Week 2 chapter 18, 33, 48(47) Flashcards Preview

Pharmacology II: term 4 > Week 2 chapter 18, 33, 48(47) > Flashcards

Flashcards in Week 2 chapter 18, 33, 48(47) Deck (138):
1

Ch 18
Pain is a subjective experience in that patients may describe the same degree and type of pain differently. Health care workers are assisted in the assessment of pain with the use of numerical scales and survey instruments. Effective pharmacotherapy pain management is dependent on accurate assessment of the degree of pain and on determining underlying disorders that may be causing the pain.

Pain may be classified as either _____ or chronic.

acute

2

Ch 18
Pain is a subjective experience in that patients may describe the same degree and type of pain differently. Health care workers are assisted in the assessment of pain with the use of numerical scales and survey instruments. Effective pharmacotherapy pain management is dependent on accurate assessment of the degree of pain and on determining underlying disorders that may be causing the pain.

Acute pain is usually an intense pain lasting for a defined period of time, whereas _____ pain lasts longer than 6 months and may interfere with daily activities.

chronic

3

Ch 18
Pain is a subjective experience in that patients may describe the same degree and type of pain differently. Health care workers are assisted in the assessment of pain with the use of numerical scales and survey instruments. Effective pharmacotherapy pain management is dependent on accurate assessment of the degree of pain and on determining underlying disorders that may be causing the pain.

Sources of pain are classifies as __________ pain, which is due injury to tissues, and neuropathic pain, which is caused by injury to nerves.

nociceptive

4

Ch 18
Pain is a subjective experience in that patients may describe the same degree and type of pain differently. Health care workers are assisted in the assessment of pain with the use of numerical scales and survey instruments. Effective pharmacotherapy pain management is dependent on accurate assessment of the degree of pain and on determining underlying disorders that may be causing the pain.

Nociceptive pain is exhibited either as sharp, localized pain, called _____ pain. or as a dull , throbbing, aching pain, called _______ pain. Burning, shooting, or numbing pain characterizes _______ pain.

Somatic; visceral; neuropathic

5

Ch 18
Pain transmission begins when nociceptors are stimulated. nociceptors are pain receptors found throughout the body. The spinal cord receives the pain impulse along two types of sensory neurons. A Delta fibers, which are wrapped in myelin, and the C fibers, which are unmyelinated.

A Delta fibers signal _____, well-defined pain, and C fibers signal dull, poorly, _______ pain.

Sharp; localized

6

Ch 18
Once pain impulses reach the spinal cord, neurotransmitters are responsible for transmitting the message along to the next set of neurons.
A neurotransmitter called ________ __ is thought to be responsible for continuing the pain message

Substance P

7

Ch 18
Once pain impulses reach the spinal cord, neurotransmitters are responsible for transmitting the message along to the next set of neurons.

Spinal neurotransmitters are critical because they control whether pain signals continue to the ________.

brain

8

Ch 18
Once pain impulses reach the spinal cord, neurotransmitters are responsible for transmitting the message along to the next set of neurons.

the activity of ______ __ may be affected by other neurotransmitters released from neurons located within the CNS.

Substance P

9

Ch 18
Once pain impulses reach the spinal cord, neurotransmitters are responsible for transmitting the message along to the next set of neurons.

One group of neurotransmitters called _________ opioids involves endorphins, dynophins and enkephalins.

endogenous

10

Ch 18
The fact that the pain signals begin at nociceptors located within peripheral tissues and proceed throughout the CNS allows several targets for the pharmacologic intervention. In general, two main classes of pain medications are employed to manage pain, and they act at different locations.

The opioids act within the CNS, whereas the _________ ________ drugs (NSAIDs) act at the peripheral tissue level.

Nonsteroidal anti-inflammatory

11

Ch 18
The fact that the pain signals begin at nociceptors located within peripheral tissues and proceed throughout the CNS allows several targets for the pharmacologic intervention. In general, two main classes of pain medications are employed to manage pain, and they act at different locations.

To experience pain _________ __ and other neurotransmitters must deliver the pain message to the brain, so by inhibiting these neurotransmitters in the spinal cord, a medication can reduce the experience of pain.

Substance P

12

Ch 18
The fact that the pain signals begin at nociceptors located within peripheral tissues and proceed throughout the CNS allows several targets for the pharmacologic intervention. In general, two main classes of pain medications are employed to manage pain, and they act at different locations.

Opioids exert their actions by interacting with at least four major types of receptors called:
1.______
2.______
3.______
4.______

1. mu
2. kappa
3. delta
4. an opioid-like receptor called nociceptin or orphanin FQ peptide

13

Ch 18
Due to side effects of medications for pain, some patients choose non pharmacological pain management over pharmacological management.

These therapies may be used in place of or as an _________ to medications

adjunct

14

Ch 18
Due to side effects of medications for pain, some patients choose non pharmacological pain management over pharmacological management.

Name 6 non pharmacological therapies:
1._____
2______
3. ______
4.______
5.______
6.______

1. acupuncture
2. massage
3. heat or cold compress
4. relaxation
5. chiropractic manipulation
6. transcutaneous electrical nerve stimulation (TENS)

15

Ch 18
Patients with intractable cancer pain may require more invasive therapy. Nerve blocks are also used on patients with intractable pain

Name 3 chemo therapies:

1. radiation or chemotherapy, to reduce tumor size
2. relieving nerve stimulation
3. surgery to remove tumor completely

16

Ch 18
Opioid medications interact with opioid recepetors to control pain.

Opioid ______ are drugs that stimulate certain receptors

agonists

17

Ch 18
Opioid medications interact with opioid recepetors to control pain.

The opioid receptors include:

mu, kappa, sigma, delta and epsilon

18

Ch 18
From the perspective of pain management the ____ receptors and _____ receptors have been the ones traditionally targeted.

mu;kappa

19

Ch 18
Although _____ receptors have a role in analgesia, they are connected with the emotional and affective components of the pain experience. Thus they have become recent targets for drug development.

delta

20

Ch 18
Drugs that stimulate a particular opioid receptor are called opioid _______. those that block an opioid receptor are called opioid _______

agonists; antagonists

21

Ch 18
Opioid antagonists are blockers of opioid activity. They are often used to reverse the symptoms of opioid addiction, toxicity and overdose.

Acute opioid toxicity causes severe _______ ________ and is a medical emergency.

respiratory depression

22

Ch 18
Opioid antagonists are blockers of opioid activity. They are often used to reverse the symptoms of opioid addiction, toxicity and overdose.

________ (narcan) is an opioid antagonist that inhibits mu and kappa receptors. therefore it is used to reverse respiratory depression and other symptoms of opioid toxicity.

