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Pharmacology Test 2 > Ant Inflammatory, Anti arthritis, and Related agents > Flashcards

Ant Inflammatory, Anti arthritis, and Related agents Flashcards

1
Q

Classes of drugs that reduce inflammation

A

Corticosteroids
Antihistamines
Immune-modulating agents
OTC anti inflammatory

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2
Q

Children: Anti inflammatory

A

No salicylates (Reye Syndrome)
Check OTC ingredients
Acetaminophen most commonly used - ibuprofen ok too

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3
Q

Adults: anti inflammatory

A

Caution in pregnancy

Severe ADE on neonate and mother with salicylates, NSAIDS, and gold products

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4
Q

Older adults

A

Gold salts are toxic for older adults - if used, dose must be lowered and patient needs to be monitored closely for toxicity

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5
Q

Salicylates: Names

A

Aspirin: treats inflammatory conditions
Mesalamine: treats inflammation of large intestine

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6
Q

3 effects of Salicylates

A

Block inflammatory response
Antipyretic (fever-blocking)
Analgesic (pain-blocking)

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7
Q

Salicylates: Actions / Indications

A

Inhibits synthesis of protaglandin, used to treat mild to moderate pain and fever
- should not be first choice of antipyretic in children

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8
Q

Salicylates: Contraindications

A

Allergy, bleeding abnormalities, impaired renal function

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9
Q

Adverse Effect: Salicylates

A

Effects on stomach (bleeding ulcers) and effects on clotting system

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10
Q

Drug-Drug Interactions: Salicylates

A

Affects the absorption of other drugs - interfere with drug metabolism

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11
Q

Assessment: Salicylates

A
  • Assess for allergy, renal disease, bleeding disorders, chickenpox or influenza in children (reye’s syndrome), pregnancy and lactation
  • Perform a liver evaluation and monitor bowl sounds (and stool for blood)
  • Monitor lab tests (CBC hemoglobin and hematocrit - stool guauic for occult bleeding)
  • Skin, temp, orientation, reflex, pulse, BP, respirations, breath sounds
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12
Q

Salicylates: Diagnosis

A
  • Acute pain r/t CNS and GI effects
  • Ineffective breathing pattern if toxic effects occur
  • Disturbed sensory perception if toxic effects occur
  • Deficient knowledge regarding drug therapy
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13
Q

Salicylates: Implementation

A
  • Administer with food if GI upset is severe; provide small frequent meals
  • Check other meds for salicylate ingredients
  • Monitor for severe reactions (respiratory / CNS)
  • Ensure pt is well hydrated (to minimize risk of toxicity) - IV fluids may be necessary
  • Provide thorough pt teaching
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14
Q

Salicylates: Evaluation

A

Monitor pt response to drug
Monitor ADE (GI upset and bleeding most common)
Evaluate effectiveness of teaching
Monitor compliance

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15
Q

Aspirin: Indications

A
  • Treatment of mild to moderate pain, fever, inflammation
  • reduce risk of transient ischemic attack or stroke
  • reduce risk of MI
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16
Q

Aspirin: Actions

A
  • Inhibits synthesis of protaglandins
  • blocks effects of pyrogens at hypothalamus
  • ## Inhibits platelet aggregation by blocking thromboxane A2
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17
Q

Aspirin ADE

A

N/V, heartburn, GI discomfort, occult blood loss, dizziness, tinnitus, acidosis
- most common are GI effects and bleeding

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18
Q

Non Steroidal Anti Inflammatory Drugs (NSAIDS)

What they do

A

Provide Strong anti-inflammatory and analgesic effects
Sold OTC
Anti inflammatory, analgesic, antipyretic effects

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19
Q

Common NSAIDS: Names

A

Propionic Acid: Ibuprofin, Naproxen
Acetic Acid: Indomethacin, ketolorac
Osicam derivatives: Meloxicam
Cyclooxygenase-2 Inhibitors: Celecoxib

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20
Q

NSAID Action

A

Block Cox-1 and Cox-2 (enzymes)

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21
Q

NSAID Contraindications

A

Contraindication: allergy to any NSAID or salicylate, allergy to sulfonamides (for celecoxib); pregnancy, lactation, CV dysfunction or hypertension; peptic ulcer, GI bleeding
Caution: Pregnancy / Lactation

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22
Q

NSAIDS ADE

A

Nausea, dyspepsia, GI pain, constipation, diarrhea, flatulence
GI bleed, dizziness, somnolence, platelet inhibition, hypertension, bone marrow depression (infection)

23
Q

NSAIDS: Drug Drug

A 
Loop diuretics (decrease diuretic effect) 
Beta blockers (decreased antihypertensive effect) 
Lithium (lithium toxicity, especially with ibuprofen)
24
Q

Acetaminophen: Actions

A

Actions-
Acts directly on the thermoregulatory cells of the hypothalamus
Mechanism of action unknown but related to analgesic effects
Used to treat pain and fever
Treat pain and fever associated with a variety of conditions, including influenza
Prophylaxis of children receiving diphtheria–pertussis–tetanus (DPT) immunizations
Relief of musculoskeletal pain associated with arthritis

25
Q

Acetaminophen: Contraindications

A

Contraindications-
Known allergy
Use with caution in pregnancy and lactation
Hepatic dysfunction or chronic alcoholism

26
Q

Acetaminophen: ADE

A

Adverse Effects
Headache, hemolytic anemia, renal dysfunction, skin rash and fever
Hepatotoxicity usually associated with chronic use and overdose

27
Q

Acetaminophen Drug Drug

A

Drug-Drug Interactions
Oral anticoagulants increase bleeding
Hepatotoxicity with barbiturates, carbamazepine, hydantoins, or rifampin

