Antiinflammatory and Antigout Drugs Flashcards Preview

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Flashcards in Antiinflammatory and Antigout Drugs Deck (44):
0

Allopurinol
(Functional Classification)

Antigout drug, antihyperuricemic

1

Allopurinol
(Chemical Classification)

Xanthene oxidase inhibitor

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Allopurinol
(Mechanism of Action)

Inhibits the enzyme xanthine oxidase, reducing uric acid synthesis

3

Allopurinol
(Uses)

Chronic gout, hyperuricemia associated with malignancies, recurrent calcium oxalate, calculi, uric acid calculi

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Allopurinol
(Contraindications)

Hypersensitivity

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Allopurinol
(Side Effects)

CNS: Headache, drowsiness, neuritis, paresthesia
EENT: retinopathy, cataracts, epistaxis
GI: Nausea, Vomiting, Anorexia, Malaise, metallic taste, cramps, peptic ulcer, diarrhea, stomatitis
HEMA: AGRANULOCYTOSIS, THROMBOCYTOPENIA, APLASTIC ANEMIA, PANCYTOPENIA, LEUKOPENIA, BONE MARROW SUPPRESSION, EOSINOPHILIA
INTEG: fever, chills, dermatitis, pruritus, purpura, erythema, ecchymosis, alopecia, rash, STEVENS-JOHNSON SYNDROME
MISC: myopathy, arthralgia, hepatomegaly, CHOLESTATIC JAUNDICE, RENAL FAILURE, EXFOLIATIVE DERMATITIS

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Allopurinol
(Nursing Considerations)

ASSESS:
-FOR GOUT: joint pain, swelling; may use with NSAIDs for acute gouty attacks; uric acid levels q2wk; uric acid levels should be -CBC, AST, BUN, creatinine before starting treatment, periodically
-I&O ratio; increase fluids to 2L/day to prevent stone formation and toxicity
-For rash, hypersensitivity reactions, discontinue allopurinol

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Aspirin
(Functional Classification)

Nonopioid Analgesic, Nonsteroidal Antiinflammatory, Antipyretic

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Aspirin
(Chemical Classification)

Salicylate

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Aspirin
(Mechanism of Action)

Blocks pain impulses in CNS, reduces inflammation by inhibition of prostaglandin synthesis; antipyretic action results from vasodilation of peripheral vessels; decreases platelet aggregation

10

Aspirin
(Uses)

Mild to moderate pain or fever including RA, osteoarthritis, thromboemolic disorders; TIAs, rheumatic fever, post MI, prophylaxis of MI, ischemic stroke, angina, acute MI

11

Aspirin
(Contraindications)

Pregnancy (D) 3rd trimester, breastfeeding, children <12yr, children with flulike symptoms, hypersensitivity to salicylates, tartrazine (FDC yellow dye #5), GI bleeding, bleeding disorders, vit K deficiency, peptic ulcer, acute bronchospasm, agranulocytosis, increased intracranial pressure, intracranial bleeding, nasal polyps, urticaria

12

Aspirin
(Side Effects)

CNS: stimulation, drowsiness, dizziness, confusion, SEIZURES, headache, flushing, hallucinations, COMA
CV: rapid pulse, pulmonary edema
EENT: tinnitus, hearing loss
ENDO: hypoglycemia, hyponatremia, hypokalemia
GI: Nausea, Vomiting, GI BLEEDING, diarrhea, heartburn, anorexia, HEPATITIS
HEMA: THROMBOCYTOPENIA, AGRANULOCYTOSIS, LEUKOPENIA, NEUTROPENIA, HEMOLYTIC ANEMIA, increased PT, aPTT, bleeding
INTEG: Rash, urticaria, bruising
RESP: wheezing, hyperpnea
SYST: REYE'S SYNDROME (CHILDREN), ANAPHYLAXIS, LARYNGEAL EDEMA

13

Aspirin
(Nursing Considerations)

ASSESS:
-PAIN: character, location, intensity; ROM before and 1hr after administration
-FEVER: temp before and 1hr after administration
-Hepatic studies: AST, ALT, bilirubin, creatinine if patient is receiving long-term therapy
-Renal studies: BUN, urine creatinine; I&O ratio; decreasing output may indicate renal failure (long-term therapy)
-Blood studies: CBC, Hct, Hgb, PT if patient is receiving long-term therapy
-HEPATOTOXICITY: dark urine, clay-colored stools, yellowing of skin, sclera, itching, abdominal pain, fever, diarrhea if patient is receiving long-term therapy
-ALLERGIC REACTIONS: rash, urticaria; if these occur, product may have to be discontinued; patients with asthma, nasal polyps, allergies: severe allergic reaction may occur
-OTOTOXICITY: tinnitus, ringing, roaring in ears; audiometric testing needed before, after long-term therapy
-SALICYLATE LEVEL: therapeutic level 150-300mcg/ml for chronic inflammation
-Edema in feet, ankles, legs
-Product history; many product interactions

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Aspirin
(Overdose Treatment)

Lavage, activated charcoal, monitor electrolytes, VS

15

Celecoxib (Celebrex)
(Functional Classification)

