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• The inflammatory response is designed to

protect the body from injury and pathogens.


• It employs a variety of potent chemical
mediators to produce the reaction that helps
to destroy pathogens and promote healing.
• Anti-inflammatory agents generally block or
alter the chemical reactions associated with
the inflammatory responses to stop one or
more of the signs and symptoms of
inflammation.
-Are some of the most widely used drugs in the United
States
- They provide strong anti-inflammatory and
analgesic effects yet do not have the adverse effects that
are associated with the corticosteroids.
- Acetaminophen also is
a widely used agent. It
has antipyretic and
analgesic properties but
does not have the anti-
inflammatory effects of
the salicylates or the
NSAIDs.
• Drug name: Fenoprofen (Nalfon)
Dosage: 200 – 600 mg PO t.i.d. or q.i.d.
Indication: is used to treat pain and manage arthritis.

2. Drug name: Flurbiprofen (Ansaid)


Dosage: 200 – 300 mg PO in divided doses; ophthalmic solution: 1 gtt q
30 min beginning 2 h after surgery
Indication: is used for the long-term management of arthritis and as a
topical preparation for managing pain after eye surgery.

3. Drug name: Ibuprofen (Motrin, Advil, and others)


Dosage: Adult: 400 – 800 mg PO t.i.d. to q.i,.d.
Pediatric: 30 – 40 mg/kg/d PO in three to four divided
doses for arthritis; 5 – 10 mg/kg./d PO q6-8h for
fever
Indication: is used as an OTC pain medication and for long-term
management of artyhritis pain and dysmenorrhea; it is the most
widely used of the NSAIDs.
4. Drug name: Ketoprofen (Orudis)
Dosage: 25 – 75 mg PO t.i.d. to q.i.d.; reduce dosage
with hepatic or renal impairment; SR form: 200 mg/d PO
Indication: is available for short-term management of pain
and as a topical agent to relieve ocular itching caused by
sequential rhinitis.

5. Drug name: Naproxen (Naprosyn)


Dosage: Adult: 250 – 500 mg PO b.i.t.; do not give
>200 mg q 12h for geriatric patients
Pediatric: 10 mg/kg per day PO in two divided doses for
juvenile arthritis; do not give OTC versions to children <12 y without
consulting health care provider.
Indication: is available for OTC pain relief and to treat arthritis and
dysmenorrhoea.

6. Drug name: Oxaprozin (Daypro)


Dosage: 1200 mg PO as a single dose
Indication: is very successfully used to manage arthritis.
1. Drug name: Diclofenac (Voltaren, Cutaflam)
Dosage: 100 – 200 mg/d PO
25 – 50 mg PO b.i.d. to q.i.d. PO
Indication: is used to treat acute and long-term pain
associated with inflammatory conditions.

2. Drug name: Etodolac (Lodine)


Dosage: 800 – 1200 mg/d PO in divided doses
200 – 400 mg q6-8h PO for pain management
Indication: is widely used for arthritis pain.

3. Drug name: Indomethacin (Indocin)


Dosage: Adult: 75 – 150 mg/d PO in three to four divided doses
Pediatric: >2 y; in special circumstances, 2 mg/kg/d PO in
divided doses
Indication: is available in oral, topical, and rectal preparations for the
relief of moderate to severe pain associated with inflammatory
conditions and in intravenous form to promote closure of the patient
ductus arterious in premature infants.
4. Drug name: Ketorolac (Toradol)
Dosage: 10 mg PO q4-6h, 30-60 mg IM, switching
to oral form as soon as possible, or 30 mg IV as a single
dose.
Indication: is used for short-term management of pain &
topically to relieve ocular itching.

5. Drug name: Nabumetone (Refalen)


Dosage: 1000 mg/d PO as a single dose
Indication: is used to treat acute and chronic arthritis pain.

6. Drug name: Sulindac (Clinoril)


Dosage: 150 – 200 mg PO b.i.d.
Indication: is used for long and short- term treatment of the signs and
symptoms of various inflammatory conditions.

7. Drug name: Tolmetin (Tolectin)


Dosage: Adult: 400 mg PO t.i.d.; 600-800 mg/d in 3-4 doses for
maintenance.
Indication: is used to treat acute attacks of rheumatoid arthritis and
juvenile arthritis.
• Drug name: Meclofenamate (generic)
Dosage: 200-400 mg/d PO in divide doses; 50-100 mg PO q4-6h
for mild pain.
Indication: is used to treat dysmenorrhea, mild pain, and arthritis.

2. Drug name: Mefenamic acid (Ponstel)


Dosage: 500 mg PO, then 250 mg PO q6h as needed
Indication: is used only for short-term treatment of pain.

3. Drug name: Piroxicam ( Feldene)


Dosage: 20 mg/d PO as a single dose
Indication: is used to treat for moderate pain and for the treatment
of arthritis.

4. Drug name: Diflunisal (Dolobid)


Dosage: 500 – 1000 mg/d PO in two divided
doses
Indication: is used for moderate pain and for the
treatment of arthritis
• Drug name: Celecoxib (Celebrex)
Dosage: Initially: 100-200 mg PO b.i.d.
400 mg, then 200 m,g PO b.i.d. for acute pain
400 mg PO b.i.d for FAP
Indication: is used for the acute and long-term treatment of
arthritis, particularly in pt. who cannot tolerate the GI
effect of the NSAIDs.

