Ibuprofen: Uses, Side effects, Interactions and Nursing Assessment

 Ibuprofen: Uses, Side effects, Interactions and Nursing Assessment

Action: Inhibits COX-1, COX-2 by blocking arachidonate; analgesic, anti-inflammatory, antipyretic

Uses of Ibuprofen: Rheumatoid arthritis, osteoarthritis, primary dysmenorrhea, dental pain, musculoskeletal disorders, fever, migraine, patent ductus arteriosus.

Unlabeled Uses: Ankylosing spondylitis, bone pain, cystic fibrosis, gouty arthritis, psoriatic arthritis.

Functional Class: NSAID

Chemical Class: Propionic acid derivative.

Contraindications of Ibuprofen (NSAIDS)

• Pregnancy 3rd trimester
• Hypersensitivity NSAIDs, Salicylates
• Asthma
• Severe renal/hepatic disorder.
• Perioperative pain in CABG.

Precautions

• Pregnancy 1st and 2nd trimesters.
• Breastfeeding.
• Children.
• Geriatric Patients.
• Bleeding disorders.
• GI disorders.
• Cardiac disorders.
• Hypersensitivity to other anti-inflammatory agents.
• Heart Failure.

Black Box Alert

• GI Bleeding
• MI
• Stroke.

Dosage and Routes

Self Treatment of minor aches/pains

• Adult/adolescent: PO (OTC product) 200 mg q4-6hr, may increase to 400 mg q4-6hr if needed, max 1200mg/day.
• Child 11 yr (72-95lb): PO 300mg q6-8hr.
• Child 9-10 yr (60-71 lb): PO 250 mg q6-8hr.
• Child 6-8 yr (48-59 lb): PO 200 mg q6-8hr.
• Child 4-5 yr (36-47 lb): PO 150 mg q6-8hr.
• Child 2-3 yr (24-35 lb): PO 100 mg q6-8hr.
• Child 12-23 mo (18-23 lb): PO 75 mg q6-8hr
• Child 6-11 mo (12-17 lb): PO 50 mg q6-8hr

Analgesic

• Adult: PO 200-400 mg q4-6hr, max 3.2 g/day; OTG use max 1200 mg/day.
• Child: PO 4-10 mg/kg/dose q6-8hr.

Moderate to severe pain (hospitalized patients) 

• Adult: IV 400-800 mg q6hr as an adjunct to opiate-agonist therapy.

Dysmenorrhea

• Adult: PO 400 mg q4-6hr, max 1200 mg/day.

Antipyretic

• Child 6 mo-12 yr: PO 5 mg/kg (temperature <102.5० F or 39.2० C), 10 mg/kg (temperature >102.5० F), may repeat q6-8hr, max 40 mg/kg/day.

Anti-inflammatory

• Adult: PO 400-800  mg tid-qid, max 3.2 g/day.
• Child: PO 30-40 mg/kg/day in 3-4 divided dises, max 50 mg/kg/day.

Administration

PO Route

• With food, milk or antacids to decrease GI symptoms: if nausea and vomiting occur or persist, notify the prescriber.
• Shake susp well before use.
• Do not use in pregnancy after 30 wk gestation.
• Store at room temperature.

IV routes

• Patient must be well hydrated before administration.
• Dilute to ≤ 4 mg /ml with 0.9% NaCI, LR, D5W; infuse over ≥30 min; do not give IM.
• Discard unused portion.
• Visually inspect for particulate.
• Ibuprofen lysine: dilute with dextrose or saline to appropriate volume (10 mg/mL of ibuprofen is recommended); give within 30 min of preparation; give via IV port nearest insertion site; give over 15 min.
• Check for extravasation; do not give in same line with TPN; interrupt TPN for 15 min before and after product administration.

Side Effects of Ibuprofen

• CNS: Headache, dizziness, drowsiness, fatigue, tremors, confusion, insomnia, anxiety, depression
• CV: Tachycardia, peripheral oedema, palpitations, dysrhythmias, CV thrombotic events, MI, stroke.
• EENT: Tinniutus, hearing loss, blurred vision.
• GI: Nephrotoxicity, dysuria, hematuria, oliguria, azotemia.
• HEMA: Blood dyscrasias, increased bleeding time.
• INTEG: Purpura, rash, pruritus, sweating, urticaria, necrotizing fasciitis, photosensitivity, photophobia, toxic epidermal necrolysis.
• META: Hyperkalemia, hyperuricemia, hypoglycemia, hyponatremia.

Pharmacokinetics

PO: Onset half hr, peak 1-2 hr, duration 4-6 hr; IV: duration 4-6 hr, half-life 1.8-2 hr (adult), 1-2 hr (child) metabolized in liver(inactive metabolites), excreted in urine (inactive metabolites), 90%-99% protein binding, does not enter breast milk, well absorbed.

Interactions

• Increase: Bleeding risk-valproic acid, thrombolytics, antiplatelets, anticoagulants, salicylates.
• Increase: blood dyscrasia risk-antineoplastics, radiation.
• Increase: toxicity-lithium, oral anticoagulants, cyclosporine, methotrexate.
• Increase hypoglycemia-oral antidiabetics
• Decrease ibuprofen action-aspirin.

Nursing Considerations 

ASSESS:

•  GI Bleeding/perforation; chronic use can cause gastritis with or without bleeding; for those with a prior history of peptic ulcer disease or GI bleeding, initiate treatment at lower dose; geriatric patients are at greater risk and those who consume >3 alcoholic drinks/day.
• Renal, hepatic blood studies: BUN, creatinine, AST, Hgb, stool guaiac, before treatment, periodically thereafter; monitor electrolytes as needed; make sure patient is well hydrated.
• Perioperative pain in CABG: MI and stroke can result for 10-14 days; can be fatal; those taking NSAIDs are at greater risk of MI and stroke even in first few weeks of therapy.
• Cardiac status: oedema (peripheral), tachycardia, palpitations; monitor B/P, pulse for character, quality, rhythm, especially in patients with cardiac disease, geriatric patients.
• Pain: note type, duration, location, intensity with ROM 1 hr after administration.
• Infection: may mask symptoms; fever: temperature before and after administration.
• Dysmenorrhea: give at onset of menses.
• For history of peptic ulcer disorder, asthma, aspirin use.
• Pregnancy: identify if pregnancy is planned or suspected, or if breastfeeding; do not use after 30 wk gestation; use only if benefits outweigh fetal risk before 30 wk gestation; do not breastfeed.

Evaluate:

• Therapeutic resp[onse: decreased pain, stiffness in joints; decreased swelling in joints; ability to move easily; reduction in fever or menstrual cramping.

Treatment of Overdose

• Lavage if recently ingested, induce diuresis.

Reference: Mosby Nursing drug reference