes of Lrauma when
prosLaglandlns are needed

CCx 2 lnhlblLors Laken wlLh meals or afLer meals
valdecoxlb (8exLra)
LLorlcoxlb (Arcoxla)
Celecoxlb (Celebrex)
8ofecoxlb (vloxx)

Adverse LffecLs
Cl bleedlng
Peadache dlzzlness
laLlgue
8one marrow depresslon
8ash and mouLh sores

urug lnLeracLlons decrease effecL of CCx 2 lnhlblLors
Loop dlureLlcs
8eLablockers
LlLhlum anLlmanlc drug
lbuprofen

ACL1AMINCnLN (1y|eno|) acLs dlrecLly on
LhermoregulaLory cells ln hypoLhalamus Lo cause sweaLlng
and vasodllaLlon
Mechanlsm of acLlon relaLed Lo analgeslc effecLs of
aceLamlnophen has noL been ldenLlfled
no effecL on lnflammaLlon and plaLeleL funcLlon
LxLenslvely meLabollzed ln llver

Adverse LffecLs
Peadache
PemolyLlc anemla
Skln rash fever
PepaLoLoxlclLy

urug lnLeracLlons decreased acLlon when Laken wlLh
aceLamlnophen
AnLlcoagulanLs
8arblLuraLes
8lfampln

ADkLNCCCk1ICAL AGLN1S (Stero|ds)

Adrenal Clands
Adrenal Medulla sympaLheLlc ln naLure lnner layer of
adrenal gland releases norephlnephrlne and eplnephrlne

Adrenal CorLex ouLer layer glucocorLlcolds and
mlneralocorLlcolds ln response Lo AC1P sLlmulaLlon also
responds Lo sympaLheLlc sLlmulaLlon

CorLlcosLerolds acL on arachldonlc acld
nSAlus work on prosLaglandlns

ulurnal 8hyLhm
SecreLlon of C8P (corLlcoLhropln releaslng hormone)
AC1P (adrenocorLlcoLhroplc hormone) and corLlsol
are hlgh ln Lhe mornlng ln dayorlenLed people
Lhose who have a regular cycle of wakefulness
durlng Lhe day and sleep durlng Lhe nlghL eak
levels of corLlsol ls beLween 6 and 9AM 1he levels
Lhen fall off slowly wlLh perlodlc spurLs and reach
low ln Lhe laLe evenlng wlLh Lhe lowesL levels
around mldnlghL

CLuCCCC81lCCluS enLer LargeL cells blnds Lo cyLoplasmlc
recepLors Lo cause anLllnflammaLory and
lmmunosuppresslve effecLs
ShorLLerm LreaLmenL of many lnflammaLory
dlsorders relleve dlscomforL and glve body a chance
Lo heal from Lhe effecLs of lnflammaLlon
8locks acLlon of arachldonlc acld Lhus decreaslng
prosLaglandlns and leukoLrlenes

Common urugs
4 uexameLhasone (uecadron)
4 8eLameLhasone (CelesLone)
4 PydrocorLlsone (SoluCorLef)
4 MeLhylprednlsone (SoluMedrox)
4 rednlsone (Crasone)

Adverse LffecLs
4 CasLrlc lrrlLaLlon
4 lluld reLenLlon congesLlve hearL fallure
4 lncrease appeLlLe welgh galn
4 lraglle skln loss of halr
4 Pypokalemla hypocalcemla
4 Weakness muscle aLrophy
4 CaLaracLs glaucoma
4 Amenorrhea
4 lncreased suscepLlblllLy Lo lnfecLlon
4 uevelopmenL of cancers

Cn chlldren
4 8lsk for growLh reLardaLlon assoclaLed wlLh
suppresslon of hypoLhalamlcplLulLary
glucocorLlcolds

urug lnLeracLlons
lncreased LoxlclLy of eryLhromycln and keLoconazole
ASA and phenyLoln decreases effecL of
glucocorLlcolds

