Ch. 25 - Antiinflammatory Drugs Flashcards
(64 cards)
1
Q
Inflammation
A
- ) Response to tissue injury & infection
- ) Vascular reaction
- ) Protective mechanism
2
Q
Infection:
A
caused by microorganisms –> inflammation
3
Q
5 Characteristics of Inflammation:
A
- ) Erythema
- ) Edema
- ) Heat
- ) Pain
- ) Loss of function
4
Q
Prostaglandins:
A
- ) Released when cellular injury takes place
2. ) Injection of prostaglandins into body –> inflammatory process
5
Q
Cyclooxygenase (COX):
A
COX1 = protects stomach lining & regulates platelets
COX2 = triggers inflammation & pain
6
Q
Antiinflammatory Agents:
A
- Nonsteriodal agents
- Steroidal agents
7
Q
Nonsteriodal Antiinflammatory Drugs (NSAIDS):
A
Aspirin
-Aspirin like drugs –> inhibit COX2 enzyme
8
Q
Nonsteriodal Antiinflammatory Drugs (NSAIDS): cont…
A
Salicylates & Nonsalicylates
1st generation NSAIDs
2nd generation NSAIDs (COX2 inhibitors)
9
Q
Salicylates (ASA):
A
Strong prostaglandin inhibitor
—> reduces inflammatory process
Inhibits prostaglandin synthesis
—> COX1 & COX2 enzymes
10
Q
Acetylsalicylic Acid (ASA) (1):
A
Antiplatelet drug:
- Decrease platelet aggregation
- Decrease blood clotting
11
Q
Acetylsalicylic Acid (ASA) (2):
A
Low doses —> analgesic, antipyretic effect
Higher doses —> anti-inflammatory effect
12
Q
Acetylsalicylic Acid (ASA) (3):
A
Most common adverse effects:
1. ) Gastric irritation 2. ) Occult Bleeding
13
Q
Hypersensitivity to ASA
A
- ) Tinnitus
- ) Vertigo
- ) Bronchospasm
14
Q
Tx of Headache (HA) / Fever:
A
- ) ASA
- ) Acetaminophen
- ) Ibuprofen
15
Q
Tx of Inflammation / Swelling, Pain, Stiff Joints
A
NSAIDs = cost more than ASA
Contraindicted:
-allergic to ASA (asa is Aspirin)
16
Q
Over the Counter (OTC) NSAIDs:
A
- ) Ibuprofen (Motrin, Advil)
2. ) Naproxen (Aleve)
17
Q
Rx Drugs that Contain NSAIDs :
A
- 1st Generation ——————*2ndGeneration
- meloxican (Mobic) ———- celecoxib (Celebrex)
- naproxen (Naprosyn)
- nabumentone (Relafen)
18
Q
Nursing Process (ASA):
A
Observe for signs of bleeding:
1. ) Dark Stools 2. ) Bleeding Gums 3. ) Petechiae 4. ) Ecchymosis
Bleeding from an IV site
19
Q
Client Teaching (ASA) (1):
A
- ) DO NOT take with:
- Alcohol
- Anticoagulant Drugs
- ) Inform Dentist
- ) d/c 3-7 days before surgery
20
Q
Client Teaching (ASA) (2):
A
Do not give to children for virus/flu symptoms
- Reye Syndrome
21
Q
Client Teaching (ASA) (3):
A
- ) Take with:
- Food/meals
- Fluids
5.) Enteric coated
22
Q
Other NSAIDs (1):
A
indomethacin (Indocin):
- ) Po/ rectal
- ) Arthritis
- ) Strong prostaglandin inhibitor
- ) Highly protein bound
- ) Very irritating to stomach
23
Q
Other NSAIDs (2):
A
ketorolac (Toradol):
- ) IM / IV / po
- ) Greater analgesic properties
- ) Short-term pain relief
- ) Opiate level analgesia
24
Q
SE /Adverse Reactions (1st Generation NSAIDs):
A
- ) Fewer SE than ASA
- ) GI irrigation (take with food)
- ) Sodium & water retention
- ) Alcohol —> increase gastric irritation
25
Selective COX2 Inhibitors:
2nd Generation
**Drug of choice for severe arthritis
-Does not inhibit COX1
Ex: Celecoxib (Celebrex)
26
Corticosteroids:
Steroid
Tx: inflammatory disorders
- Local
- Systemic
27
Corticosteroids (1)
1. ) Produced in adrenal cortex
2. ) Anti-inflammatory properties (Glucocorticoid)
3. ) Salt-retaining properties (Mineralcorticoid)
28
Corticosteroids (2):
High doses / over long periods --->
| -suppress hypothalamic pituitary adrenal hormone production
29
Corticosteroids (3):
Glucocorticoid properties:
| - alter CHO, protein, & lipid metabolism
30
Corticosteroids (4):
Mineralcorticoid properties:
- Enhance reabsorption of sodium
