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343 pharm exam 5 > Chapter 24 : Anti-inflammatories > Flashcards

Chapter 24 : Anti-inflammatories Flashcards

1
Q

What is the function is anti-inflammatory?

A

Treat with inflammation

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2
Q

Inflammation is a what?

A

Symptom
- not a problem

Cause needs to be identified and treated

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3
Q

Cardinal signs of inflammation? (5)

A

Redness
Swelling
Heat
Pain
Loss of function

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4
Q

Sometimes you don’t wanna treat a fever why?

A

Because it’s the way the body is trying to fight an infection

Depends on the situation
Don’t usually treat unless it’s over 100

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5
Q

What is the COX, cycloozygnase enzyme 1 and 2?

A

1 : protects stomach lining and regulates blood platelets

2 : triggers inflammation and pain

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6
Q

There is a group of anti-inflammatory medication that is COX-2 inhibitor, which does what?

A

Stops the cox-2 trigger that inflammation causes

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7
Q

However most NSAIDS, effect both cox enzymes, which is why a side effect of all NSAIDs is?

A

GI bleeding & ulcers

Because it’s stopping that protecting of stomach lining and regulates blood platelets from cox 1

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8
Q

Usually older people benefits from cox-2 inhibitors why?

A

Because they are weaker

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9
Q

What are the 5 anti-inflammatory drug groups?

A

NSAIDS
CORTICOSTEROIDS
DISEASE-MODIFYING ANTIRHEUMATIC DRUGS
Immunodulators
ANTIGOUT DRUGS

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10
Q

NSAIDS

A
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11
Q

What is the action of NSAIDS?

A

So when we are in pain, prostaglandins are produced

So NSAIDS stop prostaglandins being produced and relive the pain

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12
Q

NSAIDS also inhibit platelet aggregation, meaning what?

A

Increase risk of bleeding, mainly GI bleeding

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13
Q

NSAIDS suppress your immune system? Yes or no?

A

No

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14
Q

If someone is allergic to one NSAID, at time they can what?

A

Take an NSAID different class

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15
Q

First generation NSAID
Salicylates
What medication?

A

Aspirin ( acetylsalicylic acid ) ASA

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16
Q

What is the 3 action of aspirin?

A

Anti inflammatory
Anti platelets
Anti pyretic effects

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17
Q

Is ASPRIN highly protein bound?

A

Yes

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18
Q

Caution with aspirin??

A

Do not take with other NSAIDS!!

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19
Q

Why do we not give aspirin to children with flu or virus symptoms?

A

Because it can lead to reye syndrome

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20
Q

Why do we not give aspirin to last trimester pregnancy in woman?

A

Because of the bleeding, the post partum hemorrhage

It’s not gonna cause birth effects, baby is already developed
However labor is still needed, so bleeding will be a lot

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21
Q

What is a toxic serum salicylate level?

A

Greater than 300MCG/ML

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22
Q

What are the 4 toxic serum salicylate level side effects?

A

Tinnitus
Dizziness
Headache
Excessive sweating

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23
Q

Every single class have you talked about digoxin, oral anti fungal, warfain

These drugs interact with a lot of other drugs, protein bound!!!

So we need to what?

A

Watch out for toxic levels

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24
Q

You’re more likely to be allergic to aspirin when you have what?

A

Nasal polyps
Asthma

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25
Q

Salicylates drug interactions
Increase bleeding with __
Risk for ____ with antidiabetics
Increase ____with glucocorticoids
Decrease effects of (2)
Should not be used with other NSAJD why?

A

Anticoagulants & NSAIDS
hypoglycemic

Gastric ulcer

Ace inhibitors/loop diuretic

Because it decreases effectiveness

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26
Q

Usually we want patients to avoid these foods because they contain salicylates?

A

Prunes
Raisins
Licorice

Certain spices such as curry & paprika

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27
Q

What are your 5 adverse side effects of salicylates, aspirin?

A

GI distress
Ulceration
Tinnitus
Hearing loss
Reye syndrome

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28
Q

Clinical judgment : salicylates
Concept
- inflammation

Recognize cues
- determine patients medical history
- obtain a drug history

Analyze cues & priortize hypothesis
- acute pain, injury, nausea

Generate solutions
- the patient swelling and redness will be reduced within 1 week

A
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29
Q

Clinical judgment part 2 salicyaltes

Take action
- monitor serum salicylate level
- observe the patient for evidence of bleeding
- advise patient not to take aspirin with alcohol or warfarin to prevent increased bleeding
- instruct patient to discontinue aspirin approximately 7 days before surgery to reduce risk of bleeding
- warn parents not to give aspirin for virus or flu symptoms to children to avoid risk of Reye syndrome
- educate parents to call the poison control center immediately if a child has taken a large or unknown amount of aspirin
- inform patient that aspirin tablets can cause GI distress

Evaluate outcomes

A
30
Q

Classes of NSAIDS
Para-chlorobenzoic acid derivatives, or indoles

Propionic acid derivatives

Fenamates

Oxicans

Selective COX-2 inhibitors

A
31
Q

Indomethacin( usually pain from gout)
99% protein bound
What are the 3 things we need to know from this medication?

A

Sodium retention
Water retention

Hypertension

So look like kidney, blood pressure and sodium levels

32
Q

Propionic acid derivates
Ibuprofen

A
33
Q

NSAIDS interactions
Anticoagulants - warfarin
Aspirin
Corticosteroids & ulcers
Protein bound drugs
Diuretics and ACE inhibitors
Increase risk of lithium toxicity

Hypoglycemia possible with anti-diabetic medication

A
34
Q

If a patient is taking metformin and they are also on an NSAID, what do we tell them?

