Chinese General Hospital College of Nursing Drug Analysis

MEDICATION

MECHANISM OF ACTION Thought to inhibit prostaglandin synthesis, impeding COX-2, to produce antiinflammatory, analgesic, and antipyretic effects.

INDICATIONS

CONTRAINDICATIONS

ADVERSE / SIDE EFFECTS

DRUG-TO-DRUG INTERACTION ACE inhibitors, angiotensin II antagonists: May decrease antihypertensive effects. Monitor patients blood pressure. Antacids containing aluminum or magnesium: May decrease celecoxib level. Separate doses. Aspirin: May increase risk of ulcers; low aspirin dosages can be used safely to reduce the risk of CV events. Monitor patient forsigns and symptoms of GI bleeding. Fluconazole: May increase celecoxib level. Reduce dosage of celecoxib to minimal effective dose. Furosemide, thiazides: May reduce sodium excretion caused by diuretics, leading to sodium retention. Monitor patient for swelling and increased blood pressure. Lithium: May increase lithium level. Monitor lithium level closely during treatment. Warfarin: May increase PT and bleeding complications.

NURSING CONSIDERATIONS

GENERIC NAME: Celecoxib BRAND NAME: Celebrex CLASSIFICATION: NSAIDs Pharmacologic: Cyclooxygenase-2 (COX-2) inhibitor

Acute pain and primary dysmenorrhea

Contraindicated for the treatment of perioperative pain after CABG surgery. Contraindicated in patients hypersensitive to drug, sulfonamides, aspirin, or other NSAIDs. Contraindicated in those with severe hepatic impairment. Avoid use in the third trimester of pregnancy and with any dose of a nonaspirin Use cautiously in patients with history of ulcers or GI bleeding, advanced renal disease, dehydration, anemia, symptomatic liver disease, hypertension, edema, heart failure, or asthma, and in poor CYP2C9 metabolizers. Use cautiously in elderly or debilitated patients.

CNS: headache, dizziness, insomnia. CV: hypertension, peripheral edema. EENT: pharyngitis, rhinitis, sinusitis. GI: abdominal pain, diarrhea, dyspepsia, flatulence, GI reflux, nausea. Metabolic: hyperchloremia. Musculoskeletal: back pain. Respiratory: dyspnea, upper respiratory tract infection. Skin: erythema multiforme, exfoliative dermatitis, StevensJohnson syndrome, toxic epidermal necrolysis, rash. Other: accidental injury.

Patients allergic to or with a history of anaphylactic reactions to sulfonamides, aspirin, or other NSAIDs may be allergic to this drug. NSAIDs cause an increased risk of serious GI adverse events, including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. Elderly patients are at greater risk. Patient with history of ulcers or GI bleeding is at higher risk for GI bleeding while taking NSAIDs such as celecoxib. Other risk factors for GI bleeding include treatment with corticosteroids or anticoagulants, longer duration of NSAID treatment, smoking, alcoholism, older age, and poor overall health. Although drug may be used with low aspirin dosages, the combination may increase risk of GI bleeding. Watch for signs and symptoms of overt and occult bleeding. Black Box Warning NSAIDs may

Monitor PT and INR, and check for signs and symptoms of bleeding.

increase the risk of serious thrombotic events, MI, or stroke. The risk may be greater with longer use or in patients with CV disease or risk factors for CV disease. Drug can cause fluid retention; monitor patient with hypertension, edema, or heart failure. Assess patient for CV risk factors before therapy. Drug may be hepatotoxic; watch for signs and symptoms of liver toxicity. Before starting drug therapy, rehydrate dehydrated patient. Monitor patients renal function; renal insufficiency is possible in patients with preexisting renal disease. Longterm administration may cause renal papillary necrosis and other renal injury.