Understanding Inflammation and its Pharmacological Management

Nursing Alert: The most common adverse reactions associated with NSAIDs are gastrointestinal (GI) issues and cardiac concerns. Nurses should monitor patients for signs of GI bleeding or stomach irritation.

Corticosteroids

Corticosteroids are potent anti-inflammatory agents that profoundly reduce the mediators of inflammation. Because of their strength, they are used for serious conditions such as acute adrenal emergencies, allergic states, acute brain injury, severe asthma, and any condition where chronic inflammation could lead to permanent tissue damage.

Common prototypes include Dexamethasone (Decadron) and Prednisone (Deltasone).

Adverse Effects and Adrenal Suppression

While highly effective, corticosteroids carry a significant risk of side effects. These include sodium retention, increased blood pressure, weight gain, bruising, and reduced immunity.

A critical concern with long-term corticosteroid use is adrenal gland suppression. When a patient takes exogenous (external) steroids, the body's natural production of cortisol is suppressed through a feedback loop.

Critical Nursing Implication: Never stop corticosteroid therapy abruptly if the patient has been taking the medication daily for a week or longer. The dose must be decreased slowly over time to allow the adrenal glands to resume natural function.

Disease-Modifying Antirheumatic Drugs (DMARDs)

Unlike NSAIDs, which primarily manage symptoms, DMARDs are used to alter the course of the disease itself. In cases of rheumatoid arthritis, DMARDs work to decrease or suppress the inflammatory response, which slows down disease progression and helps preserve joint function.

Prototypes include:

• Methotrexate (Rheumatrex)
• Sulfasalazine (Azulfidine)
• Adalimumab (Humira)

Nursing Considerations: Adverse effects are often drug-specific but generally include injection-site reactions and a reduction in the immune response. Because these drugs suppress the immune system, nurses must monitor for signs of infection and be aware of potential interactions with other drugs that also reduce immunity.

Antigout Drugs

Gout is a form of inflammatory arthritis caused by the accumulation of uric acid in the joints. This occurs when there is an excess of purines (found in certain proteins) being converted into uric acid.

Mechanism and Use

The primary goal of antigout therapy is to reduce the frequency of gout attacks. The prototype drug, Allopurinol (Zyloprim), works by reducing the amount of the enzyme responsible for converting purines into uric acid.

Adverse Effects and Interactions

Patients may experience minor side effects such as headache, rash, or nausea. However, more severe adverse reactions can include:

• Kidney stones
• Liver failure
• Heart failure
• Stroke

Drug Interactions: Nurses should be cautious when patients are taking allopurinol alongside aluminum-based antacids, warfarin, or chemotherapy drugs.