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343 Pharm Exam 5 > Chapter 24 : Anti-inflammatories > Flashcards

Chapter 24 : Anti-inflammatories Flashcards

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1
Q

What is the function is anti-inflammatory?

A

Treat with inflammation

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2
Q

Inflammation is a what?

A

Symptom
- not a problem

Cause needs to be identified and treated

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3
Q

Cardinal signs of inflammation? (5)

A

Redness
Swelling
Heat
Pain
Loss of function

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4
Q

Sometimes you don’t wanna treat a fever why?

A

Because it’s the way the body is trying to fight an infection

Depends on the situation
Don’t usually treat unless it’s over 100

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5
Q

What is the COX, cycloozygnase enzyme 1 and 2?

A

1 : protects stomach lining and regulates blood platelets

2 : triggers inflammation and pain

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6
Q

There is a group of anti-inflammatory medication that is COX-2 inhibitor, which does what?

A

Stops the cox-2 trigger that inflammation causes

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7
Q

However most NSAIDS, effect both cox enzymes, which is why a side effect of all NSAIDs is?

A

GI bleeding & ulcers

Because it’s stopping that protecting of stomach lining and regulates blood platelets from cox 1

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8
Q

Usually older people benefits from cox-2 inhibitors why?

A

Because they are weaker

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9
Q

What are the 5 anti-inflammatory drug groups?

A

NSAIDS
CORTICOSTEROIDS
DISEASE-MODIFYING ANTIRHEUMATIC DRUGS
Immunodulators
ANTIGOUT DRUGS

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10
Q

NSAIDS

A
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11
Q

What is the action of NSAIDS?

A

So when we are in pain, prostaglandins are produced

So NSAIDS stop prostaglandins being produced and relive the pain

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12
Q

NSAIDS also inhibit platelet aggregation, meaning what?

A

Increase risk of bleeding, mainly GI bleeding

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13
Q

NSAIDS suppress your immune system? Yes or no?

A

No

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14
Q

If someone is allergic to one NSAID, at time they can what?

A

Take an NSAID different class

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15
Q

First generation NSAID
Salicylates
What medication?

A

Aspirin ( acetylsalicylic acid ) ASA

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16
Q

What is the 3 action of aspirin?

A

Anti inflammatory
Anti platelets
Anti pyretic effects

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17
Q

Is ASPRIN highly protein bound?

A

Yes

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18
Q

Caution with aspirin??

A

Do not take with other NSAIDS!!

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19
Q

Why do we not give aspirin to children with flu or virus symptoms?

A

Because it can lead to reye syndrome

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20
Q

Why do we not give aspirin to last trimester pregnancy in woman?

A

Because of the bleeding, the post partum hemorrhage

It’s not gonna cause birth effects, baby is already developed
However labor is still needed, so bleeding will be a lot

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21
Q

What is a toxic serum salicylate level?

A

Greater than 300MCG/ML

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22
Q

What are the 4 toxic serum salicylate level side effects?

A

Tinnitus
Dizziness
Headache
Excessive sweating

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23
Q

Every single class have you talked about digoxin, oral anti fungal, warfain

These drugs interact with a lot of other drugs, protein bound!!!

So we need to what?

A

Watch out for toxic levels

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24
Q

You’re more likely to be allergic to aspirin when you have what?

