Non –steroidal anti-inflammatory drugs (NSAIDS)-Propionic acids

Name of the Propionic Acids NSAIDS Drugs

• Flubiprofen
• Fenoprofen
• Ibuprofen
• Ketoprofen
• Naproxen

1.Flubiprofen

Mechanism of Action

Blocks the activity of cyclooxygenase, the enzyme necessary for prostaglandin synthesis. Prostaglandins, important mediators in the inflammatory response, cause local vasodilation with swelling and pain. They also play a role in pain transmission from the periphery to the spinal cord. By blocking cyclooxygenase and inhibiting prostaglandins, this NSAID causes inflammatory symptoms and pain to subside.

Pharmacokinetics

• Half-life elimination: 4.7-5.7 hr
• Onset: rapidly and non-stereo selectively
• Peak plasma time: 1.5 hr
• Bioavailability: 96%
• Protein bound: >99%
• Metabolism: hepatic, P450 enzyme CYP2C9
• Excretion: urine 70% (3% unchanged)

Patient Monitoring

• Monitor patient—especially if she’s elderly or receiving long-term flurbiprofen therapy—for less common but serious adverse GI reactions, including anorexia, constipation, diverticulitis, dysphagia, esophagitis, gastritis, gastroenteritis, gastroesophageal reflux disease, hemorrhoids, hiatal hernia, melena, stomatitis, and vomiting.
• Monitor liver function test results because, rarely, elevations may progress to severe hepatic reactions, including fatal hepatitis, liver necrosis, and hepatic failure.
• Monitor BUN and serum creatinine levels in elderly patients, patients taking diuretics or ACE inhibitors, and patients with heart failure, impaired renal function, or hepatic dysfunction; flurbiprofen may cause renal failure.
• Monitor CBC for decreased hemoglobin and hematocrit because drug may worsen anemia.
• Assess patient’s skin regularly for signs of rash or other hypersensitivity reaction because flurbiprofen is an NSAID and may cause serious skin reactions without warning, even in patients with no history of NSAID sensitivity. At first sign of reaction, stop drug and notify prescriber.

Patient Teaching

• Encourage patient to take flurbiprofen with food or milk to avoid GI distress.
• Caution patient about possible blurred vision, dizziness, and drowsiness.
• Advise patient to avoid aspirin, alcohol, and smoking during flurbiprofen therapy.
• Urge patient to notify prescriber immediately if she has blood in urine, easy bruising, itching, rash, swelling, or yellow eyes or skin.
• Caution pregnant patient not to take NSAIDs such as flurbiprofen during the last trimester because they may cause premature closure of the ductus arteriosus.
• Explain that flurbiprofen may increase the risk of serious adverse cardiovascular reactions; urge patient to seek immediate medical attention if signs or symptoms arise, such as chest pain, shortness of breath, weakness, and slurring of speech.
• Explain that flurbiprofen may increase the risk of serious adverse GI reactions; stress the importance of seeking immediate medical attention for such signs and symptoms as epigastric or abdominal pain, indigestion, black or tarry stools, or vomiting blood or material that looks like coffee grounds. • Alert patient to rare but serious skin reactions. Urge her to seek immediate medical attention for rash, blisters, itching, fever, or other indications of hypersensitivity

Contraindications

Angioedema, asthma, bronchospasm, nasal polyps, rhinitis, or urticaria induced by aspirin, iodides, or NSAIDs; hypersensitivity to NSAIDs Interactions

Adverse Reactions

• CNS: Anxiety, cerebral hemorrhage, depression, dizziness, drowsiness, forgetfulness, headache, insomnia, malaise, nervousness, stroke, tremor, weakness
• CV: Arrhythmias, heart failure, hypertension, hypotension, palpitations, peripheral edema, tachycardia
• EENT: Amblyopia, blurred vision, rhinitis, stomatitis, tinnitus, vision changes
• GI: Abdominal cramps or distress, anorexia, constipation, diarrhea, diverticulitis, dysphagia, esophagitis, flatulence, gastritis, gastroenteritis, gastroesophageal reflux disease, GI bleeding or ulceration, hemorrhoids, hiatal hernia, hepatitis, increased appetite, indigestion, jaundice, liver failure, melena, nausea, perforation of stomach or intestines, stomatitis, vomiting GU: Hematuria, interstitial nephritis, renal failure, UTI
• HEME: Agranulocytosis, aplastic anemia, eosinophilia, leukopenia, neutropenia, pancytopenia, thrombocytopenia
• SKIN: Erythema multiforme, exfoliative dermatitis, flushing, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis Other: Anaphylaxis, angioedema, hyponatremia

