Chapter 33: Drugs for Inflammation and fever

33.1

 Inflammation is a nonspecific defense of the body.

 Large numbers of chemicals and microorganisms can be neutralized through this
defense
 The purpose of inflammation is to contain or destroy the invading microorganism
 Signs of inflammation:
o Swelling
o Pain
o Warmth
o Redness to area
 Can be acute or chronic, acute lasting about 8-10 days, sometimes longer which
makes it chronic.
 Chronic inflammation has a slower onset and can be caused by autoimmune
disorders, persisting for many years and can oftentimes get worse
o Systemic lupus
o Rheumatoid arthritis
o Seasonal allergies

33.2

 When the tissue is damaged, the mast cells release chemical mediators to notify
the body of injury:
o Histamine- causes vasodilation, smooth-muscle constriction, tissue
swelling
o Leukotrienes- like histamine, contribute to symptoms of asthma and
allergies
o Bradykinin-vasodilator causing pain
o Complement- stimulates histamine release
o Prostaglandins- brings WBC to site, causes pain and induces fever
 When mediators are released on a large rapid scale = ANAPHYLAXIS (life
threatening allergy response)

33.3

 Inflammation is not a disease, try to find cause so treatment can be more

effective
 Use ice and R.I.C.E. (rest, ice, compress, elevate)
  Topical anti-inflammatory agents that are OTC should be used when applicable
due to fewer adverse effects
 Two drug classes used for nonspecific inflammation
o NSAIDs- moderate pain, inflammation and fever
o Corticosteroids- severe or disabling, used short term due to adverse
effects, pt then switched to NSAIDs.

33.4 NSAIDs

 Available OTC
 NSAIDs inhibit prostaglandins (promote inflammation) and block COX 1 (present
in all tissue for protective function) and 2(formed after tissue injury and
promoted inflammation)
 Salicylates: Aspirin
o For mild pain and inflammation
o Small doses taken for preventing blood clot formation, MI, and stroke
o Can cause GI upset, heartburn, salicylism: tinnitus, and dizziness
 Not for kids, Reyes syndrome- can be fatal
 Ibuprofen: Motrin, Advil
o Pain, fever, inflammation
o Low adverse effects (vomiting, nausea)
o Less likely to cause GI upset and potential to bleed (like aspirin)
 Alternative to aspirin
 Not for patients with renal impairments
 celecoxib: Celebrex
o COX 2 inhibitor (only) used for chronic inflammation
o No GI upset, no effect on blood coagulation
o Must build up level to achieve optimum (intended) level
o Reduces colorectal polyps in adults
 Familial adenomatous polyposis (FAP)
 Mutation in gene= hundreds of polyps
 Almost 100% risk of colon cancer

33.5 Corticosteroids

 The most effective at treating severe inflammation disorders

 Sometimes referred to as glucocorticoids
 Natural hormones released by adrenal cortex, dose is many times higher than
naturally present in blood
  Used to treat:
o Neoplasia (cancer)
o Asthma
o Arthritis
 Inhibit prostaglandins (like NSAIDs) and suppress histamine release
 Adverse effects:
o Hyperglycemia
o Mood changes
o Cataracts
o Peptic ulcers
o Electrolyte imbalances
o Osteoporosis
 Can mask infection
 Only used short-term
o Long term effects can cause Cushing’s syndrome
 Must be discontinued gradually or it can cause lack of adrenal function
o Medrol

33.6 Treating fever with antipyretics

 Antipyretic: substance that reduces fever

o Acetaminophen: Tylenol
 Natural defense against foreign organisms
 Many types of bacteria are killed by high fever
 Fevers can be more of a discomfort, but sometimes prolonged high fevers can be
life threatening
o Rhabdomyolysis (breakdown of body tissue)
o Can lead to delirium and/or coma
o Can be fatal (rare)
 Come in many forms
o Gels, caplets, enteric-coated, suspensions
o Aspirin and acetaminophen available as suppositories
 When fever cannot be diagnosed, drug patient is taking or has stopped taking
might be at fault
 Drugs that might cause fevers:
o Anti-infectives: most common to induce fevers
o SSRI
 Paxil: for depression and mood
o Antipsychotic drugs
 o Cytotoxic drugs: used in chemo to prevent transplant rejection
 People with G6PD deficiency: at risk for developing hemolysis
o Do not give acetaminophen: Tylenol

Complementary and Alternative therapies

 Fish oils (marine oils) and Omega-3 have anti-inflammatory abilities

 Diets in high fish oil show to be beneficial for conditions such as:
o RA
o Asthma
o IBS