MlnL8ALCCC81lCCluS lncrease sodlum reabsorpLlon ln Lhe
renal Lubules and lncrease poLasslum and hydrogen excreLlon
leadlng Lo sodlumwaLer reLenLlon
lndlcaLed ln comblnaLlon wlLh a glucocorLlcold for
replacemenL Lherapy ln prlmary and secondary
adrenal lnsufflclency LreaLmenL of salLwasLlng
adrenogenlLal syndrome
lludrocorLlsone (llurlnef)

Adverse LffecLs
4 lncreased fluld volume
4 Peadache
4 Ldema hyperLenslon
4 CongesLlve hearL fallure
4 ArrhyLhmla
4 Weakness
4 Pypokalemla

nurslng ConslderaLlons on CorLlcosLerold 1herapy
4 MonlLor fluld and elecLrolyLe balance
4 Adm wlLh meals
4 Adm ln Lhe mornlng
4 LlmlL sodlum lnLake
4 uo noL dlsconLlnue abrupLly Laper Lhe dosage

Arthr|t|s [olnL paln has Lhree Lypes
rheumaLold auLo lmmune
CouLy accumulaLlon of urlc acld
CsLeoarLhrlLls developmenLal (elderly)

DISLASL MCDIIING AN1IAk1nkI1IS DkUGS (DMAkDS)
Clven lf nSAlus are noL effecLlve anymore

Cold compounds
ChrysoLherapy LreaLmenL wlLh gold cmpds
Absorbed by macrophages Lhus lnhlblLs phagocyLosls
LreaLmenL for rheumaLold arLhrlLls
Common urugs
4 Auranofln (8ldaura)
4 AuraLhloglucose (Solganal)
4 Coldna LhlomalaLe (AurolaLe)

Adverse LffecLs
O Cl mucosal lrrlLaLlon sLomaLlLls glnglvlLls collLls
O Cold bronchlLls and pneumonlLls
O uermaLlLls

LLanercepL (Lnbrel)
Cenerally englneered 1nl recepLor
Adm subcuLaneously for acLlve rheumaLold arLhrlLls
May cause CnS damage and severe
myelosuppresslon and cancer developmenL

enlclllamlne (uepen)
Lowers lgM rheumaLold facLor
23 monLhs before response ls noLed

Sodlum PyaluronaLe (Pyalgan)
ln[ecLed Lo Lhe [olnLs Lo acL as lubrlcanLs Lo relleve
paln of degeneraLlve arLhrlLls

Leflunomlde (Arava)
lnhlblLs dlhydrooroLaLe dehydrogenase
PepaLoLoxlc

Adverse LffecLs
4 Local lrrlLaLlon aL ln[ecLlon slLe
4 aln aL ln[ecLlon slLe
4 lncrease rlsk for lnfecLlon
4 8ashes
4 laLal hepaLoLoxlclLy

CLher AnLlArLhrlLls urugs
O lmmunosuppresslve drugs prlmarlly suppresses
cancer growLh and prollferaLlon mlghL be used Lo
suppress Lhe lnflammaLory process when oLher
LreaLmenLs fall used Lo LreaL 8Ll8AC1C8?
8PLuMA1Clu A81P8l1lS

azaLhloprlne (lmuran)
cyclophosphamlde (CyLoxan)
meLhoLrexaLe (MexaLe)

O AnLlmalarlal drugs
unknown mechanlsm of acLlon
used for 8A lf oLher Lx fall
effecL Lake place afLer 412 weeks
comblned wlLh nSAlus lf Lx ls noL effecLlve

AN1IGCU1 DkUGS acLs sympLomaLlcally
CouL meLabollc dlsease of unknown cause
lnflammaLory condlLlon LhaL aLLack [olnLs Lendons
and oLher Llssues
CharacLerlzed by defecL ln purlne meLabollsm
Pyperurlcemla hallmark of gouL
1ophl found on hellx of ears and oLher carLllages