Naloxone

23

Ch 18
If a patient is unconscious from apparent opioid toxicity and information is not available as to the drug that has been take, opioid ______ aid in diagnosing the overdose. If the patients symptoms do not reverse rapidly, the overdose was most likely not due to an opioid substance

antagonist

24

Ch 18
Although effective at relieving pain, the opioids have a greater risk for dependence than almost any other class of medications. tolerance develops relatively quickly.

One common method of treating opioid dependence is to switch the patient from IV and inhalation forms of illegal drugs to _______(dolophine).

Methadone

25

Ch 18
Although effective at relieving pain, the opioids have a greater risk for dependence than almost any other class of medications. tolerance develops relatively quickly.

Although an opioid, oral methadone does not cause the ______ of injectable opioids

euphoria

26

Ch 18
Although effective at relieving pain, the opioids have a greater risk for dependence than almost any other class of medications. tolerance develops relatively quickly.

True or False
Methadone cures the opioid dependence.

False:
Methadone does NOT cure dependence, The patient must continue taking the drug to avoid withdrawal symptoms

27

Ch 18
Although effective at relieving pain, the opioids have a greater risk for dependence than almost any other class of medications. tolerance develops relatively quickly.

Methadone maintenance may continue for many months or years, until the patient decides to enter a total ______ _______ program

withdrawal treatment.

28

Ch 18
Although effective at relieving pain, the opioids have a greater risk for dependence than almost any other class of medications. tolerance develops relatively quickly.

A newer treatment option is to administer _______ (subutex, buprenex, others) a mixed opioid agonist-antagonist by the _________ route.

buprenorphine;sublingual

29

Ch 18
Although effective at relieving pain, the opioids have a greater risk for dependence than almost any other class of medications. tolerance develops relatively quickly.

Burprenorphine is used early in opioid abuse therapy to prevent opioid-_______ _______.

withdrawal symptoms

30

Ch 18
Although effective at relieving pain, the opioids have a greater risk for dependence than almost any other class of medications. tolerance develops relatively quickly.

_________ a combination agent that contains Both buprenorphine and naloxone, is used later in the maintenance of opioid addiction.

Suboxone

31

Ch 18
Health care providers should always be aware that when administering opioid with mixed agonist-antagonist activity, their _____-______ properties are reduced when administered in combination with opioid agonists.

pain-blocking

32

CH33:
Explain the pathophysiology of inflammation and fever.

________ is a natural, nonspecific body defense that limits the spread of invading microorganisms or injury. It occurs in response to an injury or antigen. The central purpose of inflammation is to contain the injury or destroy the microorganism. By neutralizing the foreign agent and removing cellular debris and dead cells, repair of the injured area can proceed at a faster pace. Inflammation limits the spread of injury or antigens by containing the injury or destroying the microorganism. Acute inflammation occurs over several days, whereas chronic inflammation may continue for months or years.

Inflammation

33

CH33:
Explain the pathophysiology of inflammation and fever.

Signs and symptoms of inflammation include _________, ______, _____ and ______.


swelling, pain, warmth, and redness.

34

CH33:
Outline the basic steps in the acute inflammatory response.

There are five basic steps in acute inflammation. They occur after cellular injury causes release of chemical mediators. The steps are _________, __________, __________, _________, _____________.

vasodilation
vascular permeability (edema)
cellular infiltration (pus)
thrombosis (clots)
stimulation of nerve endings (pain)

35

CH33:
Outline the basic steps in the acute inflammatory response.

Damaged tissue releases chemical mediators that alert the surrounding area of injury. The chemical mediators are _______, ______, ________, ________, and ________.

histamine, leukotrienes, bradykinin, complement, and prostaglandins.

36

CH33:
Explain the role of chemical mediators in the inflammatory response.

Damaged tissue releases a number of ___________ that act as "alarms" to notify the surrounding area of injury. Chemical mediators of inflammation include histamine, leukotrienes, bradykinin, complement, and prostaglandins.

chemical mediators

37

CH33:
Explain the role of chemical mediators in the inflammatory response.

_________ is a key chemical mediator in inflammation. It is stored in mast cells and initiates the inflammatory response. It directly stimulates pain receptors. Release of histamine produces vasodilation, allowing capillaries to become leaky, causing tissue swelling. Histamine is responsible for the symptoms of anaphylaxis.

Histamine

38

CH33:
Explain the role of chemical mediators in the inflammatory response.

There are two different receptors with which histamine interacts to elicit a response. ____ receptors are present in the smooth muscle of the vascular system, the bronchial tree, and the digestive tract. Stimulation of these receptors results in itching, pain, edema, vasodilation, bronchoconstriction, and the characteristic symptoms of inflammation and allergy. In contrast, ____ receptors are primarily present in the stomach, and their stimulation results in the secretion of large amounts of hydrochloric acid.

H1; H2

39

CH33:
Outline the general strategies for treating inflammation.

Identify and treat the underlying cause. Inflammation is usually self-limiting and nonpharmacologic treatments such as ice packs and rest should be used for mild symptoms. _________ creams, ointments, patches, suppositories, and intranasal sprays are used for inflammation of the skin and mucous membranes of the mouth, nose, rectum, and vagina. Many of these are available over the counter (OTC).

Anti-inflammatory

40

CH33:
Outline the general strategies for treating inflammation.

The goal is to _______ or decrease the intensity of the inflammatory response and reduce fever. Common diseases that benefit from anti-inflammatory agents include allergic rhinitis, anaphylaxis, ankylosing spondylitis, contact dermatitis, Crohn's disease, glomerulonephritis, Hashimoto's thyroiditis, peptic ulcer disease, rheumatoid arthritis, systemic lupus erythematosus, and ulcerative colitis.

prevent

41

CH33:
Compare and contrast the actions and adverse effects of the different nonsteroidal anti-inflammatory drugs (NSAIDs).

NSAIDs act by _______ the synthesis of prostaglandins. Prostaglandins are lipids found in all tissues that have potent physiologic effects, in addition to promoting inflammation, depending on the tissue in which they are found. The NSAIDs block inflammation by inhibiting cyclooxygenase (COX), the key enzyme in the biosynthesis of prostaglandins.

inhibiting

42

CH33:
Compare and contrast the actions and adverse effects of the different nonsteroidal anti-inflammatory drugs (NSAIDs).

_________ anti-inflammatory drugs (NSAIDs) are the primary drugs for the treatment of simple inflammation. This drug class includes aspirin, ibuprofen, and COX-2 inhibitors. All have about the same efficacy, but the side effects vary. All are also analgesics and antipyretics. Acetaminophen has no anti-inflammatory action and is not an NSAID.

Nonsteroidal

43

CH33:
Compare and contrast the actions and adverse effects of the different nonsteroidal anti-inflammatory drugs (NSAIDs).