Nursing Considerations

• Use flurbiprofen with extreme caution in patients who have a history of ulcer disease or GI bleeding because NSAIDs such as flurbiprofen increase the risk of GI bleeding and ulceration. Expect to use flurbiprofen for the shortest time possible in these patients.
• Be aware that serious GI tract ulceration, bleeding, and perforation may occur without warning signs or symptoms. Elderly patients are at greater risk. To minimize the risk, give flurbiprofen with food. If GI distress occurs, withhold drug and notify prescriber immediately.
• Use flurbiprofen cautiously in patients with hypertension, and monitor blood pressure closely throughout therapy. Drug may cause hypertension or worsen it.

2. Fenoprofen

Mechanism of Action

Blocks the activity of cyclooxygenase, the enzyme needed for prostaglandin synthesis. Prostaglandins, important mediators of the inflammatory response, cause local vasodilation with swelling and pain. When cyclooxygenase is blocked and prostaglandins inhibited, inflammatory symptoms subside. Prostaglandin inhibition also relieves pain because prostaglandins play a role in pain transmission from the periphery to the spinal cord.

Pharmacokinetics

• Peak Plasma Time: 2 hr
• Protein Bound: 99% (albumin)
• Metabolism: Liver
• Half-life: 2.5-3 hr
• Excretion: urine (primarily); feces

Contraindications

Angioedema, asthma, bronchospasm, nasal polyps, rhinitis, or urticaria induced by aspirin, iodides, or NSAIDs; hypersensitivity to fenoprofen or its components; renal impairment; severe hepatic impairment

Adverse Reactions

• CNS: Agitation, confusion, dizziness, drowsiness, headache, seizures, sleep disturbance, stroke, tremor, weakness
• CV: Hypertension, MI, palpitations, peripheral edema, tachycardia, vasodilation
• EENT: Blurred vision, dry or sore mouth, hearing loss, tinnitus
• GI: Abdominal cramps, distention, and pain; anorexia; constipation; diarrhea; diverticulitis; dysphagia; esophagitis; flatulence; gastritis; gastroenteritis; gastroesophageal reflux disease; GI bleeding or ulceration; hemorrhoids; hepatitis; hiatal hernia; indigestion; jaundice; liver failure; melena; nausea; perforation of stomach or intestines; vomiting
• GU: Acute renal failure, dysuria, interstitial nephritis
• HEME: Agranulocytosis, anemia, hemolytic anemia, leukopenia, neutropenia, pancytopenia MS: Muscle spasms and twitching, myalgia
• RESP: Dyspnea
• SKIN: Diaphoresis, erythema, erythema multiforme, exfoliative dermatitis, pruritus, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria
• Other: Anaphylaxis, angioedema

Nursing Considerations

• Use fenoprofen with extreme caution in patients with a history of ulcer disease or GI bleeding because NSAIDs such as fenoprofen increased risk of GI bleeding and ulceration. Expect to use fenoprofen for the shortest time possible in these patients.
• Serious GI tract ulceration, bleeding, and perforation may occur without warning symptoms. Elderly patients are at greater risk. To minimize risk, give drug with food. If GI distress occurs, withhold drug and notify prescriber immediately.
• Use fenoprofen cautiously in patients with hypertension, and monitor blood pressure closely throughout therapy. Drug may cause hypertension or worsen it.
• Give drug with food, milk, or antacids to decrease adverse GI reactions.
• Patients with rheumatoid arthritis may need higher doses than those with osteoarthritis to control their symptoms
• Monitor patient—especially if she’s elderly or receiving long-term fenoprofen therapy—for less common but serious adverse GI reactions, including anorexia, constipation, diverticulitis, dysphagia, esophagitis, gastritis, gastroenteritis, gastroesophageal reflux disease, hemorrhoids, hiatal hernia, melena, stomatitis, and vomiting.
• Monitor patient’s liver function test results because, in rare cases, elevations may progress to severe hepatic reactions, including fatal hepatitis, liver necrosis, and hepatic failure.
• Monitor BUN and serum creatinine levels in elderly patients, patients taking diuretics or ACE inhibitors, and patients with heart failure, impaired renal function, or hepatic dysfunction because drug may cause renal failure.
• Monitor CBC for decreased hemoglobin and hematocrit because drug may worsen anemia.
• Assess patient’s skin regularly for signs of rash or other hypersensitivity reaction because fenoprofen is an NSAID and may cause serious skin reactions without warning, even in patients with no history of NSAID sensitivity. At first sign of reaction, stop drug and notify prescriber.

