Anti-inflammatory, Anti-arthritis and Related Agents Flashcards
(93 cards)
1
Q
What is an Inflammatory response?
A
The inflammatory response protects the body from injury and pathogens by using chemical mediators to produce a reaction that destroy pathogens and promotes healing.
2
Q
What is Analgesic?
A
A pain reliever
3
Q
What are anti-Inflammatory agents?
A
Agents that block decrease the chemical reaction involved in inflammation.
4
Q
What are Antipyretic?
A
Fever reducing medication
5
Q
What is Chrysotherapy?
A
Inflammation treatment using gold salts.
6
Q
What are disease- modifying antirheumatic drugs (DMARDs)?
A
Drugs used in the treatment of arthritis.
7
Q
What is Gout?
A
Gout is a disease caused when there is a high amount of uric acid in the body and deposits of uric crystals form in the kidneys or joints.
8
Q
What is Inflammatory bowel disease?
A
Chronic inflammation of the GI tract.
9
Q
What is an inflammatory response?
A
The body responding to a perceived harmful stimuli such as bacteria, trauma or toxins.
10
Q
What are NSAIDs?
A
Non-steroidal Anti Inflammatory drugs. Drugs that have anti-inflammatory, analgesic or antipyretic effects.
11
Q
What are Salicylates?
A
Agents that have antipyretic and analgesic properties.
12
Q
What is Salicysism ?
A
When a patient have had too much of Salicylate drugs and experience dizziness, nausea, vomiting, ear ringing,, mental confusion and diarrhea.
13
Q
Why does the body swell locally during an inflammatory response?
A
Due to the chemical reaction of the immune system activating.
14
Q
Why is there a loss of function to the inflamed area when the inflammatory response is activated?
A
The prevent movement that would make the injury worse.
15
Q
What are some Anti-inflammatory, Anti-arthritis,
and Related Agents?
A
Corticosteroids
Antihistamines
Immune-modulating agents
OTC anti-inflammatory
16
Q
How does corticosteroids work here?
A
They block or alter the chemical reactions that are associated with the inflammatory response
17
Q
How does antihistamines work?
A
They block the release of histamines in the initiation of the inflammatory response.
18
Q
What lifespan considerations should we take when giving any of these agents to children?
A
Children are more suseptible to GI and CNS effects.
Parents need to check OTC ingredients.
Salicylates should not be used for fever/viral infection due to risk of Reye Syndrome.
Acetaminophen is most commonly used.
19
Q
What is Reye Syndrome?
A
If a child takes Salicylates for a fever/viral infection it may cause Reye Syndrome which may lead to liver failure. This is why children should not be taking Aspirin.
20
Q
What lifespan considerations should we take when giving any of these agents to adults?
A
Adults should be cautious when using OTC products.
Show caution in pregnancy and lactation.
There may be severe ADE on neonate and mother with salicylates, NSAIDS and gold products.
21
Q
What lifespan considerations should we take when giving any of these agents to older adults?
A
Older adults are more susceptible to ADE.
Dose should be adjusted as needed.
Gold salts are toxic for older adults.
When used, the dose must be lowered and the patient must be monitored closely for toxicity.
22
Q
What part of inflammation does Salicylates affect?
A
Fever and inflammation.
23
Q
What are the drug classes that we must know for Salicylates?
A
Aspirin and Mesalamine
24
Q
What can Salicylates be used for?
A
Used to block the inflammatory response.
The can reduce fever due to having antipyretic properties.
Can be used as pain medication due to having analgesic properties.
25
How does Salicylates work on the body?
They inhibit synthesis of prostaglandin.
26
Which patients should we not give Salicylates to?
Patients with known allergies, bleeding abnormalities, impaired renal function, chickenpox/flu in children, surgery within a week. pregnancy/lactation.
27
What are some adverse effects of Salicylates?
Effects on stomach and clotting systems.
28
Are there any drug-drug interactions to Salicylates and if so what are they?
They might interact with other drugs by interfering with the other drugs absorption.
29
What nursing assessments should we do prior to giving a patient Salicylates?
