Download Flurbiprofen Flurbiprofen sodium

Flurbiprofen
■E
(fl ur- BI H - pr o h -f e n)
CLASSIFICATION(S):
Nonsteroidal anti-inflammatory
drug
PREGNANCY CATEGORY: C
Rx: Ansaid.
WRx: Apo-Flurbiprofen.
Flurbiprofen sodium
PREGNANCY CATEGORY: C
Rx: Flurbiprofen Sodium Ophthalmic, Ocufen.
SEE ALSO NONSTEROIDAL ANTIINFLAMMATORY DRUGS, CHAPTER
2.
USES
Ophthalmic: Inhibition of intraoperative miosis.
PO: Relief of signs and symptoms of
rheumatoid arthritis and osteoarthritis.
Investigational: Inflammation following
cataract surgery, uveitis syndromes.
Topically to treat cystoid macular edema. Primary dysmenorrhea, sunburn,
mild to moderate pain.
ACTION/KINETICS
Action
By inhibiting prostaglandin synthesis,
when used ophthalmically flurbiprofen
reverses prostaglandin-induced vasodilation, leukocytosis, increased vascular
permeability, and increased intraocular
pressure. Also inhibits miosis occurring
during cataract surgery.
Pharmacokinetics
PO form, time to peak levels: 1.5 hr;
1
t /2: 5.7 hr. Over 70% excreted in the
urine. Limited if any absorption after
ophthalmic use. Plasma protein binding: More than 99%.
CONTRAINDICATIONS
Dendritic keratitis.
SPECIAL CONCERNS
■ (1) Cardiovascular risk. NSAIDs may
cause an increased risk of serious CV
thrombotic events, MI, and stroke,
which can be fatal. This risk may increase with duration of use. Clients with
CV disease or risk factors for CV disease
may be at greater risk. (2) Flurbiprofen
Bold Italic = life threatening side effect
is contraindicated for treatment of perioperative pain in the setting of coronary artery bypass graft surgery. (3) GI
risk. NSAIDs cause an increased risk of
serious GI adverse events, including
bleeding, ulceration, and perforation of
the stomach or intestines, which can be
fatal. These events can occur at any
time during use and without warning
symptoms. Elderly clients are at greater
risk for serious GI events.■
• Use with caution in clients hypersensitive to aspirin or other NSAIDs and
during lactation.
• Wound healing may be delayed with
use of the ophthalmic product.
• Acetylcholine chloride and carbachol
may be ineffective when used with
ophthalmic flurbiprofen.
• Safety and efficacy in children not
established.
SIDE EFFECTS
Most Common
After PO use: Headache, abdominal
pain/cramps, diarrhea, nausea. dyspepsia/indigestion, UTI/symptoms, edema.
After ophthalmic use: Ocular irritation,
transient stinging or burning.
See also Nonsteroidal Anti-Inflammatory
Drugs, Chapter 2, for a complete list of
possible side effects.
After ophthalmic use: Ocular irritation,
transient stinging or burning following
instillation, delay in wound healing, fibrosis, miosis, mydriasis. Increased
bleeding of ocular tissues in conjunction with ocular surgery.
HOW SUPPLIED
Flurbiprofen: Tablets: 50 mg, 100 mg.
Flurbiprofen sodium: Ophthalmic Solution: 0.03%.
DOSAGE
FLURBIPROFEN
• TABLETS
Rheumatoid arthritis, osteoarthritis.
Adults, initial: 200–300 mg/day in divided doses 2, 3, or 4 times per day;
then, adjust dose to client response.
The largest recommended single dose
in a multiple-dose daily regimen is 100
mg. Doses greater than 300 mg/day are
not recommended.
Dysmenorrhea.
50 mg 4 times per day.
FLURBIPROFEN SODIUM
• OPHTHALMIC SOLUTION
■ = black box warning
W = Available in Canada
Inhibit intraoperative miosis.
Beginning 2 hr before surgery, instill 1
gtt q 30 min (i.e., total of 4 gtt of 0.03%
solution).
NURSING CONSIDERATIONS
E Do not confuse flurbiprofen with fenoprofen (also a NSAID). Also, do not
confuse Ocufen with Ocuflox (a fluoroquinolone antibiotic).
ADMINISTRATION/STORAGE
1. Use a dose of 300 mg only for initiating therapy or for treating acute exacerbations of the disease.
2. Seek the lowest dose for each client.
3. Store ophthalmic solution from
15–25°C (59–79°F) and tablets from
20–25°C (68–77°F).
ASSESSMENT
1. Rate pain level; note reasons for
therapy, onset, location, characteristics.
2. Assess ROM of involved extremity,
noting any discoloration, swelling, crepitus, deformity, or warmth.
3. Note any heart disease, heart attack,
stroke, if smoker, have high cholesterol,
hypertension, ulcers, or diabetes. May
cause an increased risk of serious CV
thrombotic events, MI, and stroke. Risk
increased with longer use and with
heart disease.
4. Prior to eye surgery, carefully follow
the prescribed dosing intervals. Use
care not to touch eye surface with
dropper. Report any post-op tearing,
dry eye, pain, light sensitivity.
5. Monitor CBC, renal and LFTs with
longer use.
C = see color insert
H = Herbal
CLIENT/FAMILY TEACHING
1. May take tablets with food to decrease GI upset. Do not cut or chew
tablets.
2. Review appropriate method of administering eye medication. Wash
hands before administering. Do not allow dropper to come in contact with
any skin surfaces, avoid rubbing eyes
after instilled. Report stinging, burning,
or irritation immediately.
3. Report delays in wound healing, unusual bruising/bleeding, lack of
response.
4. Perform
muscle-strengthening
(weight-bearing) exercises daily.
5. Avoid alcohol and aspirin as they
may increase GI upset.
6. Report any persistent stomach pain,
skin rash/itching, vomiting blood,
bloody/black stools, rapid weight gain,
swelling, changes in urine patterns, fever, unusual bruising/bleeding, unexplained tiredness, flu-like symptoms,
yellowing of skin/eyes, or visual
changes.
7. Review risks of having a heart attack
or a stroke with continued NSAID use.
8. Keep all F/U to assess response, labs,
and for adverse SE.
OUTCOMES/EVALUATE
• 앗 Pain and inflammation with 앖
joint mobility
• 앗 Optic inflammation
• 앗 Abnormal pupillary contractions
IV = Intravenous
E = sound alike drug