There are ____ forms of the enzyme cyclooxygenase (COX). Cyclooxygenase-1 (COX-1) is present in all tissues. It reduces gastric-acid secretion, promotes renal blood flow, and promotes platelet aggregation. Inhibition of COX-1 results in bleeding, gastric upset, and reduced renal function. Cyclooxygenase-2 (COX-2) is present at sites of injury. It promotes inflammation, sensitizes pain receptors, and mediates fever in the brain. Inhibition of COX-2 results in suppression of inflammation.

two

44

CH33:
Compare and contrast the actions and adverse effects of the different nonsteroidal anti-inflammatory drugs (NSAIDs).

______ treats inflammation by inhibiting both COX-1 and COX-2. It is readily available, inexpensive, and effective. Large doses are needed to relieve severe inflammation. Adverse effects include irritation to the digestive system, bleeding, and salicylism (tinnitus, dizziness, headache, excessive perspiration).

Aspirin

45

CH33:
Compare and contrast the actions and adverse effects of the different nonsteroidal anti-inflammatory drugs (NSAIDs).

________ is an alternative to aspirin. It inhibits COX-1 and COX-2. A common side effect is nausea and vomiting. Ibuprofen causes less gastric irritation and bleeding than aspirin

Ibuprofen

46

CH33:
Compare and contrast the actions and adverse effects of the different nonsteroidal anti-inflammatory drugs (NSAIDs).

COX-2 inhibitors are the newest and most controversial class. They do not ______
COX-1; thus, they do not affect blood coagulation and do not irritate the digestive system. They were the treatment of choice for moderate to severe inflammation until 2004, when rofecoxib (Vioxx) was found to double the risk of heart attack and stroke and was subsequently removed from the market. Valdecoxib (Bextra) was also removed in 2005. Celecoxib (Celebrex) is the only remaining COX-2 inhibitor.

inhibit

47

CH33:
Explain the role of corticosteroids in the pharmacologic management of inflammation.

_________ are effective for short-term treatment of acute or severe inflammation. They are naturally released from the adrenal cortex, suppress histamine and prostaglandins, and can inhibit the immune system to reduce inflammation. If they are absolutely necessary for long-term treatment, the dose is kept as low as possible, and use of alternate-day dosing is established.

Corticosteroids

48

CH33:
Explain the role of corticosteroids in the pharmacologic management of inflammation.

Serious adverse effects may include suppression of adrenal gland function, hyperglycemia, mood changes, cataracts, peptic ulcers, electrolyte imbalances, and osteoporosis. Corticosteroids can also _____ infections; this creates the potential for existing infections to grow rapidly and undetected. For this reason, corticosteroids are contraindicated in active infections Cushing's syndrome may result when glucocorticoids are used long term. They must be gradually discontinued.

mask

49

CH33:
Prototype drug-ibuprofen

The mechanism of action is to inhibit prostaglandin synthesis.

The primary use is for treatment of pain associated with musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis, mild to moderate pain, reduction of fever, and primary dysmenorrheal pain.

Adverse effects include nausea, heartburn, epigastric pain, and dizziness. GI ulceration with occult of gross bleeding may occur.

50

CH33:
Prototype drug-prednisone

The mechanism of action is metabolization to an active form of glucocorticoids.

The primary use is to treat inflammation, acute bronchospasm in patients with asthma, and as an antineoplastic agent for patients with certain cancers.

Few serious adverse effects are noted when used for short-term therapy. Cushing's syndrome and gastric ulcers may occur if used for long-term therapy.

51

CH33:
Prototype drug-acetaminophen

The mechanism of action is to reduce fever by direct action at the level of the hypothalamus and dilation of peripheral blood vessels, which enables sweating and dissipation of heat. It has no anti-inflammatory properties.

The primary use is to relieve pain and reduce fever. It has no anti-inflammatory properties.

Adverse effects include possible liver damage. It causes less gastric irritation than aspirin and does not affect blood coagulation.

52

Ch 18:
There are two primary goals for the pharmacological therapy of migraines. The first is to stop migraines in progress, and the second is to prevent migraines from occurring. The drugs used to abort migraines are different from those used for prophylaxis.

Drug therapy is most effective if begun _____ a migraine has reached a severe level.

before

53

Ch 18:
There are two primary goals for the pharmacological therapy of migraines. The first is to stop migraines in progress, and the second is to prevent migraines from occurring. The drugs used to abort migraines are different from those used for prophylaxis.

There are two major drug classes that stop migraines in progress: ______ and _____ alkaloids. Both stimulate serotonin (5-HT).

Triptans; ergot

54

Ch 18
Pharmacotherapy of migraine termination generally begins with acetaminophen or NSAIDs. If over-the-counter (OTC) or milder prescription analgesics are unable to abort the migraine, the drugs of choice are often the triptans.

Triptans, such as ______ (Imitrex), are selective for 5-HT receptor subtype and act by constricting certain blood vessels in the brain.

Sumatriptan

55

CH 18
Pharmacotherapy of migraine termination generally begins with acetaminophen or NSAIDs. If over-the-counter (OTC) or milder prescription analgesics are unable to abort the migraine, the drugs of choice are often the triptans.

For patients who are unresponsive to triptans, the _______ _______ may be used to abort migraines

ergot alkaloids

56

CH 18
Pharmacotherapy of migraine termination generally begins with acetaminophen or NSAIDs. If over-the-counter (OTC) or milder prescription analgesics are unable to abort the migraine, the drugs of choice are often the triptans.


Ergot alkaloids, such as ergotamine (Ergostat), interact with ______, ________, and _________ receptors and promote vasoconstriction, which stops ongoing migraines.

adrenergic, dopaminergic and serotonin

57

Ch 18
The role of the nurse in opioid therapy involves careful monitoring of a patient’s condition and providing education as it relates to the prescribed drug treatment.

Perform an initial assessment to determine the presence or history of severe ________ ________, _____, _______, and liver or renal disease.

respiratory disorders, ICP, Seizures

58

Ch 18
The role of the nurse in opioid therapy involves careful monitoring of a patient’s condition and providing education as it relates to the prescribed drug treatment.

Obtain an ______ _______ before administering these drugs. Complete lab work as ordered by the physician.

allergy history

59

Ch 18
The role of the nurse in opioid therapy involves careful monitoring of a patient’s condition and providing education as it relates to the prescribed drug treatment.

Assess the patient’s pain level before and during therapy, including the _______, _______, ______, and intensity of pain.

Character, duration, location

60

Ch 18
The role of the nurse in opioid therapy involves careful monitoring of a patient’s condition and providing education as it relates to the prescribed drug treatment.

Obtain a history of current medication, especially ______ and other ___ ________.

alcohol; CNS depressants

61

Ch 18
The role of the nurse in opioid therapy involves careful monitoring of a patient’s condition and providing education as it relates to the prescribed drug treatment.

