NSAIDs hepatic

Percutaneous Hver biopsy after each 1.5 g of total accumulated methotrexate dosage to detect hepatic fibrosis or cirrhosis not rehably predicted by semm aminotransferase tests are recommended (1,50). Concurrent use of NSAIDs may increase toxicity of methotrexate, although toxicity may be avoided if the dmgs are separated by 12 h. 

Before administering an NSAID, it is important for the nurse to determine if the patient has any history of allergy to aspirin or any otiier NSAID. The nurse determines if die patient has a history of gastrointestinal bleeding, hypertension, peptic ulceration, or impaired hepatic or renal function. If so, the nurse notifies the primary health care provider before administering an NSAID. 

NSAIDs are associated with gastrointestinal, renal, hepatic, and central nervous system toxicity and may increase blood pressure. NSAIDs that are selective for the cyclooxygenase-2 (COX-2) isozyme are less likely to cause gastrointestinal complications but may increase the risk of cardiovascular events. They are no more effective than nonselective NSAIDs. Selective agents should be reserved for patients at high risk of gastrointestinal complications and low risk for cardiovascular events. 

Fever, rigors, chills, malaise headaches, myalgia Nausea, emesis Neutropenia Hepatic enzyme elevation Cutaneous—alopecia, transient, mild rashlike reaction Acetaminophen (APAP). NSAID if APAP is not effective. Meperidine for severe chills and rigors. Bedtime administration. 5-HT3 antagonist, prochlorperazine, metoclopramide, fluids Weekly complete blood count reduce dose by 30-50% Liver function tests (LFTs) weekly withhold treatment until LFTs normalize restart at 30-50% dose reduction reversible on dose reduction or cessation. Interferon is contraindicated in patients with psoriasis because exacerbation of psoriasis has been noted during IFN therapy. 

NSAIDs may also cause kidney diseases, hepatitis, hypersensitivity reactions, rash, and CNS complaints of drowsiness, dizziness, headaches, depression, confusion, and tinnitus. All nonselective NSAIDs inhibit COX-l-dependent thromboxane production in platelets, thereby increasing bleeding risk. NSAIDs should be avoided in late pregnancy because of the risk of premature closure of the ductus arteriosus. 

Porphyria Avoid the use of NSAIDs in patients with hepatic porphyria. 

X in renal/hepatic impair Caution [D, -] Contra IT administration Disp Caps, inj SE NA (emesis in 10-30%), X BM, alopecia, X BP w/ rapid IV, anorexia, anemia, leukopenia, T risk secondary leukemias Interactions T Bleeding W/ ASA, NSAIDs, warfarin T BM suppression W/ antineoplastics radiation T effects OF cisplatin X effects OF live vaccines EMS Pt has T risk of bleeding when combined w/ ASA, NSAIDs, anticoagulants/anti-plts OD May cause N/V symptomatic and supportive... 

Uses w/ cisplatin in nonresectable mesothelioma NSCLC Action Antifolate antineoplastic Dose 500 mg/m IV over 10 min q3wk hold if CrCl <45 mLAnin give w/ vit Bi2 (1000 meg IM q9wk) folic acid (350-1000 meg PO daily) start 1 wk before dexamethasone 4 mg PO bid x 3 start 1 d before each Rx Caution [D, -] w/ renal/hepatic/ BM impair Contra Component sensitivity Disp IV SE Neutropenia, thrombocytopenia, N/V/D, anorexia, stomatitis, renal failure, neuropathy, fevCT, fatigue, mood changes, dyspnea, anaphylactic Rxns Interactions t Effects W/ NSAIDs, probenecid d/t decreased pemetrexed EMS Monitor for S/Sxs of Infxn OD May cause profound BM suppression, mucous membrane irritation, D, and rash symptomatic and supportive... 

Dose Initial 0.25 mg PO tid, wkly 10.25 mg/dose, to 3 mg max max 4 mg for RLS Caution [C, /-] Sev e CV, renal, or hepatic impair Contra Component allergy Disp Tabs SE Syncope, postural X BP, NA, HA, somnolence, dosed-related hallucinations, dyskinesias, dizziness Interactions t Risk of bleeding W/ ASA, NSAIDs, fevCTfew, garlic, ginger, horse chestnut, red clover, EtOH, tobacco t effects OF amitriptyline, Li, MTX, theophylline, warfarin t risk of photosensitivity W/ dong quai— use sunscreen, St. John s wort X effects W/ antacids, rifampin X effects OF ACEIs, diuretics EMS t Bleeding risk w/ concurrent EtOH, tobacco, ASA, and NSAID use t effects of warfarin OD May cause N/V, drowsiness, hypotension, and CP symptomatic and supportive... 

Uses AML, ALL, CML Action Purine-based antimetabolite (substitutes for natural purines interfering w/ nucleotide synth) Dose 2-3 mg/kg/d X in severe renal/hepatic impair Caution [D, -] Contra Resistance to mercaptopurine Disp Tabs SE X BM (leucopenia/thrombocytopenia), NA /D, anorexia, stomatitis, rash, hyperuricemia, rare hepatotox Interactions t Bleeding W/ anticoagulants, NSAIDs, salicylates, thrombolytics EMS t Effects of anticoagulants/salicylates/ NSAIDs T risk of Infxn OD May cause NA, hypotension, and diaphoresis symptomatic and supportive... 

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