Chapter 24: Antiinflammatory Drugs & Corticosteroids

Antiinflammatory Drugs & Corticosteroids begins by defining the pathophysiology of inflammation, mediated by chemical factors such as histamines, kinins, and prostaglandins, which drive the vascular and delayed phases responsible for the five cardinal signs: redness, swelling, heat, pain, and loss of function. A central theme is the mechanism of Cyclooxygenase (COX) enzymes, distinguishing between the constitutive COX-1, which protects the gastric lining and regulates platelet aggregation, and the inducible COX-2, which triggers inflammation at injury sites. The text extensively categorizes Nonsteroidal Antiinflammatory Drugs (NSAIDs), contrasting first-generation non-selective inhibitors—including salicylates (aspirin), propionic acid derivatives (ibuprofen, naproxen), and para-chlorobenzoic acid derivatives (indomethacin)—with second-generation selective COX-2 inhibitors like celecoxib. Significant attention is given to the unique properties of aspirin, its contraindications in children due to Reye syndrome, signs of salicylate toxicity like tinnitus, and the gastrointestinal risks associated with non-selective NSAIDs. The chapter also explores the management of refractory rheumatoid arthritis using Disease-Modifying Antirheumatic Drugs (DMARDs), covering immunosuppressives and immunomodulators such as Tumor Necrosis Factor (TNF) blockers (infliximab, adalimumab) and interleukin antagonists (anakinra). Finally, the discussion addresses the metabolic disorder of gout, detailing the pharmacotherapy for hyperuricemia including the anti-inflammatory colchicine for acute attacks, xanthine oxidase inhibitors like allopurinol and febuxostat to block uric acid biosynthesis, and uricosurics like probenecid to promote renal excretion, alongside essential nursing interventions regarding fluid intake and dietary restrictions.