Overview
This lecture covers anti-inflammatory medications, pain management (opioid and non-opioid analgesics), and a broad overview of antibiotics, including classes, mechanisms, nursing considerations, and unique side effects.
Inflammation and Anti-inflammatory Medications
- Inflammation is a protective tissue response to injury, aiming to eliminate harmful stimuli and start healing.
- Five cardinal signs: redness, swelling, heat, pain, loss of function.
- Two phases: vascular (immediate, 10–15 min) and delayed (leukocyte infiltration).
- COX-1 enzyme maintains gastric mucosa and supports platelets; COX-2 is induced in inflammation and causes pain and swelling.
- NSAIDs (Nonsteroidal Anti-inflammatory Drugs) block COX enzymes; non-selective (e.g., ibuprofen) block both, increasing GI risk.
- Selective COX-2 inhibitors (e.g., celecoxib) reduce GI risk, may increase cardiovascular risk.
- Corticosteroids (e.g., prednisone) mimic cortisol, used for severe/systemic inflammation, with risks like immunosuppression and hyperglycemia.
Pain Management: Analgesics
- Pain types: acute, chronic, nociceptive, neuropathic.
- Mild pain: treated with non-opioid analgesics (e.g., acetaminophen, NSAIDs).
- Moderate pain: often needs opioid plus non-opioid combinations.
- Severe pain: managed with strong opioids (e.g., morphine).
- Opioid risks: respiratory depression, sedation, constipation.
- Opioid overdose antidote: naloxone.
- Acetaminophen: pain and fever reducer, not anti-inflammatory; risk of liver toxicity; antidote is acetylcysteine.
Disease-Modifying Antirheumatic Drugs (DMARDs)
- Used for autoimmune/inflammatory diseases when NSAIDs are insufficient.
- Types: immunosuppressive agents (e.g., methotrexate), immunomodulators (e.g., infliximab), antimalarials (e.g., hydroxychloroquine).
- Require monitoring for toxicity (liver, kidney, blood counts).
- Slower onset of action (weeks–months); may require eye exams (antimalarials).
Gout and Anti-gout Medications
- Gout is caused by uric acid metabolism disorder; uric acid crystals deposit in joints.
- Acute relief: colchicine; chronic management: allopurinol (xanthine oxidase inhibitor), probenecid (uricosuric).
- Patients should increase fluid intake, avoid purine-rich foods and alcohol, and avoid aspirin.
Antibiotics Overview
- Mechanisms: inhibit cell wall synthesis, protein synthesis, or DNA replication.
- Resistance is increased by misuse; gold standard is culture and sensitivity before starting therapy.
- Common adverse reactions: allergy, superinfection, organ toxicity.
- Penicillins: first antibiotics, resistance common; classified by spectrum and resistance.
- Beta-lactamase inhibitors protect antibiotics from bacterial enzymes.
- Cephalosporins: classified by generation; risk of cross-sensitivity with penicillins.
- Macrolides, oxazolidinones, lincosamides, glycopeptides, lipopeptides: cover a wide range, each with unique side effects and uses.
- Tetracyclines: broad-spectrum, cause tooth/tongue discoloration, avoid in young children/pregnancy.
- Aminoglycosides: used IV/IM, require drug level monitoring.
- Fluoroquinolones: risk of tendon rupture (e.g., ciprofloxacin).
- Sulfonamides: used for UTIs, eye infections; risk of crystalluria, hydration important.
Key Terms & Definitions
- COX enzyme — cyclooxygenase enzyme; involved in prostaglandin synthesis.
- NSAIDs — nonsteroidal anti-inflammatory drugs; reduce inflammation and pain.
- DMARDs — disease-modifying antirheumatic drugs; slow progression of autoimmune diseases.
- Superinfection — secondary infection from disruption of normal flora by antibiotics.
- Beta-lactamase — bacterial enzyme that inactivates beta-lactam antibiotics.
- Red man syndrome — rash from rapid vancomycin IV infusion.
- Tinnitus — ringing in the ears, a sign of salicylate toxicity.
- Uricosuric — drug increasing excretion of uric acid.
Action Items / Next Steps
- Review all comparison and prototype drug charts in the textbook/slides.
- Study unique, exam-focused side effects and contraindications.
- Complete assigned readings for chapters 24–29.
- Be familiar with nursing considerations for each major drug class.
- Review provided handouts on antibiotics' mechanisms and adverse reactions.