Ch. 25 - Antiinflammatory Drugs Flashcards Preview

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Flashcards in Ch. 25 - Antiinflammatory Drugs Deck (64):
1

Inflammation

1.) Response to tissue injury & infection
2.) Vascular reaction
3.) Protective mechanism

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Infection:

caused by microorganisms --> inflammation

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5 Characteristics of Inflammation:

1.) Erythema
2.) Edema
3.) Heat
4.) Pain
5.) Loss of function

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Prostaglandins:

1.) Released when cellular injury takes place
2.) Injection of prostaglandins into body --> inflammatory process

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Cyclooxygenase (COX):

COX1 = protects stomach lining & regulates platelets

COX2 = triggers inflammation & pain

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Antiinflammatory Agents:

-Nonsteriodal agents
-Steroidal agents

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Nonsteriodal Antiinflammatory Drugs (NSAIDS):

Aspirin

-Aspirin like drugs --> inhibit COX2 enzyme

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Nonsteriodal Antiinflammatory Drugs (NSAIDS): cont...

Salicylates & Nonsalicylates
1st generation NSAIDs
2nd generation NSAIDs (COX2 inhibitors)

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Salicylates (ASA):

Strong prostaglandin inhibitor
---> reduces inflammatory process

Inhibits prostaglandin synthesis
---> COX1 & COX2 enzymes

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Acetylsalicylic Acid (ASA) (1):

Antiplatelet drug:
-Decrease platelet aggregation
-Decrease blood clotting

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Acetylsalicylic Acid (ASA) (2):

Low doses ---> analgesic, antipyretic effect

Higher doses ---> anti-inflammatory effect

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Acetylsalicylic Acid (ASA) (3):

Most common adverse effects:
1.) Gastric irritation
2.) Occult Bleeding

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Hypersensitivity to ASA

1.) Tinnitus
2.) Vertigo
3.) Bronchospasm

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Tx of Headache (HA) / Fever:

1.) ASA
2.) Acetaminophen
3.) Ibuprofen

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Tx of Inflammation / Swelling, Pain, Stiff Joints

NSAIDs = cost more than ASA

Contraindicted:
-allergic to ASA (asa is Aspirin)

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Over the Counter (OTC) NSAIDs:

1.) Ibuprofen (Motrin, Advil)
2.) Naproxen (Aleve)

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Rx Drugs that Contain NSAIDs :

*1st Generation ------------------*2ndGeneration
-meloxican (Mobic) ---------- celecoxib (Celebrex)
-naproxen (Naprosyn)
-nabumentone (Relafen)

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Nursing Process (ASA):

Observe for signs of bleeding:
1.) Dark Stools
2.) Bleeding Gums
3.) Petechiae
4.) Ecchymosis

Bleeding from an IV site

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Client Teaching (ASA) (1):

1.) DO NOT take with:
-Alcohol
-Anticoagulant Drugs

2.) Inform Dentist

3.) d/c 3-7 days before surgery

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Client Teaching (ASA) (2):

Do not give to children for virus/flu symptoms
- Reye Syndrome

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Client Teaching (ASA) (3):

4.) Take with:
-Food/meals
-Fluids

5.) Enteric coated

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Other NSAIDs (1):

indomethacin (Indocin):
1.) Po/ rectal
2.) Arthritis
3.) Strong prostaglandin inhibitor
4.) Highly protein bound
5.) Very irritating to stomach

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Other NSAIDs (2):

ketorolac (Toradol):
1.) IM / IV / po
2.) Greater analgesic properties
3.) Short-term pain relief
4.) Opiate level analgesia

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SE /Adverse Reactions (1st Generation NSAIDs):

1.) Fewer SE than ASA
2.) GI irrigation (take with food)
3.) Sodium & water retention
4.) Alcohol ---> increase gastric irritation

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Selective COX2 Inhibitors:

2nd Generation
**Drug of choice for severe arthritis

-Does not inhibit COX1
Ex: Celecoxib (Celebrex)

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Corticosteroids:

Steroid

Tx: inflammatory disorders
-Local
-Systemic

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Corticosteroids (1)

1.) Produced in adrenal cortex

2.) Anti-inflammatory properties (Glucocorticoid)

3.) Salt-retaining properties (Mineralcorticoid)

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Corticosteroids (2):

High doses / over long periods --->
-suppress hypothalamic pituitary adrenal hormone production

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Corticosteroids (3):

Glucocorticoid properties:
- alter CHO, protein, & lipid metabolism

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Corticosteroids (4):

Mineralcorticoid properties:
-Enhance reabsorption of sodium
-increase excretion of potassium & hydrogen ions ---> effects fluid / electrolyte

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Side Effects:

Fluid retention
Altered glucose levels
Altered fat disposition
*moon face* , buffalo hump

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Corticosteroids (5):

