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Drugs for Management of Fever
& Inflammation
Brenda B. Rowe
Prostaglandin Synthesis
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COX –1 enzyme – synthesizes
prostaglandins involved in regulation of
normal cell activity
COX –2 enzyme – produces prostaglandins
at site of inflammation
Most NXAIDS are nonselective in targeting
COX-1 & COX-2
Nonsteroidal Anti-inflammatory Agents
(NSAIDS)
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Salicylates
Acetylsalicylic acid (aspirin)
Has antipyretic, anti-inflammatory and antiplatelet
effects
AE – GI (Give with milk or food)
Contraindications – peptic ulcer disease, gout, renal
or hepatic impairment, bleeding disorders, children
with varicella or flu like illness, pregnancy, lactating
women
Teaching Points with aspirin
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Watch for AEs
Avoid alcohol and smoking
Take as directed
Caution about OTC use with aspirin
Effects of long term aspirin use
Prostaglandin Synthetase Inhibitors
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Subgroup of NSAIDS
Ibuprofen (Motrin, Advil)
Higher doses required for anti-inflammatory
effect than analgesia
AEs – GI – Give with milk or food
Cautious use with many diseases
COX-2 Inhibitors
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Celecoxib (Celebrex)
Selective inhibit of COX-2 prostaglandin
synthesis but not platelet aggregation
Anti-inflammatory, analgesic, & antipyretic
Tx osteoarthritis & dysmenorrheal
Contraindicated if have sulfa allergy
AE – GI - but not as likely
Para-Aminophenol derivative
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Acetaminophen (Tylenol)
No anti-inflammatory effect
Tx fever & pain
Use with caution with pregnancy & lactation
but safest antipyretic for children and
pregnancy
AEs – hepatic, renal, hematologic & GI
systems
Issues with self-administration
Antirheumatic drugs
(DMARDS)
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Auranofin (Ridaura)
Tx RA when patient have not responded to NSAIDS
Many contraindications & precautions
AEs – most significant is bone marrow suppression,
most common is GI - diarrhea
Takes 8-12 weeks to get therapeutic response
Monitor CBC, platelets, renal & hepatic function
Antigout Drugs
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Colchicine
Decreases inflammatory response caused by
hyperuricemia
Tx acute gout
AEs – GI
Many contraindications & precautions
Take at first sign of acute gout & d/c when symptoms
resolve
Avoid alcohol & diet high in purines
Uricosuric Drugs
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Probenecid (Benemid)
Reduces uric acid level
Tx chronic gout
AEs – serious is blood dyscrasias, common
is headache, nausea, vomiting & anorexia –
take with milk or food
Do not take during acute attack
Limit taking with vitamin C or cranberry juice
Sample Question
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Which of the following drugs is a prototype
drug for NSAIDS Prostaglandin Synthetese
Inhibitor?
A. aspirin
B. acetaminophen (Tylenol)
C. ibuprofen (Motrin)
D. celecoxib (Celebrex)
Sample Question
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What is the drug of choice for pregnant
women & children with fever or mild to
moderate pain?
A. aspirin
B. acetaminophen (Tylenol)
C. ibuprofin (Motrin)
D. codeine
Sample Question
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Patients taking colchicine should be
educated regarding limiting which of the
following foods?
A. liver
B. cheese
C. beef
D. citrus fruits