Patient Teaching

• Advise patient to take fenoprofen with food, milk, or antacids to minimize GI distress. Also instruct her to take drug with a full glass of water and to stay upright for 30 minutes afterward to decrease the risk of drug lodging in the esophagus and causing irritation.
• Instruct patient to swallow drug whole and not to crush, break, chew, or open capsules.
• Caution patient to avoid alcohol, aspirin, and other NSAIDs, unless prescribed, while taking fenoprofen.
• If patient takes an anticoagulant, urge her to immediately report bleeding, including bloody or tarry stools and bloody vomitus.
• Caution patient to avoid hazardous activities until drug’s CNS effects are known.
• Explain that NSAIDs may increase the risk of serious adverse cardiovascular reactions; urge patient to seek immediate medical attention if signs or symptoms arise, such as chest pain, shortness of breath, weakness, and slurring of speech.
• Explain that fenoprofen also may increase the risk of serious adverse GI reactions; stress the need to seek immediate medical attention for such signs and symptoms as epigastric or abdominal pain, indigestion, black or tarry stools, or vomiting blood or material that looks like coffee grounds.
• Alert patient to the possibility of rare but serious skin reactions. Urge her to seek immediate medical attention for rash, blisters, itching, fever, or other indications of hypersensitivity.

3.Ibuprofen

Mechanism of Action

Blocks activity of cyclooxygenase, the enzyme needed to synthesize prostaglandins, which mediate inflammatory response and cause local vasodilation, swelling, and pain. By inhibiting prostaglandins, this NSAID reduces inflammatory symptoms and relieves pain. Ibuprofen’s antipyretic action probably stems from its effect on the hypothalamus, which increases peripheral blood flow, causing vasodilation and encouraging heat dissipation.

Contraindications

•   Hypersensitivity to drug or other NSAIDs
•   Perioperative use in coronary artery bypass graft surgery

Precautions :

• Severe cardiovascular, renal, or hepatic disease; GI disease; asthma; chronic alcohol use
• Elderly patients
• Pregnant (avoid use after 30 weeks’ gestation) or breastfeeding patients
• Children younger than age 17 (safety and efficacy not established).

Administration

• Ideally, give oral form 1 hour before or 2 hours after meal. If GI upset occurs, give with meals.
• Be aware that patients must be well hydrated before I.V. form is administered.
• Dilute injection form before administering

Adverse reactions

• CNS: headache, dizziness, drowsiness, nervousness, aseptic meningitis
• CV: hypertension, arrhythmias EENT: amblyopia, blurred vision, tinnitus
• GI: nausea, vomiting, constipation, dyspepsia, abdominal discomfort, GI bleeding
• GU: cystitis, hematuria, azotemia, renal failure
• Hematologic: anemia, prolonged bleeding time, aplastic anemia, neutropenia, pancytopenia, thrombocytopenia, leukopenia, agranulocytosis
• Hepatic: hepatitis
• Metabolic: hyperglycemia, hypoglycemia Respiratory: bronchospasm
• Skin: rash, pruritus, urticaria, StevensJohnson syndrome
• Other: edema, allergic reactions including anaphylaxis

Patient monitoring

• Monitor for desired effect.
• Watch for GI upset, adverse CNS effects (such as headache and drowsiness), and hypersensitivity reaction.
• Stay alert for GI bleeding and ulcers, especially in long-term therapy.
• In long-term therapy, assess renal and hepatic function regularly.
• Monitor blood pressure closely during treatment.

Patient teaching

• Tell patient to take oral drug with full glass of water, with food, or after meals to minimize GI upset.
• To help prevent esophageal irritation, instruct patient to avoid lying down for 30 to 60 minutes after taking dose.
• Instruct patient to immediately report irregular heartbeats, black tarry stools, vision changes, unusual tiredness, yellowing of skin or eyes, change in urination pattern, difficulty breathing, finger or ankle swelling, weight gain, itching, rash, fever, or sore throat.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, alertness, and balance.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.

