NSAIDS & TylenolJane E. Smith, MHSA, RN, C, ONC

Objectives 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 Causes

Primary Infection Pathogenesis

The ABC’s Ask Believe Choose Deliver Empower Follow-up

Wayne Heim/arthrw.jpg

Inflammatory Response Triggers Provoking Factors

Physical & Chemical

Infectious Agents

Art from: MayoClinic.com

Evolution of InflammationInjury

Release of Kinins & Histamines

Vasoconstriction

Vasodilatation

Capillary Permeability

Swelling

Pain and Impaired Function

Tylenol Properties Indications Dosage Hepatotoxicity

NSAIDs – How do they work?http://elfstrom.com/arthritis/NSAIDS/action.html

NSAIDs – Many Categories (COX-1) Carboxylic acids

Acetylated salicylates Nonacetylated

salicylates Acetic acids

Propionic acids Ibuprofen Naproxen

Fenamates Meclomen

Pyrazoles Oxicams

Piroxicam (Feldene)

Cyclooxygenase (COX – 2) Inhibitors

Cox–1 and Cox–2 Drugs Indications Rheumatoid Arthritis Osteoarthritis Juvenile Arthritis Dysmenorrhea Fever

Cox–1 and Cox–2 Drugs Contraindications

Angioedema Syndrome of nasal

polyps Bronchospasm reaction

to ASA or other NSAIDs

Hypersensitivity

Cox–1 and Cox–2 Drugs Drug to Drug Interactions

Antihypertensives, thiazide diuretics, lasix - NSAIDs effectiveness of these meds

NSAIDs digoxin and lithium levels

Sun exposure – photosensitivity

Cox–1 and Cox–2 Drugs Side Effects

Gastrointestinal bleeds Hematologic changes- bleeding time,

various anemias (prolongs INR, BUN & K+, blood glucose levels)

Renal – acute renal failure

Cox–1 and Cox–2 DrugsPatient/Family Education

Take medication with food

No ASA No ETOH Use sunscreen

Efficacy of Cyclooxygenase-2-Specific Inhibitors

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. TylenolMcPhee, 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 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 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.