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NSAIDS & Tylenol
Jane E. Smith, MHSA, RN, C, ONC
Objectives
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Review the pathophysiology of the inflammatory
response
Discuss the mechanism of action for non-steroidal
anti-inflammatory drugs and Tylenol
Discuss the indications, side effects, and nursing
implications related to NSAIDS and Tylenol
Identify key information to include in
patient/family education
NSAIDS and Tylenol
Pain Management
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Causes
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Primary
Infection
Pathogenesis
The ABC’s
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Ask
Believe
Choose
Deliver
Empower
Follow-up
Wayne Heim/arthrw.jpg
Inflammatory Response
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Triggers
Provoking Factors
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Physical &
Chemical
Infectious Agents
Art from: MayoClinic.com
Evolution of Inflammation
Injury
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Release of Kinins & Histamines
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Vasoconstriction
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Vasodilatation
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Capillary Permeability
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Swelling
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Pain and Impaired Function
Tylenol
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Properties
Indications
Dosage
Hepatotoxicity
NSAIDs – How do they work?
http://elfstrom.com/arthritis/NSAIDS/action.html
NSAIDs – Many Categories (COX-1)
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Carboxylic acids
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Acetylated salicylates
Nonacetylated
salicylates
Acetic acids
Propionic acids
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Ibuprofen
Naproxen
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Fenamates
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Meclomen
Pyrazoles
Oxicams
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Piroxicam (Feldene)
Cyclooxygenase (COX – 2) Inhibitors
Cox–1 and Cox–2 Drugs
Indications
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Rheumatoid Arthritis
Osteoarthritis
Juvenile Arthritis
Dysmenorrhea
Fever
Cox–1 and Cox–2 Drugs
Contraindications
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Angioedema
Syndrome of nasal
polyps
Bronchospasm reaction
to ASA or other
NSAIDs
Hypersensitivity
Cox–1 and Cox–2 Drugs
Drug to Drug Interactions
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Antihypertensives, thiazide diuretics, lasix NSAIDs  effectiveness of these meds
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NSAIDs  digoxin and lithium levels
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Sun exposure – photosensitivity
Cox–1 and Cox–2 Drugs
Side Effects
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Gastrointestinal bleeds
Hematologic changes-  bleeding time,
various anemias (prolongs INR, BUN
& K+,
 blood glucose levels)
Renal – acute renal failure
Cox–1 and Cox–2 Drugs
Patient/Family Education
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Take medication
with food
No ASA
No ETOH
Use sunscreen
Efficacy of
Cyclooxygenase-2-Specific Inhibitors
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COX-2 specific agents superior to placebo
and equivalent to conventional NSAIDs
COX-2 specific inhibitors offer advantages
over conventional NSAIDs on the basis of
decreased toxicity but not in terms of efficacy.
The role and guidelines for the use of COX-2
inhibitors should be based on toxicity and
other issues.
Cannon, G. W. & Breedveld, F. C. (2001) American Journal of Medicine
Costs of NSAIDS vs. Tylenol
McPhee, S. J., Pignone, M., & Schroeder, S.A. (2002)
Drug
Cost Per Unit
Cost Per 30 Days
ASA
$0.01/325 mg
$3.60
Tylenol
$0.01/325 mg
$3.60
Toradol
$0.93/10 mg
Not recommended for > 5 days
Motrin
$0.28/600 mg
$33.60
Naproxen
$1.16/500 mg
$104.40
Celebrex
$2.52/200 mg
$75.60 – OA
$151.20 - RA
Vioxx
$2.52/12.5 mg
$75.60 - OA
Key Points
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NSAIDs are effective in the management of pain by
interrupting prostaglandin synthesis.
Tylenol is an effective medication in the
management of pain but it has no anti-inflammatory
action.
COX-1 and COX-2 Inhibitors have similar efficacy
in the management of pain.
NSAIDs have significant side effects and
patient/family teaching is an integral component of
the treatment plan.
Reference List
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Boh, L. E. (1999). Osteoarthritis. In J.T. DiPiro, R.L. Talbert, G.C. Yee, G.R. Matzke, B.G.
Wells & L.M. Posey (Eds.). Pharmacotherapy: A pathophysiologic approach (4th ed.) (pp.
1441-1459). Stamford, CT: Appleton & Lange.
Cannon, G. W. & Breedveld, F. C. (2001, February). Efficacy of cyclooxygenase-2 –
specific inhibitors. American Journal of Medicine, 110, Suppl 3A. Retrieved from:
http://home.medconsult.com/das/article/body/1/jorg=journal&source=MI&sp=11895791.
Chyka, P. A. (1999). Clinical toxicology. In J.T. DiPiro, R.L. Talbert, G.C. Yee, G.R.
Matzke, B.G. Wells & L.M. Posey (Eds.). Pharmacotherapy: A pathophysiologic approach
(4th ed.) (pp. 70-90). Stamford, CT: Appleton & Lange.
Hellmann, D. B. & Stone, J. H. (2002). Arthritis & musculoskeletal disorders. In L. W.
Tierney, Jr., S. J. McPhee, & M. A. Papadakis (Eds.), Current medical diagnosis & treatment
(833-889). New York, NY: Lange Medical Books/McGraw-Hill.
McPhee, S. J., Pignone, M., & Schroeder, S. A. (2002). General approach to the patient ;
health maintenance & disease prevention; & common symptoms. In L. W. Tierney, Jr., S. J.
McPhee, & M. A. Papadakis (Eds.), Current medical diagnosis & treatment (1-31). New
York, NY: Lange Medical Books/McGraw-Hill.