Nursing Considerations

• Use ibuprofen with extreme caution in patients with a history of ulcer disease or GI bleeding because NSAIDs such as ibuprofen increase risk of GI bleeding and ulceration. Expect to use ibuprofen for shortest time possible in these patients. • Risk of serious cardiovascular thrombotic events such as a MI or stroke increases the longer ibuprofen is used. Expect to give drug for shortest time possible.
• For I.V. use, dilute Caldolor brand of ibuprofen to final concentration of 4 mg/ ml or less using 0.9% sodium chloride injection, 5% dextrose injection, or lactated Ringer’s solution. For an 800-mg dose, dilute 8 ml Caldolor in at least 200 ml diluent; for a 400-mg dose, dilute 4 ml Caldolor in at least 100 ml diluent. Diluted solutions may be kept at room temperature up to 24 hours. When infusing ibuprofen intravenously, infusion time must be at least 30 minutes.
• Serious GI tract ulceration, bleeding, and perforation may occur without warning symptoms. Elderly patients are at greater risk. To minimize risk, give oral drug with food. If GI distress occurs, withhold drug and notify prescriber immediately.
• Use ibuprofen cautiously in patients with hypertension, and monitor blood pressure closely throughout therapy. Drug may cause hypertension or worsen it.
• Monitor patient—especially if he’s elderly or receiving long-term oral ibuprofen therapy—for less common but serious adverse GI reactions, including anorexia, constipation, diverticulitis, dysphagia, esophagitis, gastritis, gastroenteritis, gastroesophageal reflux disease, hemorrhoids, hiatal hernia, melena, stomatitis, and vomiting.
• Monitor liver function test results because, in rare cases, elevations may progress to severe hepatic reactions, including fatal hepatitis, liver necrosis, and hepatic failure.
• Monitor BUN and serum creatinine levels in elderly patients, patients taking diuretics or ACE inhibitors, and patients with heart failure, impaired renal function, or hepatic dysfunction; drug may cause renal failure.
• Monitor CBC for decreased hemoglobin and hematocrit. Drug may worsen anemia.
• Assess patient’s skin regularly for signs of rash or other hypersensitivity reaction because ibuprofen is an NSAID and may cause serious skin reactions without warning, even in patients with no history of NSAID sensivitity. At first sign of reaction,stop drug and notify prescriber.
• Although analgesic effect occurs at low doses, expect to give at least 400 mg four times daily for anti-inflammatory effect.
• Expect higher doses for rheumatoid arthritis than for osteoarthritis.
• Be aware that ibuprofen oral suspension may contain sucrose, which may affect blood glucose level in diabetic patients.

4.Ketoprofen

Mechanism of Action

Blocks activity of cyclooxygenase, the enzyme needed for prostaglandin synthesis. Prostaglandins, important mediators of inflammatory response, cause local vasodilation with swelling and pain. By blocking cyclooxygenase and inhibiting prostaglandins, this NSAID reduces inflammatory symptoms and relieves pain.

Pharmacokinetics

• Bioavailability: 90%
• Protein Bound: 99%
• Metabolism: Liver
• Half-life:2-4 hr (immediate release); 3-7.5 hr (ER)
• Excretion: Urine 50-90% as glucuronide conjugates; feces 1-8%

Contraindications

Angioedema: aspirin-, iodide-, or NSAID induced asthma, bronchospasm, nasal polyps, rhinitis, or urticaria; hypersensitivity to ketoprofen or its components

Adverse Reactions

• CNS: Headache, irritability, nervousness, seizures, stroke
• CV: Edema, fluid retention, hypertension, MI, tachycardia
• EENT: Tinnitus, vision changes
• GI: Abdominal pain, anorexia, constipation, diarrhea, diverticulitis, dyspepsia, dysphagia, flatulence, gastritis, gastroenteritis, gastroesophageal reflux disease, GI bleeding and ulceration, hepatic failure, hiatal hernia, indigestion, melena, nausea, perforation of stomach or intestine, stomatitis, vomiting
• GU: Acute renal failure, decreased urine output
• HEME: Agranulocytosis, anemia, easy bruising, hemolytic anemia, leukopenia, neutropenia, pancytopenia, thrombocytopenia
• RESP: Asthma, respiratory depression
• SKIN: Erythema multiforme, StevensJohnson syndrome, toxic epidermal necrolysis, rash
• Other: Anaphylaxis, angioedema, rapid weight gain