Assess the social context of the patient’s environment for the potential for opioid dependency. If giving to drug-dependent patient, monitor for signs of opioid withdrawal such as:
1.______
2.______
3.______
4.______

1. cramping
2. vomiting
3. hypertension
4. anxiety

62

Ch 18
The role of the nurse in opioid therapy involves careful monitoring of a patient’s condition and providing education as it relates to the prescribed drug treatment.

Opioids should not be administered if respirations are below ___ per minute, and narcotic antagonists such as ______ should be readily available to reverse the effects

12 ; Narcan

63

Ch 18
The role of the nurse in opioid therapy involves careful monitoring of a patient’s condition and providing education as it relates to the prescribed drug treatment.

Assistance with activity is important. Monitor urine output for retention and patient’s bowel habits for _________

constipation

64

Ch 18
Nurses role in the pharmacologic management patients receiving analgesics and antimigraine drugs.

With the use of opioid _______ therapy, the nurse wants to continue the careful monitoring of the patient’s condition, especially respiratory status. Have resuscitative equipment available.

antagonist

65

Ch 18
In the care of the patient using nonopioid analgesics, careful monitoring of a patient’s condition and providing education as it relates to the prescribed drug treatment is necessary.

If the patient is on high doses of these medications, complete a thorough assessment for the presence or history of:
1.____
2.____
3.____
4.____
5.____

1.hypersensitivity
2.bleeding disorders
3. gastric ulcers
4.severe renal or hepatic disease
5. pregnancy

66

Ch 18
In the care of the patient using nonopioid analgesics, careful monitoring of a patient’s condition and providing education as it relates to the prescribed drug treatment is necessary.

Obtain laboratory tests on the patient’s _____ and ____ function as ordered by the physician during the patient’s pharmacotherapy.

renal; liver

67

Ch 18
In the care of the patient using nonopioid analgesics, careful monitoring of a patient’s condition and providing education as it relates to the prescribed drug treatment is necessary.

Good pain assessment is needed, including location, character, and intensity of pain. Monitor patient for ____ ______.

side effects

68

Ch 18
Migraine therapy also involves monitoring the patient’s condition and providing education regarding the medication regimen.

Data collection will include the frequency and intensity of the migraine headaches and the presence or history of __, ______, and _______ and the presence or history of renal and liver disease, diabetes, and pregnancy.

MI; angina; hypertension

69

Ch 18
Migraine therapy also involves monitoring the patient’s condition and providing education regarding the medication regimen.

Assess vital signs and the patient’s stress levels and ________ ________, because migraines may be associated with these factors. Assess the patient’s neurological status.

coping mechanisms

70

Ch 18
Migraine therapy also involves monitoring the patient’s condition and providing education regarding the medication regimen.

Provide a quiet, calm environment with decreased noise and lighting. Apply _____ _____ to help lessen the pain. Assess the pain level before medication administration.

cold packs

71

Ch 18
Migraine therapy also involves monitoring the patient’s condition and providing education regarding the medication regimen.

Monitor for these 5 side effects:

dizziness,
drowsiness,
tingling,
weakness,
and GI complaints

72

Ch 18
Representative drug examples, mechanism of drug action, primary actions, and important adverse effects:

Prototype: Morphine (Astramorph PF, Duramorph, others)
[opiod analgesic }

Class:opiod receptor agonist

Mechanism of drug action: is to bind with both mu and kappa receptor sites to produce profound analgesia

Primary use:for symptomatic relief of serious acute and chronic pain that cannot be controlled with other classes of analgesics, and as anesthesia

Adverse effects:dysphoria (restlessness, depression, and anxiety), hallucinations, nausea, constipation, dizziness, and an itching sensation. Overdose may result in severe respiratory depression or cardiac arrest.

73

Ch 18
Representative drug examples, mechanism of drug action, primary actions, and important adverse effects:

Prototype:naloxone (Narcan)
[opiod antagonists]

Class:opioid receptor antagonist

Mechanism of drug action: to block both mu and kappa receptors

Primary use:It is used for complete or partial reversal of opioid effects in emergency situations when acute opioid overdose is suspected

Adverse effects: It has minimal toxicity; however, reversal of the effects of opiods may result in rapid loss of analgesia, increased blood pressure, tremors, hyperventilation, and nausea and vomiting

74

Ch 18
Representative drug examples, mechanism of drug action, primary actions, and important adverse effects:

Prototype: aspirin (acetylsalicylic acid, ASA).
[nonopioid analgesics]

Class: salicylate; it is a cyclooxygenase (COX) inhibitor

Mechanism of drug action: has anticoagulant, antipyretic, anti-inflammatory, and analgesic abilities; Aspirin inhibits the prostaglandin synthesis involved in the processes of pain and inflammation and produces mild to moderate relief of fever

Primary use:treatment of fever and to relieve pain

Adverse effects:possible GI distress and bleeding in high doses. Aspirin may increase the action of oral hypoglycemic agents

75

Ch 18
Representative drug examples, mechanism of drug action, primary actions, and important adverse effects:

Prototype: sumatriptan (Imitrex)
[ antimigraine agent]

Class: triptan; it is a 5-HT (serontonin) receptor agent, a vasoconstrictor of the intracranial arteries

Mechanism of drug action: to cause vasoconstriction of the cranial arteries; this vasoconstriction is moderately selective and does not usually affect overall blood pressure

Primary use:It is used to prevent migraines from becoming severe at the onset of symptoms

Adverse effects: dizziness, drowsiness, or a warming sensation. In rare cases it can produce cardiac ischemia or hypertension

76

Ch 18
Categorize drugs used in the treatment of pain based on their classification and mechanism of action.

OPIOID (NARCOTIC) AGONISTS:
Opioid agonist medications exert their effects by interacting with specific receptors. Opioids are the drugs of choice for moderate to severe pain that cannot be controlled with other classes of analgesics. Some opioids are used for anesthesia. give 3 Examples:

1. hydrocodone (hycodan)
2. oxycodone (OxyContin)
3. meperidine (Demerol)

77

Ch 18
Categorize drugs used in the treatment of pain based on their classification and mechanism of action.

OPIOID ANTAGONISTS:
The opioid antagonists may be used to reverse respiratory depression and other acute symptoms of overdose that can occur as a result of overly aggressive pain therapy or as a result of substance abuse of opioids. This is a medical emergency, with respiratory depression being the most serious problem. Example:

noloxone (Narcan)

78

Ch 18
Categorize drugs used in the treatment of pain based on their classification and mechanism of action.

NONOPIOID ANALGESICS:
These are used to treat mild to moderate pain as well as inflammation and fever, and include acetaminophenNSAIDs, and a few centrally acting drugs. _______ inhibit cyclooxygenase, an enzyme responsible for the formation of prostaglandins. With the enzyme inhibited, inflammation and pain are reduced. Selective Cox-2 inhibitors, a subgroup of NSAIDs, inhibit COX-2 in addition to COX-1.

