Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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