Long term use:
-Wasting of muscle tissue in extremities
-Delayed growth in children

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Corticosteroids (6):

-Prevent or suppress inflammatory signs & symptoms
*Underlying cause of S/S may still remain
*May mask disease S/S

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Corticosteroids (7):

Po, IM, IV, SQ, topical

-Adm DIRECTLY into inflamed site
Ex: joint, skin
*Avoid systemic side effects

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Examples:

1.) betamethasone (Celestone) = po, IM, IV

2.) dexamethasone (Decadron) = po

3.) Hydrocortisone (Cortef) = po, SQ, IM, IV

4.) Solu-cortef = (IM, IV)

5.) prednisone = po

6.) prednisolone = po, IM, IV

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Avoid Abrupt D/C of Drug --->

Adrenal insufficiency
-Fatal if untreated
-Medical Emergency

D/C drug gradually

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Corticosteroids^:

Protect from infection altered response to wound healing

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Nursing Dx:

Excess fluid volume r/t fluid rentention secondary to effect of corticosteroid

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Disease-Modifying Antirheumatic Drugs:

DMARDs
-Gold therapy = Chrysotherapy

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Gold Therapy (1):

Use:
1.) Stop progression of rheumatoid arthritis
2.) Prevents deformities

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Gold Therapy (2):

Action:
3.) Depress migration of leukocytes
4.) Suppress prostaglandins

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Gold Therapy (3):

Palliative = not curative

Results:
*may take up to mos (IV)
*may take 3-6mos (PO)

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auranofin (Ridaura):

Po, Gold sakt

Common SE:
1.) Skin Problems
2.) Blood Dyscarsias
3.) GI Irritation

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Nursing Process Health Teaching:

1.) Dental hygiene
2.) Adhere to scheduled blood tests
3.) Metallic taste / pruritus ---> early symptom of possible gold toxicity

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Nursing Process:

1.) Avoid direct sunlight
2.) Assess improvement in joint pain & motion

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Gout:

1.) Inflammatory condition
2.) Chronic metabolic disease --->
Hyperuricemia (abnormally elevated amounts of uric acid in blood

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Gout -- Hyperuricemia (1):

D/T:
1.) Decreases renal elimination of uric acid
2.) Increase uric acid production

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Gout -- Hyperuricemia (2):

3.) Uric acid precipitates as crystals (tophi) -->
4.) Deposit on tissues & joints --> gouty arthritis

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Gouty Arthritis (1):

1.) Inflammation at site of crystal deposits (tophi)

2.) Acte joint pain

3.) Most susceptible site ---> Metatarsophalangeal joint of great toe

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Gouty Arthritis (2):

1.) Metatarsal bone
2.) Phalanges

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Gouty Arthritis (3):

4.) Increase fluid intake --->
-Promotes uric acid excretion
-Prevents renal calculi

5.) Avoid foods high in purine
-alcohol

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Anti-inflammatory Gout Drugs:

Colchine:
1.) Inhibits migration of leukocytes to inflamed site
2.) Alleviates acute symptoms
-take at first sign of attack

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Colchicine (1):

DOES NOT:
1.) Inhibit uric acid synthesis
2.) Promote uric acid excretion

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Colchicine (2):

Common SE = gastric irritation

High doses = n/v, diarrhea, abdominal pain

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Management:

After acute attack is over:
1.) Begin therapy to control hyperuricemia
2.) Reduce serum urate levels to

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Uric Acid Inhibitor:

allopurinol (Zyloprim)
- Prevents formation of uric acid in body

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allopurinol (Zyloprim) (1):

1.) Interferes w/ conversion of purines to uric acid ----->
2.) Inhibits enzyme xanthine oxidase ---->
3.) Good for clients w/ renal obstruction d/t uric acid secretions

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allopurinol (Zyloprim) (2):

4.) Prevents attack
5.) Increase fluid intake ---> promote diuresis & alkalization of urine

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Uricosurics:

probenecid (Benemid)
*Increases urinary excretion of uric acid
*Prevents reabsorption in renal tubules

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probenecid (Benemid):

1.) Initially increases concentration of uric acid in urine ----> @ risk: KIDNEY STONES

2.) Drink large amounts of water

3.) ASA decreases the effect of probenecid

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Nursing Process -- Nsg Dx:

Impaired skin integrity r/t inflammation of great toe

Acute pain r/t tissue swelling

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Client Teaching (1):

1.) Initiate tx at first sign of attack
2.) Avoid certain foods
3.) Encourage fluids
4.) DO NOT use ASA while taking probenecid

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Client Teaching (2):

allopurinol (Zyloprim)
*Monitor lab tests = renal, liver function, CBC

64

Client Teaching:

Annual eye exams

Report:
-Anorexia, n/v, diarrhea, stomatitis
-Dizziness, rash, pruritis, metallic taste