1reaLmenL goals
1 Lnd acuLe gouLy aLLack ASA
2 revenL recurrence of acuLe gouLy arLhrlLls
3 revenL formaLlon of urlc acld sLones ln kldneys
4 uecrease or prevenL dlsease compllcaLlons LhaL
resulL from sodlum uraLe deposlL ln [olnLs and
kldneys

nonpharmacologlcal mgmL
O lncrease fluld lnLake
O urlne should be alkallnlzed
O Avold foods rlch ln purlne
O use aceLamlnophen lnsLead of asplrln

harmacologlcal mgmL
O Colchlclne (novocolchlne) for acuLe gouLy arLhrlLls
decrease moLlllLy of leukocyLes phagocyLosls
lnhlblLs mlLosls of osLeoprogenlLor cells and acLlon
of preexlslLng osLeoclasLs
consLrlcL blood vessels and affecL cenLral
vasomoLor sLlmulaLlon
lnhlblLs mlgraLlon of W8C Lo lnflamed [olnLs Lhus
lnhlblLlng urlc acld deposlLlons

nurslng 8esponslblllLles
O Adm wlLh food lf glven orally
O CauLlously used lf elderly and Lhose wlLh hearL
renal or gasLrlc dlsease
O Avold alcohollc beverages
O WlLh narrow margln of safeLy
O lncrease fluld lnLake monlLor l C
O MonlLor blood levels
O lf glven per lv
adm over a perlod of 23 mlnuLes
avold exLravasaLlon paLenL llne
lncompaLlble wlLh u3 soluLlon (hyperLonlc soluLlon)
causes LhromboLlc reacLlon

urlc Acld lnhlblLors
O Allopurlnol (Zyloprlm) decrease producLlon of urlc
acld by lnhlblLlng xanLhlne oxldase
lncrease reuLlllzaLlon of hypoxanLhlne and xanLhlne
for nuclelc acld synLhesls
lmproves solublllLy of urlc acld

urug lnLeracLlons
Amoxlclllln and Amplclllln lncrease rlsk of rash
formaLlon
lncrease effecL of Coumadln and oral hypoglycemlcs
Lheophylllne
ACL lnhlblLors lncrease hypersenslLlvlLy
Cyclophosphamlde lncrease rlsk of bone marrow
suppresslon

Adverse LffecLs
4 8ash
4 8one marrow suppresslon
4 nausea vomlLlng abd paln

nurslng Care
4 lncrease fluld lnLake
4 MonlLor renal funcLlon
4 Clve wlLh mllk or food
4 Alkallnlze urlne (naPCC3 and k clLraLe)
4 8egln Lherapy when acuLe aLLack subsldes
4 LlmlL lnLake of purlnerlch food llke peanuLs
legumes
4 Avold alcohol
4 Avold acLlvlLles LhaL requlre menLal alerLness
4 8emlnd LhaL lL only prevenLs gouL buL noL relleve
gouL eplsodes

urlcosurlcs anLl gouL
LxerL anLllnflammaLory acLlons Lhrough Lhelr effecLs
on urlc acld levels
8educes reabsorpLlon of urlc acld aL Lhe proxlmal
convoluLed Lubule
lnhlblLs excreLlon of weak organlc aclds such as
penlclllln and some cephalosporlns
8locks renal/blllary LransporL and LransporL of many
oLher subsLances and drugs ln and ouL of CSl

Common drugs
O robenecld (8enemld)
O Sulflnpyrazone (AnLurane) Lake wlLh food

urug lnLeracLlons
O keLoprofen decrease excreLlon of keLoprofen
O AnLlneoplasLlc agenLs lncrease urlc acld
nephropaLhy
O Asplrln decrease excreLlon of asplrln
O Peparln prolonged effecL of heparln
O nlLrofuranLoln lncrease Loxlc effecL of
nlLrofuranLoln

Adverse LffecL
4 urlc acld sLone formaLlon
4 Peadache
4 nausea vomlLlng
4 Cl paln
4 8leedlng hypoglycemla assoclaLed wlLh
sulflnpyrazone