Assess for contraindications and cautions.
Perform physical assessment.
Assess for the presence of any skin lesions because Salicylates may increase the risk of skin reactions and rashes.
Monitor temperature (toxicity)
Evaluate CNS status—orientation, reflexes, eighth cranial nerve function, and affect (to see if patient is close to reaching toxic levels)
Monitor pulse, blood pressure, and perfusion.
Evaluate respirations and adventitious sounds (toxicity)
Perform a liver evaluation and monitor bowel sounds.
Monitor CBC, liver and renal function tests, urinalysis, stool guaiac (to check for blood which may happen with too much) and clotting times.
30
What nursing diagnosis can be made prior to administering salicylates?
Impaired comfort related to CNS and GI effects.
Altered breathing pattern risk, if there is toxicity.
Altered sensory perception (auditory, kinesthetic) risk, if there is toxicity.
Knowledge deficit risk regarding drug therapy.
31
What implementations can we expect to possibly make when we are giving patients Salicylates?
Administer with food if GI upset is severe; provide small, frequent meals
Administer drug as indicated; check all drugs being taken for possible salicylate ingredients to avoid OD.
Monitor for severe reactions such as excessive bleeding or signs for salicylism, Reyes Syndrome (children) or toxicity.
Arrange for supportive care and comfort measures (rest, environmental control)
Ensure that the patient is well hydrated during therapy
Provide thorough patient teaching
32
Which NSAID's do we need to know?
Propionic Acids - Ibuprofen and Naproxen.
Acetic Agents - Indomethacin and Ketorolac
Oxicam derivatives - Meloxicam
Cyclooxygenase-2 Inhibitors - Celecoxib
33
What effect does NSAID's provide?
Strong anti-inflammatory, antipyretic and analgesic effect.
34
Most NSAID's are sold OTC.
TRUE/FALSE
TRUE.
This is makes it at a risk for abuse which may result in GI bleeds.
35
What enzymes does NSAID's block?
COX-1 & 2
36
What is COX 1?
Exist in tissues throughout the body and is involved in clotting, sodium and water balance in the kidney and protecting the stomach. Which explains why blocking COX 1 may result in stomach upset, kidney issues and increased bleeding.
37
What is COX 2?
Strictly involved in the inflammatory reaction.
38
Why would you give a patient NSAID's?
To treat inflammation, pain and fever.
39
Which Type of NSAID is more likely to cause stomach upset, kidney problems and bleeding problems?
The ones with more COX 1 blocking power.
40
Which NSAID is more likely to cause cardiovascular problems?
NSAIDs with more COX 2 blockers.
41
Which patients should you not give NSAID's to?
Patients with a know allergy to NSAID's & Salicylate. If there is a known allergy to sulfonamides then Celecoxib should be avoided as well.
Patient with CV dysfunction or HTN, peptic ulcer, GI bleeding, pregnancy and lactation.
42
What are some conditions that are contraindicated with NSAID use?
Allergy to NSAIDs or Salicylates.
Celecoxib is contraindicated if the person is allergic to sulfonamides.
Relative contraindications are cardiovascular dysfunction or hypertension, peptic ulcer, GI bleeding as these medications can make these things worse.
Pregnancy & lactation
43
With what other drug class is Celecoxib contraindicated?
If the patient have an allergy to Sulfonamides because Celecoxib contains a sulfonamide group.
44
What are some known adverse effects to NSAID's?
GI effects - very common
CNS effects -related to decreased prostaglandin
CV effects - related to decreased prostaglandin
Bone marrow depression - related to decreased prostaglandin
45
What patients should we be cautious with administering NSAID's to?
Patients with renal and hepatic dysfunction
46
Are there any drug-drug interactions with NSAID's and if so what are they?
Loop Diuretics- may make these less effective due to prostaglandin involvement.
Beta-blockers - may be reduced/ineffective due to HTN risk of NSAIDs
Lithium - May increase Lithium toxicity
47
How does Acetaminophen work?
Act directly on the thermoregulatory cells of the hypothalamus which causes sweating and allows the body to cool down. MOA is not exactly known, but are related to analgesic effect.