___________ reduces fever by direct action at the level of the hypothalamus and causes dilation of peripheral blood vessels, enabling sweating and dissipation of heat. It is the primary alternative to NSAIDs when patients cannot take aspirin or ibuprofen. Centrally acting agents, such as tramadol (Ultram), have weak opioid activity, but relieve pain by inhibiting the reuptake of norepinephrine and serotonin in spinal neurons.

NSAIDs; acetaminophen

79

CH 18
Categorize drugs used in the treatment of pain based on their classification and mechanism of action.

ANTIMIGRAINE AGENTS:
Triptans and ergot alkaloids are both serotonin (5-HT) agonists. The triptans are thought to act by constricting certain intracranial vessels. Ergot alkaloids interact with adrenergic and dopaminergic receptors as well as serotonergic receptors.
Name 3 TRIPTAN examples:
Name 2 ERGOT ALKALOID examples:

Triptan: almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova).

Ergot alkaloid: dihydroergotamine mesylate (D.H.E. 45, Migranal), ergotamine tartrate (Ergostat)

*Drugs for migraine prophylaxis include various classes of drugs, including antiseizure drugs, beta-adrenergic blockers, calcium channel blockers, antidepressants, and neuromuscular blockers.

80

Ch 18:
Use the nursing process to care for patients receiving drug therapy for pain:

Assessment of a patient on drug therapy for pain includes careful monitoring of the patient’s condition.

Assess vital signs, particularly __________ status. Assess the patient’s pain level before and during therapy, including the character, duration, location, and intensity of pain.

respiration

81

Ch 18:
Use the nursing process to care for patients receiving drug therapy for pain:

Assessment of a patient on drug therapy for pain includes careful monitoring of the patient’s condition.

Obtain a history of current _________, especially alcohol and other CNS depressants. Assess for the presence or history of hypersensitivity, bleeding disorders, gastric ulcers, severe _____ or _____ disease, and pregnancy

Medications; renal, hepatic

82

Ch 18:
Use the nursing process to care for patients receiving drug therapy for pain:

Assessment of a patient on drug therapy for pain includes careful monitoring of the patient’s condition.

Obtain history of the frequency and intensity of the migraine headaches. Assess the patient’s stress levels and coping mechanisms, as migraines may be associated with these factors. Monitor for side effects and the potential for _______.

dependency

83

Ch 18:
Use the nursing process to care for patients receiving drug therapy for pain:

Name 4 Nursing diagnosis for patients receiving drug therapy for pain:

1. Knowledge Deficit regarding condition
2. Therapeutic Regimen
3. Potential Side Effects of Medication;
4. Risk for Dependency related to opioid therapy.

84

Ch 18:
Use the nursing process to care for patients receiving drug therapy for pain:

Planning: The goal for patients receiving medication for pain control is to explain the proper use of medication and to be free of _____ without ______

pain; dependency

85

Ch 18:
Use the nursing process to care for patients receiving drug therapy for pain:

Implementation: Encourage compliance with medication regimen. Provide additional education regarding _____ _______, such as consultation with the clinical pharmacist, written and/or visual educational material, and home-health visits to ensure the patient’s ability to follow prescribed therapy.

Medication regimen

86

Ch 18:
Use the nursing process to care for patients receiving drug therapy for pain:

Evaluation: An ideal outcome criterion for evaluation of the plan of care is pain control with limited ____ ______ and no dependency. Patient is able to verbalize the importance of taking prescribed medications to assist in continued management of the disease.

side effects

87

Ch 47 (48)
Calcium is the primary mineral responsible for bone formation and for maintaining bone health throughout the life span

Adequate levels of calcium in the body are necessary to:
1._____
2._____
3._____
4._____

1.properly transmit nerve impulses
2.prevent muscle spasms,
3.provide stability 4.movement

88

Ch 47 (48)
The calcium ion influences the excitability of all neurons. When calcium concentrations are too high (hypercalcemia), sodium permeability decreases across cell membranes. This is a dangerous state, because nerve conduction depends on the proper influx of sodium into cells.


When calcium levels in the bloodstream are too low (hypocalcemia), cell membranes become hyperexcitable. If this situation becomes severe, convulsions or muscle spasms may result. Calcium is also important for the normal functioning of other body processes such as _____ and _______.

blood coagulation
muscle contraction.

89

Ch 47 (48)
To maintain homeostasis, calcium balance in the body is regulated by ______, ______, and ________.

These three substances regulate the rate of absorption of calcium from the gastrointestinal (GI) tract, the excretion of calcium from the kidney, and the movement of calcium into and out of bone.

parathyroid hormone (PTH), calcitonin, and vitamin D.

90

Ch 47 (48)
Secreted by the parathyroid glands, PTH stimulates bone cells called osteoclasts. These cells accelerate the process of ______, demineralization that breaks down bone into its mineral components. Once bone is broken down (resorbed), calcium becomes available to be transported and used elsewhere in the body.

bone resorption

91

Ch 47 (48)
The opposite of this process is bone deposition, or bone building, accomplished by cells called _______. This process, which removes calcium from the blood to be placed in bone, is stimulated by the hormone calcitonin. When serum calcium levels become elevated, calcitonin is released by the thyroid gland.

osteoblasts.

92

CH 47 (48)
Vitamin D and calcium metabolism are intimately related: Absorption of calcium is increased in the presence of vitamin D, and inhibited by vitamin D deficiency. Thus, calcium disorders are often associated with _________.

vitamin D disorders

93

Ch 47 (48)
Hypocalcemia is a sign of underlying pathology; therefore, diagnosis of the cause of hypocalcemia is essential. Lack of sufficient dietary calcium and/or vitamin D is a common cause, and one that can be easily reversed by nutritional therapy.

If hypocalcemia occurs with normal dietary intake, ___ causes must be examined. _____ disease may be a cause. ______ can be a cause, as occurs when the thyroid and parathyroid glands are diseased or surgically removed. Drug therapy is occasionally a cause of hypocalcemia. Blood transfusions and certain anticonvulsants such as phenytoin can lower serum calcium levels.

GI
Chronic kidney
Decreased secretion of PTH

94

Ch 47 (48)
In addition, overtreatment with drugs used to lower serum calcium can result in “overshooting” normal levels. Long-term therapy with corticosteroids is a common cause of hypocalcemia and osteoporosis. To help prevent corticosteroid-induced osteoporosis, patients should receive daily supplements of _____ and ______.

calcium
vitamin D

95

Ch 47 (48)
Effective and inexpensive calcium supplements are readily available over the counter (OTC), in a variety of formulations. Calcium supplements often contain vitamin D. Severe _____ requires the intravenous (IV) administration of calcium salts.

hypocalcemia

96

Ch 47 (48)
Calcium has two major forms: complexed and elemental. Most calcium supplements are in the form of complexed calcium.

