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Pharmacology for Advanced Practice Nurses > Anti-Inflamatory > Flashcards

Anti-Inflamatory Flashcards

1
Q

Anitinflamatory drug classes

A

Corticosteroids
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Aspirin and nonacetylated salicylates

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2
Q

Cortisol Actions (5 items)

A 
Level of awareness and sleep pattern
Labile emotions
Stimulates gluconeogenesis
Stimulates protein catabolism
Decreases proliferation of fibroblasts, leading to poor wound healing
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3
Q

Think of cortisol as a

A

stress hormone

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4
Q

Glucocorticosteroid inhibits

A

Inhibits immune and inflammatory systems

Depresses proliferation of T lymphocytes, decreases natural killer cell activity, reverses macrophage activity

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5
Q

Glucocorticosteroid

Increases circulating

A

erythrocytes

and appetite

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6
Q

Glucocorticosteroid promotes

A

Promotes fat deposits in the face and cervical areas

Promotes lipolysis in the extremities

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7
Q

Glucocorticoid increases

A

uric acid excretion

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8
Q

Glucocorticosteroid decreases

A

serum calcium levels

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9
Q

Glucocorticosteroid promotes gastric

A

Promotes gastric acid secretion

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10
Q

Glucocorticosteroid supresses

A

Suppresses secretion and synthesis of adrenocorticotropic hormone (ACTH)
Suppresses prostaglandin E production of growth hormone secretion

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11
Q

Glucocorticosteroid causes skeletl

A

Causes skeletal wasting

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12
Q

Glucocorticosteroid potentiates the

A

Potentiates the effects of catecholamines, thyroid hormone, and growth hormone on adipose tissue

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13
Q

Mineralcorticoids (Aldosterone) Actions

A

Retain sodium and water

Excrete potassium

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14
Q

Corticosteroids well absorbed

A

from the GI tract

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15
Q

Corticosteroids metabolized in and excreted by

A

Metabolized by the liver
Metabolites are active.
Cortisone is converted to hydrocortisone.
Prednisone is converted to prednisolone.
Excreted by the kidneys

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16
Q

Corticosteroids contraindications

A

Contraindicated in patients with active untreated infections

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17
Q

Corticosteroids Cautious use in Patients with

A

hypertension and cardiovascular disorders

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18
Q

Corticosteroids may elevate

A

blood pressure, salt and water retention, and increased excretion of potassium

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19
Q

Corticosteroids cautious use

A

in postmenopausal women and others at risk for osteoporosis

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20
Q

lot less risk in ___ compared to ___ for corticosteroids

A

short term use

long term use

21
Q

Corticoseroids patients with diabetes

A

may have problems with glycemic control. (eleveted glucose)

22
Q

corticosteroids patients with ulcerative colitis

A

or peptic ulcer disease may have increased risk of gastrointestinal (GI) bleed and perforation.

23
Q

Corticosteroids: Adverse Drug Reactions (ADRs) - Muscle and skin

A

Atrophy and thinning, striae, hirsutism, poor healing

Muscle atrophy, truncal obesity, buffalo hump, moon facies

24
Q

Corticosteroids: Adverse Drug Reactions (ADRs) - Skeletal Tissues

A

Osteoporosis (up to 20% of patients)

10% of persons on long-term therapy diagnosed with a fracture

25
Q

Corticostroids can cause side effects that mirror what condition

A

cushing syndrome

26
Q

Corticosteroids: Adverse Drug Reactions (ADRs) - eyes

A

Cataracts, glaucoma, ocular infections

27
Q

Corticosteroids: Adverse Drug Reactions (ADRs) (continued) - GI

A

Peptic ulcer disease

28
Q

Corticosteroids: Adverse Drug Reactions (ADRs) (continued) - Cardiovascular

A

Hypertension

Fluid and electrolyte disturbance

29
Q

Corticosteroids: Adverse Drug Reactions (continued) - CNS

A

Delirium, agitation, insomnia, mood swings, and severe depression

30
Q

Corticosteroids: Adverse Drug Reactions (continued) - Endocrine

A

Adrenal suppression
Withdrawal syndrome if abruptly stopped
Affects glucose metabolism

31
Q

You do not have to taper corticosteroids if you are using them

A

less than 10 days

32
Q

Adrenal insufficiency drugs of choice

A

hydrocortisone, cortisone, and prednisone

33
Q

Give corticosteroids

A

in the morning before lunch, maybe before 0900

34
Q

Inflammation drugs of choice

A

Methylprednisolone, prednisone, and triamcinolone or dexamethasone can be used.

35
Q

Immune suppression drugs of choice

A

Prednisone is used because of its short half-life.

Different strength tablets make dosing and tapering easier

36
Q 
Rheumatoid arthritis (RA)
first and second line drug
A

First-line therapy is NSAIDs.

Low-dose prednisone (less than 7.5 mg/day) can be used.

37
Q

Corticosteroid Prophylaxis with a bisphosphonate and calcium/vitamin D will

A

will lower risk of osteoporosis.

38
Q

Corticosteroids: Principles of Prescribing

A

To best match the natural body rhythm, daily doses are best taken in the morning before 9 a.m (earlier in the day, preferable in the morning with food) Body releases naturally occuring corticosteroids at this time

The initial dose depends on the specific disease being treated. Maintain or adjust the dose until an acceptable response is achieved

39
Q

Corticosteroids: Principles of Prescribing - 3 and 4

A

After an acceptable response is achieved, determine the maintenance dose by tapering until the lowest dosage that maintains an adequate clinical response is reached.

If, after long-term therapy or because of spontaneous remission, the drug is to be stopped, taper off to prevent an adrenal insufficiency crisis. Tapering is generally not necessary after short-term therapy.

40
Q

Corticosteroids: Principles of Prescribing - 5 and 6

A

Most conditions that require chronic corticosteroid therapy can be well controlled on alternate-day therapy. Twice the daily dose is given every other morning before 9 a.m.
Unlike a tapering schedule, alternate-day scheduling retains the same total steroid dose.

41
Q

Corticosteroids

Short-acting agents are less likely to produce hypothalamic-pituitary-adrenal (HPA) axis suppression.

A

hypothalamic-pituitary-adrenal (HPA) axis suppression.

Long-acting agents are preferred if the effects of high doses must be sustained.

42
Q

Corticosteroids Long-acting agents are preferred if

A

if the effects of high doses must be sustained.

43
Q

Corticosteroids: Monitoring

A

Baseline and ongoing
Weight, electrolytes, glucose, and complete blood count (CBC) for all

Long-term or high-dose therapy require monitoring for GI bleeding

Lipids

Eye examination for cataracts and glaucoma in long-term therapy

44
Q

Corticosteroids - Adminsitration

A

Administration
Instruct patient to take exactly as prescribed.

Explain alternate-day or tapered dosing.

Drug should not be abruptly discontinued.

45
Q

Corticosteroids - Lifesytle

A

Need to wear medic alert bracelet
Diet high in potassium and calcium and low in sodium and carbohydrates
Caloric management

46
Q

NSAIDs MOI

A

Inhibit cyclooxygenase (COX-1 and COX-2) activity, thus inhibiting prostaglandin synthesis

47
Q

COX-1 is present in all

A

tissues and cells, especially platelets; endothelial cells; the GI tract; and renal microvasculature, glomeruli, and collecting ducts.

48
Q

COX-2 is an

A

inducible” enzyme that is synthesized mainly in response to pain and inflammation.

49
Q

NSAIDs are primarily used for ___ but also

A

pain and their anti-inflammatory activity.

Also effective antipyretic

Pharmacology for Advanced Practice Nurses (50 decks)

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