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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
Acetaminophen: Contraindications
Contraindications- Known allergy Use with caution in pregnancy and lactation Hepatic dysfunction or chronic alcoholism
26
Acetaminophen: ADE
Adverse Effects Headache, hemolytic anemia, renal dysfunction, skin rash and fever Hepatotoxicity usually associated with chronic use and overdose
27
Acetaminophen Drug Drug
Drug-Drug Interactions Oral anticoagulants increase bleeding Hepatotoxicity with barbiturates, carbamazepine, hydantoins, or rifampin
28
NSAIDS assessment
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
Acetaminophen prototype: Indications
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
Acetaminophen prototype actions
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
Acetaminophen Prototype ADE
ADE: rash, fever, chest pain, liver toxicity and failure, bone marrow suppression
32
Arthritis
Potentially debilitating inflammatory process
33
Anti arthritis agents
Prevent and suppress arthritis in selected patients with rheumatoid arthritis
34
Gold compounds action
Action Absorbed by macrophages, which results in inhibition of phagocytosis Tissue destruction is decreased
35
Gold compounds contraindication
Contraindications Known allergy Diabetes, CHF, renal or hepatic impairment, blood dyscrasias, pregnancy and lactation
36
Gold Compounds ADE
Adverse Effects | Stomatitis, glossitis, gingivitis, bone marrow depression, dermatitis, interstitial pneumonitis and anaphylactic shock
37
Gold compounds drug drug
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
Auranofin
Indications: treatment of selected adults with RA, who have insufficient response to or intolerance to NSAIDS
39
Auranofin: action
Action: taken up by macrophages, which inhibits phagocytosis and release of lysosomal enzymes that cause damage associated with inflammation
40
Auranofin: ADE
ADE: Bone marrow suppression (risk of infection), renal toxicity, dermatitis, n/v, stomatitis
41
Disease Modifying Anti-rheumatic Drugs (DMARS)
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
Common Tumor Necrosis 
Factor (TNF) Blockers
Adalimumab Etanercept Infliximab
43
TNF Blockers: Action and indication
``` 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
TNF Blockers Contraindications / Cautions
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
TNF Blockers ADE
Adverse effects- black box warnings about the risk of serious to fatal infections and the development of lymphomas and other cancers
46
TNF Blockers Drug Drug
Drug-drug interactions- Immune suppressant drugs and live vaccines
47
Etanercept: Prototype TNF Blockers: Indications
- Indications: reduction of signs and symptoms, and improvement of function with RA, polyarticular juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis
48
Etanercept: Prototype TNF Blockers: Actions
- actions: genetically engineered TNF receptor react with and deactivate TNF released by active leukocytes, keeping the inflammatory response in check
49
Etanercept: Prototype TNF Blockers: ADE
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
Nursing Considerations for DMARDs | Assessment
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
Nursing Considerations for DMARDs: Diagnosis
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
Nursing Considerations for DMARDs: Implementation
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
Nursing Considerations for DMARDs: Evaluation
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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