- increase excretion of potassium & hydrogen ions ---> effects fluid / electrolyte
31
Side Effects:
Fluid retention
Altered glucose levels
Altered fat disposition
*moon face* , buffalo hump
32
Corticosteroids (5):
Long term use:
- Wasting of muscle tissue in extremities
- Delayed growth in children
33
Corticosteroids (6):
- Prevent or suppress inflammatory signs & symptoms
* Underlying cause of S/S may still remain
* May mask disease S/S
34
Corticosteroids (7):
Po, IM, IV, SQ, topical
-Adm DIRECTLY into inflamed site
Ex: joint, skin
*Avoid systemic side effects
35
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
36
Avoid Abrupt D/C of Drug --->
Adrenal insufficiency
- Fatal if untreated
- Medical Emergency
D/C drug gradually
37
Corticosteroids^:
Protect from infection altered response to wound healing
38
Nursing Dx:
Excess fluid volume r/t fluid rentention secondary to effect of corticosteroid
39
Disease-Modifying Antirheumatic Drugs:
DMARDs
| -Gold therapy = Chrysotherapy
40
Gold Therapy (1):
Use:
1. ) Stop progression of rheumatoid arthritis
2. ) Prevents deformities
41
Gold Therapy (2):
Action:
3. ) Depress migration of leukocytes
4. ) Suppress prostaglandins
42
Gold Therapy (3):
Palliative = not curative
Results:
* may take up to mos (IV)
* may take 3-6mos (PO)
43
auranofin (Ridaura):
Po, Gold sakt
Common SE:
1. ) Skin Problems
2. ) Blood Dyscarsias
3. ) GI Irritation
44
Nursing Process Health Teaching:
1. ) Dental hygiene
2. ) Adhere to scheduled blood tests
3. ) Metallic taste / pruritus ---> early symptom of possible gold toxicity
45
Nursing Process:
1. ) Avoid direct sunlight
| 2. ) Assess improvement in joint pain & motion
46
Gout:
1.) Inflammatory condition
2.) Chronic metabolic disease --->
Hyperuricemia (abnormally elevated amounts of uric acid in blood
47
Gout -- Hyperuricemia (1):
D/T:
1. ) Decreases renal elimination of uric acid
2. ) Increase uric acid production
48
Gout -- Hyperuricemia (2):
3. ) Uric acid precipitates as crystals (tophi) -->
| 4. ) Deposit on tissues & joints --> gouty arthritis
49
Gouty Arthritis (1):
1. ) Inflammation at site of crystal deposits (tophi)
2. ) Acte joint pain
3. ) Most susceptible site ---> Metatarsophalangeal joint of great toe
50
Gouty Arthritis (2):
1. ) Metatarsal bone
| 2. ) Phalanges
51
Gouty Arthritis (3):
4. ) Increase fluid intake --->
- Promotes uric acid excretion
- Prevents renal calculi
5. ) Avoid foods high in purine
- alcohol
52
Anti-inflammatory Gout Drugs:
Colchine:
1. ) Inhibits migration of leukocytes to inflamed site
2. ) Alleviates acute symptoms
- take at first sign of attack
53
Colchicine (1):
DOES NOT:
1. ) Inhibit uric acid synthesis
2. ) Promote uric acid excretion
54
Colchicine (2):
Common SE = gastric irritation
High doses = n/v, diarrhea, abdominal pain
55
Management:
After acute attack is over:
1. ) Begin therapy to control hyperuricemia
2. ) Reduce serum urate levels to
56
Uric Acid Inhibitor:
allopurinol (Zyloprim)
| - Prevents formation of uric acid in body
57
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
58
allopurinol (Zyloprim) (2):
4. ) Prevents attack
| 5. ) Increase fluid intake ---> promote diuresis & alkalization of urine
59
Uricosurics:
probenecid (Benemid)
* Increases urinary excretion of uric acid
* Prevents reabsorption in renal tubules
60
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
61
Nursing Process -- Nsg Dx:
Impaired skin integrity r/t inflammation of great toe
Acute pain r/t tissue swelling
62
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
63
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