A

Well their more likely to get hypoglycemia

Carry a snack
Check their blood sugar
Decrease NSAID medication

35
Q

What are your big side effects of GI of NSAIDS? (2)

A

GI bleeding! ( dark tarry stools, coffee ground emesis, bleeding gums, easy bruising )

Mucosal lesions ( erosions or ulcerations )

36
Q

What are your big side effects of NSAIDS for renal?

A

Reduction in creatinine clearance
Acute tubular necrosis with renal failure

37
Q

What are your big side effects of cardiovascular ?

A

Noncardiogenic pulmonary edema

Which means your lungs fill up with fluid not because your heart isn’t working

38
Q

NSAIDS contraindications
Cross sensitive to other NSAIDS
Increase risk of Ulcer over age 65
Use cautiously if there are bleeding disorders present, renal disease, cardiovascular disease, liver disease

Contraindicated in third trimester and lactation

Should be stopped one week before elective surgery

A
39
Q

What does NSAIDS have?

A

A black box warning

40
Q

What is a black box warning mean?

A

Super serious and can kill you

41
Q

What is the black Box warning for NSAIDS for cardiovascular issues?

DONT over think it

A

Fetal cardiac events
Thrombotic events
Risk increase duration of treatment
Pre existing cardiac disease are higher

42
Q

What are your GI black box warning for NSAIDS?

A

Increase GI bleeding
Occur any time and without warning
Elderly are higher risk

43
Q

NSAIDS ARE BAD FOR YOUR WHAT??

A

KIDENYS!’

NEPHROTOXIC!!

44
Q

Corticosteroids

A
45
Q

What is the action of corticosteroids?

A

Control inflammation by suppressing or preventing many of the components of the inflammatory process at the injuries site

46
Q

How would we tell patients to discontinue the use of corticosteroids?

A

Slowly taper off for 5-10 days
Because our body becomes lazy in helping us make steroids

47
Q

What are the side effects of steroids?

A

Growth suppression
Osteoporosis
Ulcers
Hypertension

48
Q

Disease-modifying antirheumatic drugs ( DMARDS )

A
49
Q

DMARDS are used for?

A

Autoimmune disease
Or like rheumatoid arthritis

50
Q

Side effects of DMARD? (3)

A

Suppression of the immune system
( increase risk of being sick )

Hypertension
Gi distress

51
Q

Immunomodulators

A
52
Q

What is the action of immunomodulators?

A

Block tumor necrosis factor

53
Q

So if it’s blocking the tumor necrosis factor, what do you think immunomodulators put you at risk for?

A

Cancer

Since our body is using this TNF to kill off cancerous cell

54
Q

Side effects of immunomodulators?

A

Severe infections
Hypo-hypertensive
Chest pain
Pulmonary edema

Life threatening
Bronchopspams
Blood dyscrasias
Hepatitoxicity

55
Q

Gout !

A
56
Q

What is gout?

A

Uric acid accumulation usually in the great toe/joint

Usually causing redness

Inflammatory disease of joints, tendon and other tissue

57
Q

There is a low purine diet usually is what we tell patients to follow with gout is what?

A

Organ meats
Sardines
Salmon
Gravy
Herring
Liver
Meat soups
Alcohol ( especially beer )

58
Q

What is the medication for gout?

A

Colchicine

59
Q

What are the side effects of colchicine?

A

Gi distress ( nausea, vomit, diarrhea, abdominal pain )

60
Q

Colchicine is taken with what to avoid gi distress?

A

Food

61
Q

What are contraindictions of colchicine? (3)

A

Severe
Renal
Cardiac
GI problems

62
Q

For people who have frequent symptoms of gout or is having gout usually we put them on a medication called?

A

Xanthine Oxidase Inhibitors ( allopurinol )

63
Q

What is the function of allopurinol?

A

Decrease the uric acid production
And increase the uric acid excretion

To prevent gout attacks

64
Q

Allopurinol also prevents what syndrome too? Other than gout

A

Acute tumor lysis syndrome
( chemo is suppose to kill cancer cells, when the cancer is being killed really well, they release so much uric acid, that’s what it is )

10% survival
Put you on dialysis right away

When you have cancer, we usually hang a bag of fluid of allopurinol helps out with it

65
Q

Usually allopurinol is taken for how long?

A

6-9months

66
Q

Side effects of allopurinol?

A

Usually tolerated pretty well

Dizziness
Hyperglycemia
Bradycardia
GI distress
Headache

67
Q

Clinical judgment of allopurinol
Concept
Inflammation

Recognize cues
Assess serum uric acid value for future comparisons

Analyze cues and prioritize hypothesis
Acute pain

Generation solutions
Patient will report that pain level has decreased

A
68
Q

We want patients who are on allopurionol to have what 3 tests?

A

Eye exams yearly
Labs for renal(kidney) hepatic (liver )
Functions

69
Q

Practice question 1
A patient has been advised to take ibuprofen. When teaching the patient about ibuprofen, which instruction should the nurse include?
Select all that apply.

A. Avoid taking aspirin with ibuprofen

B. Taken with food to reduce GI upset

C. Monitor for bleeding gum, nosebleeds, black tarry stools

D. Take herbs, ginko and garlic with ibuprofen

E. Take NSAIDS 2 days before menstruation to decrease discomfort

A

A. Avoid taking aspirin with ibuprofen

B. Taken with food to reduce GI upset

C. Monitor for bleeding gum, nosebleeds, black tarry stools

70
Q

Practice question 2
Which of the following drugs should the nurse anticipate to help given to a 65- year old man who has been diagnosed with chronic gout?

A. Allopurinol
B. Colchicine
C. Adalimumab
D. Influximab

A

A. Allopurinol

343 pharm exam 5 (7 decks)

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