Drugs for Management of Fever

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Drugs for Management of Fever Inflammation

• Brenda B. Rowe

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Prostaglandin Synthesis

• COX 1 enzyme synthesizes prostaglandins
  involved in regulation of normal cell activity
• COX 2 enzyme produces prostaglandins at site
  of inflammation
• Most NXAIDS are nonselective in targeting COX-1
  COX-2

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Nonsteroidal Anti-inflammatory Agents(NSAIDS)

• Salicylates
• Acetylsalicylic acid (aspirin)
• Has antipyretic, anti-inflammatory and
  antiplatelet effects
• AE GI (Give with milk or food)
• Contraindications peptic ulcer disease, gout,
  renal or hepatic impairment, bleeding disorders,
  children with varicella or flu like illness,
  pregnancy, lactating women

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Teaching Points with aspirin

• Watch for AEs
• Avoid alcohol and smoking
• Take as directed
• Caution about OTC use with aspirin
• Effects of long term aspirin use

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Prostaglandin Synthetase Inhibitors

• Subgroup of NSAIDS
• Ibuprofen (Motrin, Advil)
• Higher doses required for anti-inflammatory
  effect than analgesia
• AEs GI Give with milk or food
• Cautious use with many diseases

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COX-2 Inhibitors

• Celecoxib (Celebrex)
• Selective inhibit of COX-2 prostaglandin
  synthesis but not platelet aggregation
• Anti-inflammatory, analgesic, antipyretic
• Tx osteoarthritis dysmenorrheal
• Contraindicated if have sulfa allergy
• AE GI - but not as likely

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Para-Aminophenol derivative

• Acetaminophen (Tylenol)
• No anti-inflammatory effect
• Tx fever pain
• Use with caution with pregnancy lactation but
  safest antipyretic for children and pregnancy
• AEs hepatic, renal, hematologic GI systems
• Issues with self-administration

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Antirheumatic drugs(DMARDS)

• Auranofin (Ridaura)
• Tx RA when patient have not responded to NSAIDS
• Many contraindications precautions
• AEs most significant is bone marrow
  suppression, most common is GI - diarrhea
• Takes 8-12 weeks to get therapeutic response
• Monitor CBC, platelets, renal hepatic function

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Antigout Drugs

• Colchicine
• Decreases inflammatory response caused by
  hyperuricemia
• Tx acute gout
• AEs GI
• Many contraindications precautions
• Take at first sign of acute gout d/c when
  symptoms resolve
• Avoid alcohol diet high in purines

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Uricosuric Drugs

• Probenecid (Benemid)
• Reduces uric acid level
• Tx chronic gout
• AEs serious is blood dyscrasias, common is
  headache, nausea, vomiting anorexia take with
  milk or food
• Do not take during acute attack
• Limit taking with vitamin C or cranberry juice

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Sample Question

• Which of the following drugs is a prototype drug
  for NSAIDS Prostaglandin Synthetese Inhibitor?
• A. aspirin
• B. acetaminophen (Tylenol)
• C. ibuprofen (Motrin)
• D. celecoxib (Celebrex)

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Sample Question

• What is the drug of choice for pregnant women
  children with fever or mild to moderate pain?
• A. aspirin
• B. acetaminophen (Tylenol)
• C. ibuprofin (Motrin)
• D. codeine

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Sample Question

• Patients taking colchicine should be educated
  regarding limiting which of the following foods?
• A. liver
• B. cheese
• C. beef
• D. citrus fruits