Nonsteroidal antiinflammatory, antirheumatic

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Celecoxib (Celebrex)
(Chemical Classification)

COX-2 inhibitor

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Celecoxib (Celebrex)
(Mechanism of Action)

Inhibits prostaglandin synthesis by selectively inhibiting cyclooxygenase-2 (COX-2), an enzyme needed for biosynthesis

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Celecoxib (Celebrex)
(Uses)

Acute, chronic rheumatoid arthritis, osteoarthritis, acute pain, primary dysmenorrhea, ankylosing spondylitis, juvenile rheumatoid arthritis (JRA)

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Celecoxib (Celebrex)
(Contraindications)

Pregnancy (D) 3rd trimester; hypersensitivity to salicylatesm iodides, other NSAIDs, sulfonamides, CABG

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Celecoxib (Celebrex)
(Side Effects)

CNS: Fatigue, Anxiety, Depression, Nervousness, Paresthesia, dizziness, insomnia
CV: STROKE, MI, TACHYCARDIA, CHF, angina, palpitations, dysrhythmias, hypertension, fluid retention
EENT: tinnitus, hearing loss, blurred vision, glaucoma, cataract, conjunctivitis, eye pain
GI: nausea, anorexia, vomiting, constipation, dry mouth, diverticulitis, gastritis, gastroenteritis, hemorrhoids, hiatal hernia, stomatitis, GI BLEEDING/ULCERATION
GU: NEPHROTOXICITY: Dysuria, HEMATURIA, OLIGURIA, AZOTEMIA, cystitis, UTI, RENAL PAPILLARY NECROSIS
HEMA: BLOOD DYSCRASIAS, epistaxis, bruising, anemia, PLATELET AGGREGATION
INTEG: SERIOUS (SOMETIMES FATAL) STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, purpura, rash, pruritus, sweating, erythema, petechiae, photosensitivity, alopecia
RESP: pharyngitis, SOB, pneumonia, coughing

21

Celecoxib (Celebrex)
(Nursing Considerations)

ASSESS:
-PAIN of rheumatoid arthritis, osteoarthritis; check ROM, inflammation of joints, characteristics of pain
-For cardiac disease that may be worse after taking product; MI, stroke; do not use with coronary artery bypass graft (CABG)
-CBC during therapy; watch for decreasing platelets; if low, therapy may need to be discontinued, restarted after hematologic recovery; LFTs, serum creatinine/BUN, stool guaiac
-For blood dyscrasias (thrombocytopenia): bruising, fatigue, bleeding, poor healing
-GI TOXICITY: black, tarry stools; abdominal pain
-SERIOUS SKIN DISORDERS: Stevens-Johnson syndrome, toxic epidermal necrolysis; may be fatal

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Ibuprofen
(Functional Classification)

Nonsteroidal antiinflammatory, antipyretic, nonopioid analgesics

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Ibuprofen
(Chemical Classification)

Propionic acid derivative

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Ibuprofen
(Mechanism of Action)

Inhibits COX-1, COX-2 by blocking arachidonate; analgesic, antiinflammatory, antipyretic

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Ibuprofen
(Uses)

Rheumatoid arthritis, osteoarthritis, primary dysmenorrhea, gout, dental pain, musculoskeletal disorders, fever, migraine

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Ibuprofen
(Contraindications)

Pregnancy (D) 3rd trimester; hypersensitivity to this product, NSAIDs, salicylates; asthma; severe renal/hepatic disease

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Ibuprofen
(Side Effects)

CNS: Headache, dizziness, drowsiness, fatigue, tremors, confusion, insomnia, anxiety, depression
CV: tachycardia, peripheral edema, palpitations, dysrhythmias, CV THROMBOTIC EVENTS, MI, STROKE
EENT: tinnitus, hearing loss, blurred vision
GI: nausea, Anorexia, vomiting, diarrhea, jaundice, HEPATITIS, constipation, flatulence, cramps, dry mouth, peptic ulcer, GI BLEEDING, ULCERATION, NECROTIZING ENTEROCOLITIS, GI PERFORATION
GU: NEPHROTOXICITY: dysuria, hematuria, oliguria, azotemia
HEMA: BLOOD DYSCRASIAS, increased bleeding time
INTEG: purpura, rash, pruritus, sweating, urticaria, NECROTIZING FASCIITIS
SYST: ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME

28

Ibuprofen
(Nursing Considerations)

ASSESS:
-Renal, hepatic, blood studies: BUN, creatinine, AST, ALT, Hgb, stool guaiac, before treatment, periodically thereafter
-PAIN: note type, duration, location, intensity with ROM 1hr after administration
-Audiometric, ophthalmic exam before, during, after long-term treatment; for eye, ear problems: blurred vision, tinnitus; may indicate toxicity
-INFECTION, may mask symptoms; fever: temp before 1hr after administration
-Cardiac status: edema (peripheral), tachycardia, palpitations; monitor BP, pulse for character, quality, rhythm, especially in patients with cardiac disease, geriatric patients
-For history of peptic ulcer disorder; asthma, aspirin, hypersensitivity; check closely for hypersensitivity reactions

