NSAIDs, Glucocorticoids, and Immunosuppressants: Side Effects and Patient Care
Side Effects of NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause a range of side effects, particularly affecting the gastrointestinal and renal systems.
Gastrointestinal System
- Dyspepsia
- Nausea
- Vomiting
- Ulcers and potential hemorrhagic risk with chronic use
Renal System
- Renal involvement/nephrotoxicity
- Renal failure may occur after years of chronic abuse
Other
- Bronchospasm
- Rashes
- Other allergic-type reactions
Drug Interactions: Anticoagulants and Flu Medications
Individuals taking anticoagulants or antiplatelet medications, such as Adiro (aspirin), should avoid most multicomponent medications for relieving flu symptoms. These medications often cause lower gastrointestinal issues. Combining Adiro with other drugs that cause anticoagulation should be avoided, as there is a mutual enhancement of anticoagulant and antiplatelet effects, increasing the risk of bleeding.
Side Effects of Glucocorticoids
Glucocorticoids can lead to various side effects, including:
- Adrenal insufficiency due to inhibition of the adrenal gland
- Hyperglycemia
- Mood swings
- Precipitation of a manic phase in individuals with bipolar disorder
- Peptic ulcer
- Fluid and electrolyte imbalance: retention of water and sodium (Na+)
- Increased risk of opportunistic infections due to suppressed immune function
- Masking of infections by inhibiting the inflammatory response, leading to rapid and unnoticed infection growth
- Osteoporosis
- Iatrogenic Cushing’s syndrome in the long term
Glucocorticoids and Opportunistic Infections
Glucocorticoid administration increases the risk of opportunistic infections due to the suppression of the immune system.
Monitoring Patients Treated with Glucocorticoids
Cushing’s Syndrome
- Rounded face (moon face) due to fat deposition in the cheeks
- Rounded shoulders (buffalo hump)
- Bruising
Diabetics
- Monitor rapid glucose levels
Heart Failure, Hypertension, and Renal Disease
- Monitor for shortness of breath
- Monitor for water and sodium retention (edema)
Immobility, Bipolar Disorder, or Risk of Pressure Ulcers
- Monitor body weight
- Look for signs of infection before and during treatment
Preventing Falls in Patients Taking Glucocorticoids
Statement: Preventing falls is a priority in people taking glucocorticoids.
Argument: This statement is correct, especially in postmenopausal women and older individuals, because there is a high risk of fractures due to glucocorticoid-induced osteoporosis.
Discontinuing Glucocorticoid Treatment
Abruptly discontinuing glucocorticoid treatment should be avoided due to the risk of steroid withdrawal syndrome. This syndrome is characterized by:
- Malaise
- Weakness
- Muscle pain
- Difficulty breathing
- Hypotension
- Hypoglycemia
- Fever
- Vomiting
Immunosuppressants and Opportunistic Infections
Patients taking immunosuppressive drugs are more likely to develop opportunistic infections. Most of these drugs are toxic to the bone marrow, and immune system suppression favors the onset of these infections. Patients with multiple invasive lines are at a particularly high risk.
Complications and Monitoring of Immunosuppressants
| Complication | Monitoring |
|---|---|
| Renal failure | Urine volume |
| Arrhythmias, muscle cramps, muscle aches | Monitor for symptoms |
| Hypertension | Blood pressure every 8 hours |
| Superinfection | Temperature every 8 hours, monitor for shaking and chills, assess signs of infection, particularly associated with invasive lines or pneumonia |
| Hemorrhage | Monitor for bruising, check stools for evidence of gastrointestinal bleeding, monitor blood pressure and heart rate every 8 hours |