48
What do we give Acetaminophen to patients for?
To treat fever and pain.
To treat prophylaxis of children receiving diphtheria-pertussis-tetanus (DPT) immunizations.
Relief of musculoskeletal pain associated with arthritis.
49
What happens if a patient takes too much of Aceteminophen?
Can seriously damage he liver and lead to death.
50
Which patients should we not give Acetaminophen to?
Patients with a known allergy to Acetaminophen.
51
What patients/conditions should we be cautious of when giving Acetaminophen to a patient?
Patients that are pregnant or breastfeeding.
Patient that have hepatic dysfunction or chronic alcoholism (an already damaged liver may worsen with use)
52
What are some known adverse effects of Acetaminophen?
* Headache, (rebound headache when patients have been taking the medications chronically)
* Hemolytic anemia,
* renal dysfunction,
* skin rash and fever (may be a sensitivity reaction)
53
What are some adverse drug-drug reactions that we need to be aware of with Aceteminophens?
Should not be taken with ORAL anticoagulants as they may increase the effect.
Hepatotoxicity with barbiturates, carbamazepine, hydantoins or rifampin.
54
What is the antidote for acetaminophen overdose?
Acetylcysteine
55
What nursing assessments should we be doing prior to giving NSAID's and Acetaminophen?
Assess for contraindications or cautions such as kidney and liver failure.
Assess for presence of any skin lesions;
temperature; orientation, reflexes, and
affect; pulse, blood pressure, and perfusion;
respirations and adventitious sounds; liver evaluation; bowel sounds
Monitor CBC, liver and renal function tests, urinalysis, stool guaiac, and serum electrolytes.
56
Why do we give patient's Anti-arthritis agents?
To prevent and suppress arthritis in selected patients with rheumatoid arthritis.
They can potentially debilitate inflammatory processes.
57
What is the indication for using Auranofin?
Rheumatoid Arthritis.
58
What is the drug we need to know for Gold Compounds?
Auranofin
59
When would we use Auranofin?
When other medications have not been effective. Gold salts are very toxic and needs to be used very carefully.
60
How does Auranofin work on the body?
It is absorbed by macrophages, which results in inhibition of phagocytosis.
Tissue destruction is decreased., but it cannot repair already damaged tissue.
61
Which patients/diseases should we NOT give Auranofin to?
Allergy
* Patients with diabetes,
* CHF, renal or hepatic impairment (due to the toxicity of Auranofin)
* blood dyscrasias (May be exacerbated)
* pregnancy and lactation.
62
What are some known adverse reactions to Auranofin/Gold Compounds?
All adverse effects are related to the fact that although Gold Salts are given to reduce inflammation with autoimmune conditions, they may also provoke and inappropriate immune response leading to inflammation of other tissues. The reaction may be so severe that it leads to anaphylactic shock.
* Stomatitis,
* Glossitis Gingivitis,
* bone marrow depression, (toxicity of the drug)
* dermatitis,
* interstitial pneumonitis
* anaphylactic shock.
63
Are there any known drug-drug interactions to Auranofin, and if so, what are they?
Yes, Penicillamine, Antimalarials, cytotoxic drugs and immunosuppressive agents increases the likelihood of severe toxicity.
64
Why are Disease Modifying Antirheumatic Drugs (DMARD's) used?
When treating arthritis that aggressively affect the process of inflammation.
Used in early diagnosis before joint damage has occurred.
65
What are the drug names that we need to know for TNF blockers?
Adalimumab
Etanercept - receptor fusion protein
Infliximab
66
DMARD's side effects may be life threatening.
TRUE/FALSE
TRUE
DMARDs suppress the body's ability to fight off an infection.
67
How does TNF blockers work?
They decrease the local effects of the TNF which is a locally released cytokine that causes the death of tumor cells and stimulate a wide range of proinflammatory activities.
68
Why do we give TNF blockers?
We give it to treat Rheumatoid arthritis, polyarticular juvenile arthritis, psoriatic arthritis, plaque psoriasis and ankylosing spondylitis.