A

Nasal polyps
Asthma

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25
Salicylates drug interactions Increase bleeding with __ Risk for ____ with antidiabetics Increase ____with glucocorticoids Decrease effects of (2) Should not be used with other NSAJD why?
Anticoagulants & NSAIDS hypoglycemic Gastric ulcer Ace inhibitors/loop diuretic Because it decreases effectiveness
26
Usually we want patients to avoid these foods because they contain salicylates?
Prunes Raisins Licorice Certain spices such as curry & paprika
27
What are your 5 adverse side effects of salicylates, aspirin?
GI distress Ulceration Tinnitus Hearing loss Reye syndrome
28
Clinical judgment : salicylates Concept - inflammation Recognize cues - determine patients medical history - obtain a drug history Analyze cues & priortize hypothesis - acute pain, injury, nausea Generate solutions - the patient swelling and redness will be reduced within 1 week
29
Clinical judgment part 2 salicyaltes Take action - monitor serum salicylate level - observe the patient for evidence of bleeding - advise patient not to take aspirin with alcohol or warfarin to prevent increased bleeding - instruct patient to discontinue aspirin approximately 7 days before surgery to reduce risk of bleeding - warn parents not to give aspirin for virus or flu symptoms to children to avoid risk of Reye syndrome - educate parents to call the poison control center immediately if a child has taken a large or unknown amount of aspirin - inform patient that aspirin tablets can cause GI distress Evaluate outcomes
30
Classes of NSAIDS Para-chlorobenzoic acid derivatives, or indoles Propionic acid derivatives Fenamates Oxicans Selective COX-2 inhibitors
31
Indomethacin( usually pain from gout) 99% protein bound What are the 3 things we need to know from this medication?
Sodium retention Water retention Hypertension So look like kidney, blood pressure and sodium levels
32
Propionic acid derivates Ibuprofen
33
NSAIDS interactions Anticoagulants - warfarin Aspirin Corticosteroids & ulcers Protein bound drugs Diuretics and ACE inhibitors Increase risk of lithium toxicity Hypoglycemia possible with anti-diabetic medication
34
If a patient is taking metformin and they are also on an NSAID, what do we tell them?
Well their more likely to get hypoglycemia Carry a snack Check their blood sugar Decrease NSAID medication
35
What are your big side effects of GI of NSAIDS? (2)
GI bleeding! ( dark tarry stools, coffee ground emesis, bleeding gums, easy bruising ) Mucosal lesions ( erosions or ulcerations )
36
What are your big side effects of NSAIDS for renal?
Reduction in creatinine clearance Acute tubular necrosis with renal failure
37
What are your big side effects of cardiovascular ?
Noncardiogenic pulmonary edema Which means your lungs fill up with fluid not because your heart isn’t working
38
NSAIDS contraindications Cross sensitive to other NSAIDS Increase risk of Ulcer over age 65 Use cautiously if there are bleeding disorders present, renal disease, cardiovascular disease, liver disease Contraindicated in third trimester and lactation Should be stopped one week before elective surgery
39
What does NSAIDS have?
A black box warning
40
What is a black box warning mean?
Super serious and can kill you
41
What is the black Box warning for NSAIDS for cardiovascular issues? DONT over think it
Fetal cardiac events Thrombotic events Risk increase duration of treatment Pre existing cardiac disease are higher
42
What are your GI black box warning for NSAIDS?
Increase GI bleeding Occur any time and without warning Elderly are higher risk
43
NSAIDS ARE BAD FOR YOUR WHAT??
KIDENYS!’ NEPHROTOXIC!!
44
Corticosteroids
45
What is the action of corticosteroids?
Control inflammation by suppressing or preventing many of the components of the inflammatory process at the injuries site
46
How would we tell patients to discontinue the use of corticosteroids?
Slowly taper off for 5-10 days Because our body becomes lazy in helping us make steroids
47
What are the side effects of steroids?
Growth suppression Osteoporosis Ulcers Hypertension
48
Disease-modifying antirheumatic drugs ( DMARDS )
49
DMARDS are used for?
Autoimmune disease Or like rheumatoid arthritis
50
Side effects of DMARD? (3)
Suppression of the immune system ( increase risk of being sick ) Hypertension Gi distress
51
Immunomodulators
52
What is the action of immunomodulators?
Block tumor necrosis factor
53
So if it’s blocking the tumor necrosis factor, what do you think immunomodulators put you at risk for?
Cancer Since our body is using this TNF to kill off cancerous cell
54
Side effects of immunomodulators?
Severe infections Hypo-hypertensive Chest pain Pulmonary edema Life threatening Bronchopspams Blood dyscrasias Hepatitoxicity
55
Gout !
56
What is gout?
Uric acid accumulation usually in the great toe/joint Usually causing redness Inflammatory disease of joints, tendon and other tissue
57
There is a low purine diet usually is what we tell patients to follow with gout is what?
Organ meats Sardines Salmon Gravy Herring Liver Meat soups Alcohol ( especially beer )
58
What is the medication for gout?
Colchicine
59
What are the side effects of colchicine?
Gi distress ( nausea, vomit, diarrhea, abdominal pain )
60
Colchicine is taken with what to avoid gi distress?
Food
61
What are contraindictions of colchicine? (3)
Severe Renal Cardiac GI problems
62
For people who have frequent symptoms of gout or is having gout usually we put them on a medication called?
Xanthine Oxidase Inhibitors ( allopurinol )
63
What is the function of allopurinol?
Decrease the uric acid production And increase the uric acid excretion To prevent gout attacks
64
Allopurinol also prevents what syndrome too? Other than gout
Acute tumor lysis syndrome ( chemo is suppose to kill cancer cells, when the cancer is being killed really well, they release so much uric acid, that’s what it is ) 10% survival Put you on dialysis right away When you have cancer, we usually hang a bag of fluid of allopurinol helps out with it
65
Usually allopurinol is taken for how long?
6-9months
66
Side effects of allopurinol?
Usually tolerated pretty well Dizziness Hyperglycemia Bradycardia GI distress Headache
67
Clinical judgment of allopurinol Concept Inflammation Recognize cues Assess serum uric acid value for future comparisons Analyze cues and prioritize hypothesis Acute pain Generation solutions Patient will report that pain level has decreased
68
We want patients who are on allopurionol to have what 3 tests?
Eye exams yearly Labs for renal(kidney) hepatic (liver ) Functions
69
Practice question 1 A patient has been advised to take ibuprofen. When teaching the patient about ibuprofen, which instruction should the nurse include? Select all that apply. A. Avoid taking aspirin with ibuprofen B. Taken with food to reduce GI upset C. Monitor for bleeding gum, nosebleeds, black tarry stools D. Take herbs, ginko and garlic with ibuprofen E. Take NSAIDS 2 days before menstruation to decrease discomfort
A. Avoid taking aspirin with ibuprofen B. Taken with food to reduce GI upset C. Monitor for bleeding gum, nosebleeds, black tarry stools
70
Practice question 2 Which of the following drugs should the nurse anticipate to help given to a 65- year old man who has been diagnosed with chronic gout? A. Allopurinol B. Colchicine C. Adalimumab D. Influximab
A. Allopurinol

343 Pharm Exam 5 (7 decks)

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