28
Q

NSAIDS assessment

A

Assessment
Assess for contraindications or precautions: known allergies to any salicylates, NSAIDs, or tartrazine; pregnancy or lactation; hepatic or renal disease; CV dysfunction; hypertension; and GI bleeding or peptic ulcer
Assess for skin lesions; temperature; orientation, reflex, and affect; pulse, BP, and perfusion; respirations and adventitious sounds; liver evaluation; BS; appropriate labs

29
Q

Acetaminophen prototype: Indications

A

Indications: treatment of mild to moderate pain, fever, or sings and symptoms of the common cold or flu; musculoskeletal pain associated with arthritis and rheumatic disorders

30
Q

Acetaminophen prototype actions

A

Actions: acts directly on the hypothalamus to cause vasodilation and sweating, which will reduce fever; mechanism of action as an analgesic is not understood

31
Q

Acetaminophen Prototype ADE

A

ADE: rash, fever, chest pain, liver toxicity and failure, bone marrow suppression

32
Q

Arthritis

A

Potentially debilitating inflammatory process

33
Q

Anti arthritis agents

A

Prevent and suppress arthritis in selected patients with rheumatoid arthritis

34
Q

Gold compounds action

A

Action
Absorbed by macrophages, which results in inhibition of phagocytosis
Tissue destruction is decreased

35
Q

Gold compounds contraindication

A

Contraindications
Known allergy
Diabetes, CHF, renal or hepatic impairment, blood dyscrasias, pregnancy and lactation

36
Q

Gold Compounds ADE

A

Adverse Effects

Stomatitis, glossitis, gingivitis, bone marrow depression, dermatitis, interstitial pneumonitis and anaphylactic shock

37
Q

Gold compounds drug drug

A

Drug-Drug Interactions
Penicillamine, antimalarials, cytotoxic drugs, or immunosuppressive agents
- they all increase gold toxicity
- not first choice drugs because of risk of toxicity, especially in elderly

38
Q

Auranofin

A

Indications: treatment of selected adults with RA, who have insufficient response to or intolerance to NSAIDS

39
Q

Auranofin: action

A

Action: taken up by macrophages, which inhibits phagocytosis and release of lysosomal enzymes that cause damage associated with inflammation

40
Q

Auranofin: ADE

A

ADE: Bone marrow suppression (risk of infection), renal toxicity, dermatitis, n/v, stomatitis

41
Q

Disease Modifying Anti-rheumatic Drugs (DMARS)

A

Available for treating arthritis that aggressively affect the process of inflammation
Drug side effects can be severe to life-threatening
Used early in diagnosis, before damage to the joints has occurred

42
Q

Common Tumor Necrosis 
Factor (TNF) Blockers

A

Adalimumab
Etanercept
Infliximab

43
Q

TNF Blockers: Action and indication

A 
Often the first class used with progressing arthritis
Actions- Act to decrease the local effects of TNF, a locally released cytokine that can cause the death of tumor cells and stimulate a wide range of proinflammatory activities
44
Q

TNF Blockers Contraindications / Cautions

A

Contraindications- Can not be used in anyone with an acute infection, cancer, sepsis, tuberculosis, hepatitis, myelosuppression or demyelinating disorders

Cautions- pregnancy, lactation, hepatic and renal disorders

45
Q

TNF Blockers ADE

A

Adverse effects- black box warnings about the risk of serious to fatal infections and the development of lymphomas and other cancers

46
Q

TNF Blockers Drug Drug

A

Drug-drug interactions- Immune suppressant drugs and live vaccines

47
Q

Etanercept: Prototype TNF Blockers: Indications

A
  • Indications: reduction of signs and symptoms, and improvement of function with RA, polyarticular juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis
48
Q

Etanercept: Prototype TNF Blockers: Actions

A
  • actions: genetically engineered TNF receptor react with and deactivate TNF released by active leukocytes, keeping the inflammatory response in check
49
Q

Etanercept: Prototype TNF Blockers: ADE

A

ADE: serious to fatal injections, lymphoma and other cancers, demyelinating disorders, MI, heart failure, injection site reactions
- injection site reactions and discomfort are most common

50
Q

Nursing Considerations for DMARDs

Assessment

A

Assessment
Assess allergy, lesions, temperature, any sign of infection - listen to lung sounds
Evaluate CNS status
Arranged for required cancer screening
Monitor range of motion, movement, and pain levels (baseline and progress evaluation)
Evaluate respirations and adventitious sounds
Monitor laboratory test (CBC - WBC looking for signs of infection - look at liver and kidney function - TB test)

51
Q

Nursing Considerations for DMARDs: Diagnosis

A

Nursing Diagnoses
Acute pain related to CNS, disease process
Risk for infection related to drug effects
Anxiety related to disease process and drug effects
Deficient knowledge regarding drug therapy

52
Q

Nursing Considerations for DMARDs: Implementation

A

Teach patient proper preparation, administration of subcutaneous injections
Monitor for immune suppression reaction and CNS toxicity
Arrange for continuation of nondrug therapies to deal with arthritis - ice heat splints
Ensure that the patient has routine cancer screening and regular follow-up
Provide thorough patient teaching
follow up appointments, labs, prevent infection, how to handle injure, avoid live vaccines, make sure do cancer screenings

53
Q

Nursing Considerations for DMARDs: Evaluation

A

Evaluation
Monitor patient response to the drug (improvement in condition being treated, relief of signs and symptoms of arthritis)
Monitor for adverse effects (infections, cancer development, and CNS toxicity)
Evaluate the effectiveness of the teaching plan
Monitor compliance with a drug regimen

Pharmacology Test 2 (3 decks)

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