Nursing Considerations

• Use ketoprofen with extreme caution in patients with history of ulcer disease or GI bleeding because NSAIDs such as ketoprofen increased risk of GI bleeding and ulceration. Expect to use ketoprofen for shortest time possible in these patients.
• Be aware that serious GI tract ulceration, bleeding, and perforation may occur without warning symptoms. Elderly patients are at greater risk. To minimize risk, give drug with food. If GI distress occurs, withhold drug and notify prescriber immediately.
• Use ketoprofen cautiously in patients with hypertension and monitor blood pressure closely throughout therapy. Drug may cause hypertension or worsen it may cause stroke, because NSAIDs increase the risk.
• Monitor patient—especially if he’s elderly or receiving long-term ketoprofen therapy—for less common but serious adverse GI reactions, including anorexia, constipation, diverticulitis, dysphagia, esophagitis, gastritis, gastroenteritis, gastroesophageal reflux disease, hemorrhoids, hiatal hernia, melena, stomatitis, and vomiting.
• Monitor liver function test results because, rarely, elevations may progress to severe hepatic reactions, including fatal hepatitis, liver necrosis, and hepatic failure.
• Monitor BUN and serum creatinine levels in elderly patients, patients taking diuretics or ACE inhibitors, and patients with heart failure, impaired renal function, or hepatic dysfunction; drug may cause renal failure.
• Monitor CBC for decreased hemoglobin level and hematocrit because drug may worsen anemia.
• Assess patient’s skin regularly for signs of rash or other hypersensitivity reaction because ketoprofen is an NSAID and may cause serious skin reactions without warning, even in patients with no history of NSAID sensivitity. At first sign of reaction, stop drug and notify prescriber.
• If patient takes acetaminophen, monitor fluid intake and output, BUN level, and serum creatinine level for evidence of adverse renal effects.

Patient Teaching

• Instruct patient to take ketoprofen with food or after meals to prevent GI upset. Advise him to take drug with a full glass of water and to avoid lying down for 15 to 30 minutes afterward to prevent drug from lodging in esophagus and causing irritation.
• Advise patient to swallow drug whole and not to crush, break, chew, or open capsules.
• Instruct patient to avoid aspirin, aspirincontaining products, and alcohol while taking ketoprofen to decrease risk of adverse GI effects.
• Tell patient not to take more drug than prescribed because stomach bleeding may occur.
• If patient takes an anticoagulant, tell him to watch for and immediately report bleeding problems, such as bloody or tarry stools and bloody vomitus.
• If patient takes insulin or an oral antidiabetic, advise him to monitor blood glucose level closely. Urge him to carry candy or other simple sugars to treat mild hypoglycemia. If he has frequent or severe episodes, instruct him to consult prescriber. • Inform patient that he may be nervous and irritable while taking ketoprofen.
• Instruct patient to notify prescriber immediately if he develops a rash, decreased urine output, dark yellow or brown urine, or signs of fluid retention, including swelling of extremities and unexplained rapid weight gain.
• Caution pregnant patient not to take NSAIDs such as ketoprofen during last trimester because they may cause premature closure of the ductus arteriosus.
• Explain that ketoprofen may increase risk of serious adverse cardiovascular reactions; urge patient to seek immediate medical attention if signs or symptoms arise, such as chest pain, shortness of breath, weakness, and slurring of speech.
• Explain that ketoprofen may increase risk of serious adverse GI reactions; stress importance of seeking immediate medical attention for such signs and symptoms as epigastric or abdominal pain, indigestion, black or tarry stools, or vomiting blood or material that looks like coffee grounds.
• Alert patient to rare but serious skin reactions. Urge him to seek immediate medical attention for rash, blisters, itching, fever, or other indications of hypersensitivity.

5.Naproxen

Mechanism of Action

Blocks cyclooxygenase, the enzyme needed to synthesize prostaglandins, which mediate the inflammatory response and cause local vasodilation, swelling, and pain. Thus, naproxen, an NSAID, reduces symptoms of inflammation and relieves pain. Antipyretic action probably stems from effects on the hypothalamus, which increases peripheral blood flow, causing vasodilation and heat dissipation

Pharmacokinetics

• Bioavailability: 95%
• Protein bound: <99%
• Metabolized in liver via conjugation
• Half-life: 12-17 hr
• Excretion: Urine (95%), feces (<3%)

Administration

• Give with food or milk to avoid GI upset.

Contraindications

•  Hypersensitivity to drug or other NSAIDs
• Asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
• Perioperative pain in the setting of coronary artery bypass graft surgery

Precautions:

• Severe cardiovascular, renal, or hepatic disease
• Advanced renal disease (not recommended)
• History of ulcer disease or GI bleeding (use with extreme caution)
• Chronic alcohol use or abuse
• Elderly patients
• Pregnant patients
• Breastfeeding patients (avoid use)
• Children (naproxen sodium-controlled release) and naproxen use in children younger than age 2 (safety not established).

