Anti-Inflamatory

Question 1

Anitinflamatory drug classes

Answer 1

Corticosteroids
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Aspirin and nonacetylated salicylates

Question 2

Cortisol Actions (5 items)

Answer 2

Level of awareness and sleep pattern
Labile emotions
Stimulates gluconeogenesis
Stimulates protein catabolism
Decreases proliferation of fibroblasts, leading to poor wound healing

Question 3

Think of cortisol as a

Answer 3

stress hormone

Question 4

Glucocorticosteroid inhibits

Answer 4

Inhibits immune and inflammatory systems

Depresses proliferation of T lymphocytes, decreases natural killer cell activity, reverses macrophage activity

Question 5

Glucocorticosteroid

Increases circulating

Answer 5

erythrocytes

and appetite

Question 6

Glucocorticosteroid promotes

Answer 6

Promotes fat deposits in the face and cervical areas

Promotes lipolysis in the extremities

Question 7

Glucocorticoid increases

Answer 7

uric acid excretion

Question 8

Glucocorticosteroid decreases

Answer 8

serum calcium levels

Question 9

Glucocorticosteroid promotes gastric

Answer 9

Promotes gastric acid secretion

Question 10

Glucocorticosteroid supresses

Answer 10

Suppresses secretion and synthesis of adrenocorticotropic hormone (ACTH)
Suppresses prostaglandin E production of growth hormone secretion

Question 11

Glucocorticosteroid causes skeletl

Answer 11

Causes skeletal wasting

Question 12

Glucocorticosteroid potentiates the

Answer 12

Potentiates the effects of catecholamines, thyroid hormone, and growth hormone on adipose tissue

Question 13

Mineralcorticoids (Aldosterone) Actions

Answer 13

Retain sodium and water

Excrete potassium

Question 14

Corticosteroids well absorbed

Answer 14

from the GI tract

Question 15

Corticosteroids metabolized in and excreted by

Answer 15

Metabolized by the liver
Metabolites are active.
Cortisone is converted to hydrocortisone.
Prednisone is converted to prednisolone.
Excreted by the kidneys

Question 16

Corticosteroids contraindications

Answer 16

Contraindicated in patients with active untreated infections

Question 17

Corticosteroids Cautious use in Patients with

Answer 17

hypertension and cardiovascular disorders

Question 18

Corticosteroids may elevate

Answer 18

blood pressure, salt and water retention, and increased excretion of potassium

Question 19

Corticosteroids cautious use

Answer 19

in postmenopausal women and others at risk for osteoporosis

Question 20

lot less risk in ___ compared to ___ for corticosteroids

Answer 20

short term use

long term use

Question 21

Corticoseroids patients with diabetes

Answer 21

may have problems with glycemic control. (eleveted glucose)

Question 22

corticosteroids patients with ulcerative colitis

Answer 22

or peptic ulcer disease may have increased risk of gastrointestinal (GI) bleed and perforation.

Question 23

Corticosteroids: Adverse Drug Reactions (ADRs) - Muscle and skin

Answer 23

Atrophy and thinning, striae, hirsutism, poor healing

Muscle atrophy, truncal obesity, buffalo hump, moon facies

Question 24

Corticosteroids: Adverse Drug Reactions (ADRs) - Skeletal Tissues

Answer 24

Osteoporosis (up to 20% of patients)

10% of persons on long-term therapy diagnosed with a fracture

Question 25

Corticostroids can cause side effects that mirror what condition

Answer 25

cushing syndrome

Question 26

Corticosteroids: Adverse Drug Reactions (ADRs) - eyes

Answer 26

Cataracts, glaucoma, ocular infections

Question 27

Corticosteroids: Adverse Drug Reactions (ADRs) (continued) - GI

Answer 27

Peptic ulcer disease

Question 28

Corticosteroids: Adverse Drug Reactions (ADRs) (continued) - Cardiovascular

Answer 28

Hypertension | Fluid and electrolyte disturbance

Question 29

Corticosteroids: Adverse Drug Reactions (continued) - CNS

Answer 29

Delirium, agitation, insomnia, mood swings, and severe depression

Question 30

Corticosteroids: Adverse Drug Reactions (continued) - Endocrine

Answer 30

Adrenal suppression Withdrawal syndrome if abruptly stopped Affects glucose metabolism