These products are often compared on the basis of their ability to release elemental calcium into the bloodstream. The greater the ability of complexed calcium to release elemental calcium, the more _____ is the supplement.

potent

97

Ch 47 (48)
Metabolic bone disease (MBD) is a general term referring to a cluster of disorders that have in common defects in the structure of bone.

MBDs are caused by abnormal amounts of the minerals or hormones required for proper bone homeostasis, such as _____, ______, ______, or _____. Primary therapies for MBD include vitamin D, bisphosphonates, selective estrogen receptor modulators, and calcitonin.

calcium
phosphate
vitamin D
PTH

98

Ch47 (48)
Osteoporosis is the most common metabolic bone disease. Osteoporosis is related to bone deterioration; bone resorption outpaces bone deposition. Etiology is related to lack of dietary calcium and vitamin D and disrupted bone homeostasis.

The most common risk factor for osteoporosis is the onset of menopause. Other risk factors include _______ or ______ consumption, _______, _______ use, __________, __________, and lack of _________ or _______. Drugs that lower calcium in the blood include corticosteroids, anticonvulsants, and immunosuppressants.

high alcohol
caffeine
anorexia nervosa
tobacco
physical inactivity
testosterone deficiency
vitamin D
calcium.

99

Ch 47 (48)
Pharmacotherapy of osteoporosis includes calcium supplements and vitamin D, bisphosphonates, estrogen replacement therapy (ERT), estrogen receptor modulators, calcitonin, slow-release sodium fluoride, and statins. Bisphosphonates are the most common treatment; they block bone resorption by inhibiting osteoclast activity and increase bone density.

Selective estrogen receptor modulators (SERMs) ______ bone resorption and ______ bone density. They may be either estrogen agonists or antagonists, depending on the drug or tissue involved. ________ is approved for osteoporosis in women who are more than 5 years postmenopause. It increases bone density and reduces the risk of vertebral fractures. Calcitonin is a hormone secreted by the thyroid when serum calcium is elevated. It increases bone density.

decrease
increase
Calcitonin

100

Ch 47 (48)
Hormone replacement therapy (HRT) is no longer used for osteoporosis. Until recently, HRT was a common treatment for osteoporosis; however, recent research shows increased risks of ______, ___________, _________, and other chronic disorders with use of hormone replacement therapy.

uterine cancer
thromboembolic disease
breast cancer

101

Ch 47 (48)
Osteomalacia is a MBD characterized by softening of bones due to demineralization. In the United States, osteomalacia is most prevalent in the elderly, in premature infants, and in individuals on strict vegetarian diets. The term osteomalacia is usually used for adults with this MBD; if it occurs in children, it is called rickets.

Signs and symptoms of osteomalacia include ________ , __________, _________, and ___________, especially in the hip area. Classic signs of rickets in children include bowlegs and a pigeon breast. Children may also develop a slight fever and become restless at night. In extreme cases, surgical correction of disfigured limbs may be required.

hypocalcemia
muscle weakness
muscle spasms
diffuse bone pain

102

Ch 47 (48)
Pharmacotherapy of osteomalacia: Drug therapy for children and adults consists of ______ supplements and _________.

calcium supplements vitamin D.

103

Ch 47 (48)
Osteoarthritis (OA) is a degenerative disease characterized by wearing away of cartilage at articular joint surfaces. Symptoms include _________, _________ and _______, and _____________________ .

muscle spasms localized pain stiffness joint bone enlargement.

104

Ch 47 (48)
The goal in the pharmacotherapy of osteoarthritis is reduction of pain and inflammation. Acetaminophen is often used first, then nonsteroidal anti-inflammatory drugs (NSAIDs) and tramadol (Ultram). If those fail to relieve pain, opiods with acetaminophen may be prescribed. Topical medications include salicylates and counterirritants such as capsaicin cream. A newer approach to treating patients with moderate OA who do not respond adequately to analgesics includes sodium hyaluronate (Hyalgan), a chemical normally found in high amounts within synovial fluid.

Administered by injection directly into the knee joint, this drug replaces or supplements the body’s natural _____________ that deteriorated because of the inflammation of osteoarthritis.

hyaluronic acid

105

Ch 47 (48)
Rheumatoid arthritis is a systemic autoimmune disorder characterized by inflammation of multiple joints. Autoantibodies called rheumatoid factors attack the person’s tissues, activating complement and drawing leukocytes into the area, where they attack the cells of the synovial membranes and blood. This results in persistent injury and the formation of inflammatory fluid within the joints.

Joint capsules, tendons, ligaments, and skeletal muscles may also be affected. Other extra-articular systemic manifestations may develop, such as ________, _____________, _________, _______________, and _______________.

infections
pulmonary disease pericarditis blood abnormalities
metabolic dysfunction.

106

Ch 47 (48)
Pharmacotherapy for rheumatoid arthritis (RA) begins with NSAIDs to relieve pain and inflammation. Corticosteroids are used for severe inflammation but are not used for long-term therapy because of adverse effects. The progression of the disease can be modified with drug therapy with disease-modifying antirheumatic drugs (DMARDs), a diverse drug class that has been found to improve symptoms, reduce mortality rates, and enhance the quality of life in patients with RA. The choice of specific DMARD depends upon the experiences of the health care provider and the response of the patient to therapy.

Therapy often begins with hydroxychloroquine (Plaquenil), methotrexate (Rheumatrex, Trexall), or sulfasalazine (Azulfidine), because these drugs have the most research-based evidence for reducing mortality due to RA. Gold salts, D-penicillamine (Cuprimine), cyclosporine (Neoral), and cyclophosphamide (Cytoxan) are used as second-line drugs because they are more toxic. Biologic therapies are the newest DMARDs available for the treatment of RA. These biologic agents, most of which are monoclonal antibodies, block steps in the _________, reduce ___________, and slow the progression of ____________.

inflammatory cascade
joint inflammation
joint damage.

107

Gout is a form of acute arthritis caused by an accumulation of uric acid (urate) crystals in the joints and other body tissues, causing inflammation. Primary gout is caused by a hereditary defect in uric acid metabolism that causes uric acid to be produced faster than it can be excreted by the kidneys. Secondary gout is caused by diseases or drugs that increase the metabolic turnover of nucleic acids, or that interfere with uric acid excretion. Examples of drugs that may cause gout include thiazide diuretics, aspirin, cyclosporine, and alcohol, when ingested on a chronic basis.

