Chapter 44: Antiinflammatory and Antigout Drugs

The inflammatory response originates from the arachidonic acid cascade, which generates prostaglandins and leukotrienes responsible for the cardinal signs of inflammation including pain, edema, erythema, warmth, and functional impairment. Nonsteroidal antiinflammatory drugs represent a primary therapeutic class that inhibits cyclooxygenase enzymes to suppress prostaglandin synthesis, thereby reducing inflammation and fever while providing analgesic effects. Aspirin uniquely produces irreversible platelet inhibition through covalent enzyme modification, making it essential for cardiovascular event prevention. Additional NSAIDs including ibuprofen, naproxen, indomethacin, ketorolac, meloxicam, and diclofenac address various inflammatory conditions such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, dysmenorrhea, and musculoskeletal injuries. Selective cyclooxygenase-2 inhibitors like celecoxib offer improved gastrointestinal tolerability but present cardiovascular risks. NSAID therapy requires vigilant monitoring for serious adverse effects including gastrointestinal hemorrhage, ulcer formation, renal dysfunction, hepatic injury, thrombotic cardiovascular events, and hypersensitivity reactions, with black box warnings highlighting these risks. Salicylate toxicity manifests through tinnitus, vertigo, acid-base disturbances, and neurological symptoms requiring dose adjustment and clinical surveillance. The chapter addresses gout as a crystalline arthropathy resulting from uric acid supersaturation in serum and tissues, developing through overproduction or underexcretion mechanisms. Acute gout management often employs NSAIDs, while long-term urate management utilizes xanthine oxidase inhibitors such as allopurinol and febuxostat to suppress uric acid formation. Colchicine suppresses the inflammatory response to monosodium urate crystals through leukocyte inhibition but demands careful renal dosing. Uricosuric agents including probenecid and lesinurad enhance renal uric acid clearance, though lesinurad carries black box warnings for acute kidney injury. Comprehensive nursing care encompasses pretreatment assessment of renal and hepatic function, bleeding risk stratification, drug interaction evaluation, patient education regarding dosing adherence, dietary modification, adequate hydration, alcohol avoidance, and long-term therapy compliance to prevent disease progression and recurrent attacks.