2. Drug name: Valdecoxib (Bextra)


Dosage: Adult: 10 mg/d PO; 20 mg PO b.i.d.
Indication: is used as a once-a-day treatment for
osteoarthritis, & treatment of adult rheumatoid arthritis &
primary dysmenorrhoea.

3. Drug name: Rofecoxib (Vioxx)


Dosage PO Osteoarthritis Initial: 12.5 mg once daily.
Rheumatoid arthritis 25 mg/day. Acute symptomatic pain
Initial: 50 mg once daily, then 25-50 mg/day.
Absorption – The NSAIDs are rapidly absorbed from the GI tract,
reaching peak levels.
Distribution – The NSAIDs cross the placenta and cross into breast milk.
Metabolism – Metabolized in the liver and excreted in the urine.
Excretion – 1 to 3 hours.

Route Onset Peak Duration


Oral 30 mins. 1-2 hrs. 4-6 hrs.
-Pt. receiving NSAIDs - The potential caused by
often experience : direct GI bleeding often
is a cause of
• Nausea discontinuation of the
• Dyspepsia drug.

• GI pain 2. Headache

• Constipation 3. Dizziness

• Diarrhea or 4. Somnolence
Flatulence 5. Fatigue
1. The NSAIDs are contraindicated in the presence of allergy to any
NSAIDs or salicylate, and celecoxib is also contraindicated in the
presence of allergy to sulfomides.
2. Cardiovascular dysfunction or hypertension, peptic ulcer, and
pregnancy.

1. Screen for know allergies to any salicylates, NSAIDs


or tartazine; pregnancy or lactation; hepatic or renal
disease; cardiovascular dysfunction; hypertension;
and GI bleeding or peptic ulcer.
2. Screening for baseline status before beginning
therapy & for potential adverse effects.
• Are popular anti-inflammatory agents, not only because
of their ability to block the inflammatory response, but also
because of their antipyretic (fever blocking) and analgesic
(pain-blocking) properties. They are generally available
without prescription and are relatively non-toxic when
used as directed.

• Salicylates are some of the oldest anti-inflammatory


drugs used. They were extracted from willow bark, poplar
trees, and other plants by ancient peoples to treat fever,
pain and what we now call inflammation.
1. Drug name : aspirin (Bayer, Empirin others)
Dosage: Adult: 325 – 650 mg PO or PR q4h
Myocardial infraction (MI): 300 – 325 mg PO
Pediatric: 65 – 100 mg/kg per day PO or PR in four to six
divided
doses: if <2 y of age, consult with prescriber.
Indication: Treatment of fever, pain, inflammatory conditions; at
low dose to prevent the risk of death and MI in patients with
history of MI, prevention of transient ischemic attacks.

2. Drug name : balsalazide (Colazal)


Dosage: Three 750-mg capsules PO t.i.d for 8 weeks
Indication: Treatment of mildly to moderately acute ulcerative
colitis in adults.

3. Drug name : cholin magnesium trisalicylate (Tricosal)


Dosage: Adult: 1.5 – 3 g/d PO in two to three divided doses
Pediatric: 50 mg/kg per day PO in two divided doses
Adult and children: >12 y: 870 mg PO q3-4h
Indication: Relief of mild pain, fevers; treatment of arthritis
4. Drug name : mesalamine (Pentasa, others)
Dosage: 800 mg PO t.i.d. for 6 wk; or 4 g/60 ml rectal
suspension q.d. at bedtime or 500 mg b.i.d.
Indication: suppository PR, retained for 1-3 h Treatment of
ulcerative colitis and other inflammatory bowel disease in
adults.

5. Drug name : olsalazine (Dipentum)


Dosage: 1 g/d PO in two divided doses
Indication: Treatment of ulcerative colitis and other
inflammatory bowel disease in adults.

6. Drug name : salsalate (Argesic, others)


Dosage: 3000 MG/D PO in divided doses
Indication: Treatment of pain, fever, inflammation in adults.

7. Drug name : sodium thiosalicylate (Rexolate)


Dosage: 50 – 150 mg IM q3 – 6h
Indication: Relief of gout, muscular pain; treatment of
rheumatic fever in adults.
Absorption – Salicylates are readily absorbed directly from the
stomach, reaching peak levels.
Distribution – Salicylates cross the placenta and enter breast milk.
Metabolism – They are metabolized in the liver and excreted in the
urine, with a half life of 15 minutes to 12 hours, depending on the
salicylates involved.
Excretion – 5 to 30 minutes

Route Onset Peak Duration


Oral 5-30 mins. 0.25-2 hrs. 3-6 hrs.
Rectal 1-2 hrs. 4-5 hrs. 6-8 hrs.
- Result of direct drug effects -Salicylisn can occur with
on the stomach high levels of aspirin
• Nausea • Dizziness
• Dyspepsia • Ringing in the ears
• Heartburn • Difficulty of hearing
• Epigastric discomfort • Nausea
• Vomitting
- On clotting systems
• Diarrhrea
• Blood loss
• Mental confusion
• Bleeding abnormalities
• Lassitude
1. Salicylates are contraindicated in the presence of
known allergy to salicylates, other NSAIDs.
2. Bleeding abnormalities
3. Impaired renal function
4. Chicken pox or influenza
5. Surgery or other invasive procedures scheduled
within 1 week
1. Screen for any known allergies to any salicylates,
NSAIDs, or tartrazine; renal disease; bleeding
disorders; chicken pox; influenza; and pregnancy or
lactation.
2. Include screening for baseline status before
beginning therapy and for any potential adverse
effects.