Lilley Chapter 49: Anti-inflammatory and Antigout Drugs Flashcards
What is the mechanism of action of nonsteroidal anti-inflammatory drugs (NSAIDs)?
A. Enhancing pain perception
B. Increasing the supply of natural endorphins
C. Increasing blood flow to painful areas
D. Inhibiting prostaglandin production
D. Inhibiting prostaglandin production
Prostaglandins are produced in response to activation of the arachidonic pathway. NSAIDs work by blocking cyclo-oxygenase (as COX-1 and COX-2), the enzyme responsible for the conversion of arachidonic acid into prostaglandins. Decreasing the synthesis of prostaglandins results in decreased pain and inflammation.
When teaching a patient about the potential adverse effects of NSAID therapy, the nurse will teach the patient to immediately notify the health care provider about which effect?
A. Mild indigestion
B. Nonproductive cough
C. Diarrhea
D. Black, tarry stools
D. Black, tarry stools
A major adverse effect of NSAID therapy is gastrointestinal (GI) distress with potential GI bleeding. Black or tarry stools are indicative of a GI bleed.
The nurse is administering probenecid to a patient with recurrent strep throat. The nurse teaches the patient that the most likely reason for taking this medication is to
A. inhibit bacterial growth and replication.
B. prevent the occurrence of gout.
C. prolong the effectiveness of penicillin therapy.
D. increase uric acid excretion.
C. prolong the effectiveness of penicillin therapy.
Besides being used for the treatment of the hyperuricemia associated with gout and gouty arthritis, probenecid is also used for its ability to delay the renal excretion of penicillin, thus increasing serum levels of penicillin and prolonging its effect.
What is advantage of COX-2 inhibitors over other NSAIDs?
A. They have a more rapid onset of action.
B. They maintain GI mucosa.
C. They are less likely to cause hepatic toxicity.
D. They have a longer duration of action.
B. They maintain GI mucosa.
By not inhibiting the COX-1 enzyme to maintain an intact gastric mucosal barrier by increasing the secretion of mucus, the risks of GI adverse effects are decreased.
The patient asks the nurse about the use of herbal and dietary supplements to treat arthritis pain. What is the nurse’s best response?
A. “Ginkgo biloba has shown tremendous benefit as an anti-inflammatory drug and is used to treat the symptoms of pain.”
B. “There really are no safe herbal treatments for pain. Your best action would be to take your prescription medications.”
C. “There is evidence that glucosamine sulphate with chondroitin does decrease joint stiffness and pain. Discuss this with your health care provider.”
D. “High doses of vitamins and minerals have been used for many years to help maintain joint health.”
C. “There is evidence that glucosamine sulphate with chondroitin does decrease joint stiffness and pain. Discuss this with your health care provider.”
There is evidence that patients would benefit from glucosamine and chondroitin supplements to decrease the pain of osteoarthritis. However, they should always be used in consultation with a health care provider.
Colchicine exerts its therapeutic effect by what action?
A. Increasing the production of lactic acid
B. Increasing uric acid metabolism
C. Decreasing the mobility of leukocytes
D. Increasing the process of phagocytosis
C. Decreasing the mobility of leukocytes
Colchicine works by inhibiting the metabolism and migration of leukocytes into joints affected by gout, thus resulting in decreased inflammation.
Which nursing diagnosis is appropriate for a patient who has been prescribed colchicine?
A. Risk for infection related to medication-induced leukocytosis
B. Risk for fluid volume deficiency related to nausea, vomiting, and diarrhea
C. Risk for injury related to the adverse effect of life-threatening seizures
D. Constipation related to an adverse effect of the medication
B. Risk for fluid volume deficiency related to nausea, vomiting, and diarrhea
Colchicine is administered on an hourly basis until pain is relieved or until nausea, vomiting, or diarrhea develops. Bleeding into the GI or urinary tracts is a potential serious adverse effect of colchicine.
A nurse teaching a patient who is receiving allopurinol (Zyloprim®) should give the patient which of the following instructions for taking the medication??
A. “Include salmon and organ meats in your diet on a weekly basis.”
B. “Increase your fluid intake to three litres per day.”
C. “Take the medication with an antacid to minimize gastrointestinal distress.”
D. “This medication may cause your urine to turn orange.”
B. “Increase your fluid intake to three litres per day.”
Patients taking allopurinol should be told to increase their fluid intake to 3 L per day, avoid hazardous activities if dizziness or drowsiness occurs with the medication, and avoid the use of alcohol and caffeine, because these drugs will increase uric acid levels and decrease the levels of allopurinol.
The nurse would question a prescription to administer NSAIDs to a patient with which condition?
A. Nursing mothers
B. Gastroesophageal reflux disease
C. Peptic ulcer
D. Chronic obstructive pulmonary disease
A. Nursing mothers
These drugs are also not recommended for nursing mothers because they are known to be excreted into human milk.
The nurse should question a prescription to administer acetylsalicylic acid (aspirin) to which patient?
A. A 62-year-old patient with a history of stroke
B. A 14-year-old patient with a history of flulike symptoms
C. A 28-year-old patient with a history of sports injury
D. A 45-year-old patient with a history of heart attack
B. A 14-year-old patient with a history of flulike symptoms
Aspirin should never be administered to children with flulike symptoms. The use of aspirin for children with flulike symptoms has been associated with Reye’s syndrome.
Which NSAID would the nurse anticipate administering parenterally for the treatment of acute postoperative pain?
A. ketorolac (Toradol®)
B. indomethacin (Indocid P.D.A.®)
C. diclofenac
D. allopurinol (Zyloprim)
A. ketorolac (Toradol®)
Ketorolac can be administered by injection (intramuscularly or intravenously) and is indicated for the short-term treatment of moderate to severe acute pain.