Adverse reactions

• CNS: dizziness, drowsiness, headache, vertigo, light-headedness
• CV: palpitations, tachycardia, hypertension
• GU: renal toxicity (with long-term use in patients in whom renal prostaglandins have a compensatory role in maintenance of renal perfusion), renal papillary necrosis
• EENT: visual disturbances, tinnitus, auditory disturbances
• GI: nausea, diarrhea, constipation, heartburn, abdominal pain, stomatitis, GI bleeding
• Skin: rash, pruritus, skin eruptions, sweating, photosensitivity, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis
• Other: thirst, edema, allergic reactions including anaphylaxis

Patient monitoring

• Monitor GI status. Stay alert for signs and symptoms of GI bleeding.
• In long-term use, assess CBC with white cell differential and coagulation studies, and monitor for visual and hearing impairment and renal toxicity.
• Monitor cardiovascular status for tachycardia, palpitations, hypertension, and edema.
• Monitor blood glucose level closely in diabetic patients.
• Monitor patient for signs and symptoms of serious skin manifestations; discontinue drug at first appearance of rash or other signs of hypersensitivity.

Patient teaching

• Tell patient to take medication with food or milk followed by 8 oz of water, and to stay upright for 30 minutes afterward. ● Inform patient that he may crush or break regular tablets but must swallow delayed- or controlled-release form whole.
• Tell patient that drug’s full therapeutic effect may take up to 2 weeks.
• Caution patient not to exceed recommended dosage.
• Instruct patient how to recognize and immediately report signs and symptoms of renal toxicity and serious skin manifestations.
• Advise patient to use sunscreen to prevent photosensitivity reaction.
• Instruct patient not to take overthe-counter medications unless prescribed.
• Tell patient to consult prescriber before taking herbs.
• Advise female patient to tell prescriber if she is pregnant or breastfeeding before starting drug.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.

Nursing Considerations

• Use naproxen with extreme caution in patients with a history of ulcer disease or GI bleeding because NSAIDs such as naproxen increase risk of GI bleeding and ulceration. Expect to use naproxen for the shortest time possible in these patients.
• Serious GI tract ulceration, bleeding, and perforation may occur without warning symptoms. Elderly patients are at greater risk. To minimize risk, give drug with food. If GI distress occurs, withhold drug and notify prescriber immediately.
• Use naproxen cautiously in patients with hypertension and monitor blood pressure closely. Drug may cause hypertension or worsen it. Because of naproxen’s sodium content, watch for fluid retention.
• Rehydrate a dehydrated patient before giving drug. If patient has renal disease, monitor renal function closely during therapy.
• Naproxen isn’t recommended for patients with advanced renal disease.
• Monitor patient—especially if elderly or receiving long-term naproxen therapy— for less common but serious adverse GI reactions, including anorexia, constipation, diverticulitis, dysphagia, esophagitis, gastritis, gastroenteritis, gastroesophageal reflux disease, hemorrhoids, hiatal hernia, melena, stomatitis, and vomiting.
• Monitor liver function test results because, in rare cases, elevations may progress to severe hepatic reactions, including fatal hepatitis, liver necrosis, and hepatic failure.
• Monitor BUN and serum creatinine levels in elderly patients, patients taking diuretics or ACE inhibitors, and patients with heart failure, impaired renal function, or hepatic dysfunction; naproxen may cause renal failure.
• Monitor CBC for decreased hemoglobin and hematocrit because drug may worsen anemia.
• Assess patient’s skin regularly for signs of rash or other hypersensitivity reaction because naproxen is an NSAID and may cause serious skin reactions without warning, even in patients with no history of NSAID sensivitity. At first sign of reaction, stop drug and notify prescriber.
• Assess drug effectiveness in ankylosing spondylitis, as evidenced by decreased night pain, morning stiffness, and pain at rest; in osteoarthritis: decreased joint pain or tenderness and increased mobility, range of motion, and ability to perform daily activities; in rheumatoid arthritis: increased mobility and decreased joint swelling and morning stiffness; in acute gouty arthritis: decreased heat, pain, swelling, and tenderness in affected joints.
• Tell prescriber if patient complains of vision changes; patient may need ophthalmic exam

REFERENCES

1. Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
2. McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
3. April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
4. Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
5. Nursebro.com, Search – Nursebro

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