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.
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