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Ibuprofen
(Overdose Treatment)

Lavage, activated charcoal, induce diuresis

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Indomethacin (Indocin)
(Functional Classification)

Nonsteroidal antiinflammatory product (NSAID), antirheumatic

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Indomethacin (Indocin)
(Chemical Classification)

Propionic Acid Derivative

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Indomethacin (Indocin)
(Mechanism of Action)

Inhibits prostaglandin synthesis by decreasing enzyme needed for biosynthesis; analgesic, antiinflammatory, antipyretic

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Indomethacin (Indocin)
(Uses)

RA, ankylosing spondylitis, osteoarthritis, bursitis, tendinitis, acute gouty arthritis; closure of patent ductus arteriosus in premature infants (IV)

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Indomethacin (Indocin)
(Contraindications)

Pregnancy (D) 3rd trimester, neonates, aortic coarctation, bleeding salicylate/NSAID hypersensitivity, ulcer disease

35

Indomethacin (Indocin)
(Side Effects)

CNS: dizziness, drowsiness, fatigue, tremors, confusion, insomnia, anxiety, depression, Headache
CV: tachycardia, peripheral edema, palpitations, dysrhythmias, hypertension, CV THROMBOTIC EVENTS, MI, STROKE
EENT: tinnitus, hearing loss, blurred vision
GI: Nausea, anorexia, Vomiting, diarrhea, jaundice, CHOLESTATIC HEPATITIS, Constipation, flatulence, cramps, dry mouth, peptic ulcer, ULCERATION, PERFORATION, GI BLEEDING
GU: NEPHROTOXICITY: DYSURIA, HEMATURIA, OLIGURIA, AZOTEMIA
HEMA: BLOOD DYSCRASIAS, prolonged bleeding
INTEG: purpura, rash, pruritus, sweating

36

Indomethacin (Indocin)
(Nursing Considerations)

ASSESS
-Arthritis symptoms: ROM, pain, swelling before and 2hr after treatment
-Cardiac disease, CV, thrombotic events (MI, stroke) before administration
-Patent ductus arteriosus: respiratory rate, character, heart sounds
-Renal, hepatic, blood studies: BUN, creatinine, AST, ALT, Hgb before treatment, periodically thereafter; if renal function has decreased, do not give subsequent doses
-Eye/ear problems: blurred vision, tinnitus; may indicate toxicity; audiometric, ophthalmic exam before, during, after treatment if patient receiving long-term therapy
-Confusion, mood changes, hallucinations, especially among geriatric patients
-Asthma, nasal polyps, aspirin sensitivity, may develop hypersensitivity to indomethacin

37

Ketorolac (Toradol)
(Functional Classification)

Nonsteroidal antiinflammatory/nonopioid analgesic

38

Ketorolac (Toradol)
(Chemical Classification)

Acetic acid

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Ketorolac (Toradol)
(Mechanism of Action)

Inhibits prostaglandin synthesis by decreasing an enzyme needed for biosynthesis; analgesic, antiinflammatory, antipyretic effects

40

Ketorolac (Toradol)
(Uses)

Mild to moderate pain (short term); seasonal allergic conjunctivitis (ophthalmic)

41

Ketorolac (Toradol)
(Contraindications)

Pregnancy (D) 3rd trimester, hypersensitivity, asthma, hepatic disease, peptic ulcer disease, CV bleeding
Breastfeeding, severe renal disease, L&D, perioperative pain in CABG, prior to major surgery, epidural/intrathecal administration, GI bleeding, hypovolemia

42

Ketorolac (Toradol)
(Side Effects)

CNS: dizziness, Drowsiness, tremors, SEIZURES
CV: hypertension, flushing, syncope, pallor, edema, vasodilation, CV THROMBOTIC EVENTS, MI, STROKE
EENT: tinnitus, hearing loss, blurred vision
GI: nausea, anorexia, vomiting, diarrhea, constipation, flatulence, cramps, dry mouth, peptic ulcer, GI BLEEDING, PERFORATION, taste change, HEPATITIS, HEPATIC FAILURE
GU: NEPHROTOXICITY: DYSURIA, HEMATURIA, OLIGURIA, AZOTEMIA
HEMA: BLOOD DYSCRASIAS, prolonged bleeding
INTEG: purpura, rash, pruritus, sweating, ANGIEDEMA, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS

43

Ketorolac (Toradol)
(Nursing Considerations)

ASSESS:
-Aspirin sensitivity, asthma: patients may be more likely to develop hypersensitivity to NSAIDs; monitor for hypersensitivity
-Pain: type, location, intensity, ROM before and 1hr after treatment
-Renal, hepatic, blood studies: BUN, creatinine, AST, ALT, Hgb before treatment, periodically thereafter; check for dehydration
-Bleeding times; check for bruising, bleeding, occult blood in urine
-Eye/ear problems: blurred vision, tinnitus (may indicate toxicity)
-Hepatic dysfunction: jaundice, yellow sclera and skin, clay-color stool
-CV thrombotic events: MI, stroke
-Audiometric, ophthalmic exam before, during, after treatment