Conditions that can cause secondary gout include diabetic ketoacidosis, kidney failure, and diseases associated with a rapid cell turnover such as leukemia, hemolytic anemia, and polycythemia. Symptoms of acute attacks include _____, _________, often in the ________, __________, _______, _______, _______, and _________. Attacks are triggered by diet, injury, or other stress and often occur at night.

red
swollen tissue big toes
ankles
fingers
wrists
knees
elbows.

108

Goals of the pharmacotherapy of gout are termination of acute attacks and prevention of future attacks. For acute attacks, medications include NSAIDs, such as indomethacin (Indocin), for pain and inflammation. Corticosteroids are sometimes used as well.

For chronic gout, uricosurics increase the excretion of uric acid by blocking its reabsorption in the kidney. Prophylactic therapy of gout includes drugs that inhibit the formation of uric acid. Prophylactic therapy is used for patients who suffer frequent and acute gout attacks. Allopurinol blocks _____________, thus inhibiting the formation of uric acid. A third strategy for preventing hyperuricemia is to convert uric acid to a less toxic form. The two drugs that act by this mechanism are Rasburicase (Elitek) and pegloticase (Krystexxa).


xanthine oxidase

109

Ch 47 (48)
The role of the nurse in the pharmacologic management of disorders related to bones and joints involves careful monitoring of a client’s condition and providing education as it relates to the prescribed drug treatment.

Obtain baseline ________, ______, and _____ history; lifestyle and dietary habits, including use of herbal or alternative therapies; and a detailed description of symptomology and current therapies

medical, surgical, drug

110

Ch 47 (48)
The role of the nurse in bisphosphonate drug therapy:

Obtain a thorough history to determine risk factors, past medical history (especially a history of ______), ____ problems, and current medications and supplements.

fractures; GI

111

Ch 47 (48)
The role of the nurse in bisphosphonate drug therapy:

Clients with preexisting ________ __ deficiency or __________ should be placed on supplements, and these conditions should be corrected prior to initiating bisphosphonate therapy

Vitamin D; hypocalcemia

112

Ch 47 (48)
The role of the nurse in bisphosphonate drug therapy:

A complete physical examination should include complete blood count (CBC), ______, chemistry panel, renal- and liver-function studies, vital signs, and _____ ______ studies such as a dual x-ray absorptiometry (DXA scan) to establish baseline data.

pH; bone density

113

Ch 47 (48)
The role of the nurse in calcium-supplement therapy:

Assess for 9 signs and symptoms of hypercalcemia, such as:

drowsiness
lethargy
weakness
headache
anorexia, nausea
vomiting
thirst
increased urination

114

Ch 47 (48)
The role of the nurse in calcium-supplement therapy:

Signs and symptoms to assess for hypocalcemia are:

facial twitching
muscle spasms
paresthesias
seizures

115

Ch 47 (48)
The role of the nurse in calcium-supplement therapy:

Obtain baseline and periodic vital signs, labs, and ____ to determine the effectiveness of the medication.

ECG

116

Ch 47 (48)
The role of the nurse in calcium-supplement therapy:

A history of fracture should be investigated. ______ supplements are contraindicated in clients with a history of renal calculi, digoxin toxicity, dysrhythmias, or hypercalcemia.

Calcium

117

Ch 47 (48)
The role of the nurse in vitamin D therapy:

Obtain a thorough history to assess _____ function, intake of fat-soluble vitamins, and current medications. Liver impairment and an accumulation of fat-soluble vitamins may cause ______.

liver; toxicity

118

Ch 47 (48)
The role of the nurse in vitamin D therapy:

Assess sclera, skin pigment, and bowel movements. Monitor liver-function tests; _______, ________, and _______ levels; and urinary calcium and phosphate levels during vitamin D therapy. Emphasize the importance of including extra dietary vitamin D in children and pregnant women.

Calcium, magnesium, phosphate

119

Ch 47 (48)
The role of the nurse in drug therapy with anti-gout medications involves careful monitoring of a client’s condition and providing education as it relates to the prescribed drug treatment.

Obtain a thorough history, including current medications, vital signs, and a complete physical examination. The client should have the following lab studies:

CBC
platelets
liver- and renal-function studies
uric acid levels
urinalysis

120

Ch 47 (48)
Drugs at a Glance, know drugs, mechanisms of action, primary actions, and important adverse effects.

Prototype: Calcium salts

Mechanism of action:to return serum calcium levels to normal.

Primary action: to prevent and treat mild, chronic hypocalcemia and for osteoporosis, Paget’s disease, osteomalacia, chronic hypoparathyroidism, rickets, pregnancy, lactation, and rapid childhood growth.

Adverse effects:It is safe when taken as directed but can result in hypercalcemia. Symptoms include drowsiness, lethargy, weakness, headache, anorexia, nausea and vomiting, increased urination, and thirst. IV administration of calcium may cause hypotension, bradycardia, dysrhythmias, and cardiac arrest.

121

Ch 47 (48)
Drugs at a Glance, know drugs, mechanisms of action, primary actions, and important adverse effects.

Prototype: Calcitriol (Calcijex, rocaltrol
[Vitamin D therapy]

Mechanism of action: as the active form of vitamin D. It promotes the intestinal absorption of calcium, reduces bone resorption, and elevates serum levels of calcium

Primary action:to treat impaired kidney function or hypoparathyroidism. It is also useful in treating rickets

Adverse effects:hypercalcemia, headache, weakness, dry mouth, thirst, increased urination, and muscle or bone pain

122

Ch 47 (48)
Drugs at a Glance, know drugs, mechanisms of action, primary actions, and important adverse effects.

Prototype: alendronate (Fosamax)
[bisphosphonates]

Mechanism of action:to lower serum alkalin phosphate, the enzyme associated with bone turnover.

Primary action: for prevention and treatment of osteoporosis in postmenopausal women, for treatment of corticosteroid-induced osteoporosis, to increase bone mass in men with osteoporosis, and for treatment of Paget’s disease

Adverse effects: diarrhea, nausea, vomiting, GI irritation, and a metallic- or altered-taste perception. Pathologic fractures may occur if the drug is taken longer than 3 months or in cases of chronic overdose.

123

Ch 47 (48)
Drugs at a Glance, know drugs, mechanisms of action, primary actions, and important adverse effects.

Prototype: raloxifene (Evista)
[selective estrogen receptor modulators SERMs]

Mechanism of action: to decrease bone resorption and increase bone mass and density by acting through the estrogen receptor

Primary action: for the prevention of osteoporosis in postmenopausal women.

Adverse effects: hot flashes, leg cramps, weight gain, migraine headache, flulike symptoms, endometrial disorder, breast pain, and vaginal bleeding.

124

Ch 47 (48)
Drugs at a Glance, know drugs, mechanisms of action, primary actions, and important adverse effects.