69
which patients/conditions should we not give TNF blockers to?
The contraindication's are the same as for the Monoclonal antibodies due to these drugs being the same :
Acute infections -increased risk of infections
cancer : due to the anti tumor necrosis factor which would increase the tumor.
sepsis,
TB,
Hepatitis,
myelosuppression (bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets) - this would worsen.
or demyelinating disorders (neurological conditions that damage the myelin sheath that surrounds nerve fibers)
70
Which patients should we exhibit caution when administering TNF blockers to?
Pregnant and lactating patients and patients suffering from hepatic and renal disorders.
71
What are some adverse effects of TNF blockers?
BB warning: serious to fatal infections and the developement of lymphomas and other cancers.
Injection site irritation
72
Are there any drug-drug interactions to TNF blockers and if so, what are they?
Immune suppressant drugs and live vaccines.
73
What should we be assessing before giving patients DMARD's?
Assess for contraindications or cautions
Perform physical assessment
Assess lesions, temperature, any sign of infection
Evaluate CNS status—orientation, reflexes, eighth cranial nerve function, and affect
Arrange for required cancer screening
Monitor range of motion, movement, and pain levels (to check effectiveness)
Evaluate respirations and adventitious sounds
Monitor CBC, liver and renal function tests, and TB test
74
What nursing diagnosis can be made prior to giving patients DMARD's?
Acute pain related to CNS, disease process.
Infection risk related to drug effects.
Fear/anxiety risk related to disease process and drug effects.
Knowledge deficit risk regarding drug therapy.
75
What implementations should we be prepared to make when giving patients DMARD's?
Teach patient proper preparation, administration of subcutaneous injections, and safe disposal of needles and syringes.
Monitor for immune suppression reactions.
Monitor for CNS toxicity.
Arrange for continuation of nondrug therapies.
Ensure that the patient has routine cancer screening and regular follow-up.
Provide thorough patient teaching.
76
What is Gout and how is it characterized?
Gout is characterized by elevated uric acid and urate crystal deposits in kidneys and joints. It is very painful due to the local inflammation caused by the crystal deposits.
77
What are the drug classes we need to know for Antigout agents?
Allopurinol & Colchicine
78
How does Antigout agents work?
By decreasing inflammation by blocking the action of neutrophils (colchicine).
Inhibits xanthine oxidase, and enzyme needed to convert xanthine to uric acid (Allopurinol)
79
What patients should we not give antigout agents to?
Allergy / hypersensitivity
80
What patient should we be cautious with giving antigout agents to?
Patients with severe renal and hepatic diseases.
81
What are some adverse effects of Antigout agents?
GI distress - take with food.
Hepatic and renal dysfunction
Blood dyscrasias & Rhabdomyolysis (colchicine)
82
There are numerous drug-drug interactions with antigout agents.
TRUE/FALSE
True
For example Allopurinol may increase the effect or Warfarin.
83
What does Mesalamine treat and which drug category does it belong to?
Mesalamine treats inflammation of the large intestine and it is a Salicylate.
84
How does Salicylates effect the blood?
They cause a blood thinning effect.
85
What gives Salicylates their pain and fever reduction abilities?
Their interruption to prostaglandin production.
86
what causes Salicylsism?
Over dose of Asprin. May lead to nausea, dizziness, vomiting, fever
87
What are the most severe effect with Salicylate toxicity?
Pulmonary edema, convulsions, coma, tachycardia, dehydration and cardiovascular, renal and respiratory failure that may result in death.
88
Which NSAID is used to treat pain related to joint stiffness and arthritis?
Celecoxib.
89
What is classified as chronic NSAID use?
using NSAIDs daily for 3 or more months.
90
which anti-arthritis medications only prevents further damage on the tissue and cannot repair arthritis damage?
Auranofin (Gold Compound)
91
Which type of drug increases the risk of cancer?
TNF blockers.
92
Which two drug classes should not be given to children who are suffering from chickenpox or the flu?
Aspirin & Mesalamine which are both Salicylates
93
What condition may cause ringing ears?
Salicylism