Question 31

You do not have to taper corticosteroids if you are using them

Answer 31

less than 10 days

Question 32

Adrenal insufficiency drugs of choice

Answer 32

hydrocortisone, cortisone, and prednisone

Question 33

Give corticosteroids

Answer 33

in the morning before lunch, maybe before 0900

Question 34

Inflammation drugs of choice

Answer 34

Methylprednisolone, prednisone, and triamcinolone or dexamethasone can be used.

Question 35

Immune suppression drugs of choice

Answer 35

Prednisone is used because of its short half-life. | Different strength tablets make dosing and tapering easier

Question 36

``` Rheumatoid arthritis (RA) first and second line drug ```

Answer 36

First-line therapy is NSAIDs. | Low-dose prednisone (less than 7.5 mg/day) can be used.

Question 37

Corticosteroid Prophylaxis with a bisphosphonate and calcium/vitamin D will

Answer 37

will lower risk of osteoporosis.

Question 38

Corticosteroids: Principles of Prescribing

Answer 38

To best match the natural body rhythm, daily doses are best taken in the morning before 9 a.m (earlier in the day, preferable in the morning with food) Body releases naturally occuring corticosteroids at this time The initial dose depends on the specific disease being treated. Maintain or adjust the dose until an acceptable response is achieved

Question 39

Corticosteroids: Principles of Prescribing - 3 and 4

Answer 39

After an acceptable response is achieved, determine the maintenance dose by tapering until the lowest dosage that maintains an adequate clinical response is reached. If, after long-term therapy or because of spontaneous remission, the drug is to be stopped, taper off to prevent an adrenal insufficiency crisis. Tapering is generally not necessary after short-term therapy.

Question 40

Corticosteroids: Principles of Prescribing - 5 and 6

Answer 40

Most conditions that require chronic corticosteroid therapy can be well controlled on alternate-day therapy. Twice the daily dose is given every other morning before 9 a.m. Unlike a tapering schedule, alternate-day scheduling retains the same total steroid dose.

Question 41

Corticosteroids | Short-acting agents are less likely to produce hypothalamic-pituitary-adrenal (HPA) axis suppression.

Answer 41

hypothalamic-pituitary-adrenal (HPA) axis suppression. Long-acting agents are preferred if the effects of high doses must be sustained.

Question 42

Corticosteroids Long-acting agents are preferred if

Answer 42

if the effects of high doses must be sustained.

Question 43

Corticosteroids: Monitoring

Answer 43

Baseline and ongoing Weight, electrolytes, glucose, and complete blood count (CBC) for all Long-term or high-dose therapy require monitoring for GI bleeding Lipids Eye examination for cataracts and glaucoma in long-term therapy

Question 44

Corticosteroids - Adminsitration

Answer 44

Administration Instruct patient to take exactly as prescribed. Explain alternate-day or tapered dosing. Drug should not be abruptly discontinued.

Question 45

Corticosteroids - Lifesytle

Answer 45

Need to wear medic alert bracelet Diet high in potassium and calcium and low in sodium and carbohydrates Caloric management

Question 46

NSAIDs MOI

Answer 46

Inhibit cyclooxygenase (COX-1 and COX-2) activity, thus inhibiting prostaglandin synthesis

Question 47

COX-1 is present in all

Answer 47

tissues and cells, especially platelets; endothelial cells; the GI tract; and renal microvasculature, glomeruli, and collecting ducts.

Question 48

COX-2 is an

Answer 48

inducible” enzyme that is synthesized mainly in response to pain and inflammation.

Question 49

NSAIDs are primarily used for ___ but also

Answer 49

pain and their anti-inflammatory activity. | Also effective antipyretic