Prototype:hydroxychloroquine (Plaquenil)
[disease-modifying anti rheumatic drugs]

Mechanism of action:
This drug relieves severe inflammation, although its mechanism of action is not known.

Primary action: for rheumatoid arthritis and lupus erythematosus in clients who have not responded well to other anti-inflammatory drugs

Adverse effects: anorexia, GI disturbances, loss of hair, possible ocular effects, headache, and mood and mental changes

125

Ch 47 (48)
Drugs at a Glance, know drugs, mechanisms of action, primary actions, and important adverse effects.

Prototype: allopurinol (Lopurin, Zyloprim).
[uric acid inhibitor]

Mechanism of action: to inhibit the synthesis of microtubules, subcellular structures responsible for helping white blood cells infiltrate an area

Primary action: to control hyperuricemia that causes severe gout and to reduce the risk of acute gout attacks

Adverse effects: rashes, Stevens-Johnson syndrome, hypersensitivity syndrome, drowsiness, headache, vertigo, nausea, vomiting, abdominal discomfort, malaise, diarrhea, retinopathy, and thrombocytopenia

126

Ch 47 (48)
Pharmacotherapy for osteoporosis and other bone disorders—

Assessment: Obtain a complete health history, including _____________, gastrointestinal, ___________, neurologic, endocrine, hepatic, or renal disease. Obtain a drug history, including allergies, signs of hypercalcemia or hypocalcemia, and possible drug interactions

musculoskeletal; cardiovascular

127

Ch 47 (48)
Pharmacotherapy for osteoporosis and other bone disorders—

Assessment: Assess muscle strength, gait, and note any pain or discomfort on movement or at rest. Obtain _____ ______ studies if ordered

bone density

128

Ch 47 (48)
Pharmacotherapy for osteoporosis and other bone disorders—

Assessment: Obtain a dietary history, noting adequacy of essential vitamins, minerals, and nutrients obtained through food sources, particularly _________, _______ __, and ___________. Note amount of soda intake daily. Note sunscreen use and amount of sun exposure. Obtain baseline height, weight, and vital signs. Evaluate appropriate laboratory findings (e.g., CBC, electrolytes, calcium, phosphorus, and magnesium levels, hepatic- and renal-function studies).

Calcium, vitamin D, magnesium

129

Ch 47 (48)
Pharmacotherapy for osteoporosis and other bone disorders—
Nursing diagnoses: 4 Possible nursing diagnoses include:

1.Acute or Chronic Pain (bone or joints), related to disease condition;
2.Deficient Knowledge (drug therapy);
3.Risk for Injury,
4.Risk for Falls related to disease condition, adverse drug effects

130

Ch 47 (48)
Pharmacotherapy for osteoporosis and other bone disorders—

planning: The client will experience therapeutic effects (e.g., maintenance of adequate bone density, lessened fracture risk) of the drug; be free from or experience minimal ______ ______ of the drug; verbalize an understanding of the drug’s use, adverse effects, and required precautions; and demonstrate proper self-administration of the medication (e.g., dose, timing, when to notify provider).

adverse effects

131

ch 47
Pharmacotherapy for osteoporosis and other bone disorders—

Implementation: Review the dietary history with the patient and discuss food source options for correcting any deficiencies, particularly calcium and vitamin D intake. Encourage the patient to adopt a healthy lifestyle of increased physical activity, adequate ___ _______, limited caffeine and soda intake, and limited or eliminated alcohol consumption.

sun exposure

132

ch 47
Pharmacotherapy for osteoporosis and other bone disorders—

Implementation: . Monitor for GI irritation or abdominal pain. Monitor periodic lab work, especially Ca, Mg, phosphorus levels, and creatinine as needed. Assess for signs or symptoms of _________ or ______. Increase fluid intake, avoiding caffeine or soda. Monitor compliance with recommended regimen. Instruct the patient and/or family in proper self-administration of drug

hypocalcemia, hypercalcemia

133

Ch 47
Pharmacotherapy for osteoporosis and other bone disorders—

Evaluation: Experiences maintenance of adequate ______ ______ and lessened fracture risk; is free from or experiences minimal adverse effects of the drug; verbalizes an understanding of the drug’s use, adverse effects, and required precautions; and demonstrates proper self-administration of the medication (e.g., dose, timing, when to notify provider).

bone density

134

Ch 47
Antigout therapy—

Assessment: Obtain a complete health history, including musculoskeletal, gastrointestinal, cardiovascular, neurologic, endocrine, hepatic, or renal disease. Obtain a drug history, including allergies and possible drug interactions. Assess for ___________, location, and note any pain or discomfort on movement or at rest. Obtain a dietary history, noting correlations between _______ intake and increase in symptoms. Assess fluid intake. Obtain baseline weight and vital signs. Evaluate appropriate laboratory findings (e.g., uric acid level, CBC, hepatic and renal function studies, urinalysis). Assess for and promptly report adverse effects.

inflammation; food

135

ch 47
Antigout therapy—

Nursing diagnoses: 5 Possible nursing diagnoses include:

1.Acute Pain related to acute stage of disease;
2. Activity Intolerance related to joint pain;
3. Disturbed Body Image related to joint inflammation and swelling;
4. Deficient Knowledge (drug therapy);
5. Risk for Injury related to acute inflammatory condition.

136

ch 47
Antigout therapy—

Planning: The client will experience therapeutic effects (e.g., diminished inflammation, decreased or absent joint pain, increased ability to continue ADLs) of the drug; be free from or experience minimal adverse effects of the drug; verbalize an understanding of the drug’s use, adverse effects, and required precautions; and demonstrate proper _____-________of the medication (e.g., dose, timing, when to notify provider).

self-administration

137

ch 47
Antigout therapy—

implementation: Review the dietary history, noting any correlation between diet and symptoms, especially after ingestion of purine-containing foods. Increase fluid intake to __ to __ liters per day. Monitor urine output and obtain periodic urinalysis. Monitor serum and urinary uric acid levels and symptoms associated with acute inflammatory period. Monitor daily weight and urinary output. Observe for skin rashes, fever, stomatitis, flulike symptoms, or general malaise. Instruct patient and/or family in proper self-administration of drug. Monitor lab results throughout therapy, and perform ______test for hemolytic anemia. Monitor for signs of toxicity. Monitor for signs of renal impairment, such as oliguria. Record intake and output. Ensure that medication is administered correctly. Monitor for pain and mobility.

2-4; Coombs’

138

ch 47
Antigout therapy—
Evaluation: The client will experience diminished _________, decreased or absent joint pain, increased ability to continue ADLs) and be free from or experience minimal adverse effects. Verbalize an understanding of the ______ ____, adverse effects, and required precautions. Demonstrate proper self- administration of the medication (e.g., dose, timing, when to notify provider).

inflammation; drug’s use