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Nur 243 Nsaids, Glucocorticoids, AND Gastric Agents Summary

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This is a comprehensive and detailed summary on Nsaids, Glucocorticoids, AND Gastric Agents from the book Pharmacology for Nursing Care by Richard A. Lehne.

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  • 18 september 2024
  • 16
  • 2021/2022
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Cyclooxygenase Inhibitors: Nonsteroidal Anti-Inflammatory Drugs and
Acetaminophen

Cyclooxygenase (COX) inhibitors:
● Suppress inflammation, relieve pain, reduce fever
● Protects against MI and Stroke in ASPIRIN
● Inhibition of cyclooxygenase (COX)
○ COX is the enzyme responsible for conversion of arachidonic acid into
prostanoids (prostaglandins and related compounds)
■ Prostaglandins promote inflammation and
sensitize receptors to painful stimuli
■ COX 1 promotes synthesis of PGE2 and PGI2 which
protect gastric mucosa, promote vasodilation, maintain renal
blood flow
● Reduced gastric acid secretion
● Increased bicarbonate and cytoprotective mucus
● Maintenance of submucosal BF
■ COX 1 promotes TXA2 which stimulates platelet
aggression
■ COX 2 promotes Prostacyclin synthesis causing
vasodilation
■ Prostaglandins contribute to perception of pain and
mediate fever
■ COX derived prostaglandins promote contractions at
term (inhibition reduces prostaglandin synthesis in uterine
smooth muscle)
■ Prostaglandin, Prostacyclin and TXA2 act LOCALLY
■ COX 1: “good cox”
● Found in all tissues; “housekeeping”
● Protect gastric mucosa
● Support renal function
● Promote platelet aggression
● INHIBITION: (harmful effects)
○ Gastric erosion and ulceration
○ Bleeding tendencies
○ Renal impairment
● INHIBITION: (1 beneficial effect)
○ Protection against MI and Stroke secondary to
reduced platelet aggression

, ■ COX 2: “bad cox”
● Found at tissue injury sites
● Mediates inflammation and sensitizes receptors to painful
stimuli
● Mediates fever and contributes to perception of pain in the
brain
● Supports renal function
● Promotes vasodilation in blood vessels
● Can contribute to colon cancer
● INHIBITION: (beneficial effects)
○ Suppression of inflammation
○ Alleviation of pain
○ Reduction of fever
○ Protection against colorectal cancer
● INHIBITION: (2 adverse effects)
○ Renal Impairment
○ Promotion of MI and Stroke
● 2 Categories:
1. DRUGS THAT HAVE ANTI-INFLAMMATORY PROPERTIES→ NSAIDS:
Non-steroidal anti-inflammatory drugs
■ Aspirin
■ Ibuprofen (Advil, Motrin)
■ Naproxen (Aleve)
○ FIRST GENERATION NSAIDS:
■ INHIBIT COX 1 AND COX 2
■ Prototype= 
● Only IRREVERSIBLE COX inhibitor
● Chemical family: Salicylates
○ Acetylsalicylic acid (ASA)
● Relief of mild to moderate pain (headache,
joint pain, muscle pain), reduces fever in adults by lowering
set-point (cannot use in children→ Reye’s syndrome:
encephalopathy and fatty liver degeneration; should avoid
in children and tennagers who might have influenza or
chicken pox), protects against thrombotic disorders, drug of
choice for rheumatoid arthritis, rheumatic fever,
osteoarthritis, tendinitis, bursitis and other inflammatory
disorders; modulation of T cell function, suppression of
inflammatory cell infiltration, stabilization of lysosomes,

, relief of dysmenorrhea, ~Can be more effective for post-op
pain than opioids, ineffective against severe visceral origin
pain, cannot lower normal body temperature, Toxicity
common in treating inflammatory disorders which require
long-term high dose treatment
○ → aspirin levels slightly above TR
■ Tinnitus (maximum dosage is achieved; OA
may not experience), sweating, headache,
dizziness, disturbance→ CNS stimulates
increased respiration→ increased CO2 →
respiratory alkalosis
■ d/c until symptoms subside; resume w/
decreased dosage
● Protection against MI and ischemic stroke,
suppresses TXA 2 the enzyme that promotes platelet
aggregation thereby suppressing it through irreversible
inhibition
○ heartburn, nausea gastric
perforation, occult GI bleeding (inhibition of platelet
aggregation; do not give to pts w/ bleeding disorders
and should be d/c 1 week prior to childbirth or
surgery), gastric ulceration→ increased secretion of
acid and pepsin, decreased production of
cytoprotective mucus and bicarb, decreased
submucosal BF
■ asymptomatic→ perforation and Upper GI
hemorrhage can occur w/o warning signs
■ risk factors for ulceration: previous ulcers
(screen for H. pylori), advanced age, previous
peptic ulcer disease, previous NSAID
intolerance, alcohol abuse, cigarette smoking;
if at risk PPI (omeprazole, lansoprazole) is
recommended; anemia in chronic aspirin use
○ acute, reversible, impairment of
renal function
■ Salt and water retention
■ Signs: reduced urine output, weight gain
despite diuretic use, rapid increase in serum
creatinine and BUN

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