Anti-inflammatories

Question 1

What are the 5 cardinal signs of Inflammation?

Answer 1

Redness (erythema), swelling (edema), heat, pain, Loss of function.

Question 2

What prototype drugs are listed as NSAIDs?

Answer 2

Salicylates (Aspirin)

Propionic acid Derivatives (ibuprofen)

Selective COX-2 Inhibitors (Celecoxib)

Question 3

What prototype drugs are listed as Immune Modulators?

Answer 3

Infliximab

Question 4

What prototype drugs are listed as Uric Acid Biosynthesis Inhibitors?

Answer 4

Allopurinol

Question 5

What is the role of Cyclooxygenase (COX)?

Answer 5

Enzyme responsible for converting arachidonic acid into prostaglandins.

Question 6

What are prostaglandins?

Answer 6

Causes inflammation and pain at the site of injury.

Question 7

What are the two types of COX enzymes?

Answer 7

Cox-1

Cox-2

Question 8

What are the functions of COX-1?

Answer 8

1) Protects stomach lining
2) Decreases fever
3) Promotes platelet aggregation.

Question 9

What are the functions of Cox-2?

Answer 9

1) Triggers pain and inflammation

Question 10

What happens if we inhibited COX-1 enzyme?

Answer 10

1) Loss of stomach lining protection= ulcer

2) Prevents blood clotting.

Question 11

What happens if we inhibited COX-2 enzyme?

Answer 11

1) Reduces Pain

2) Suppresses inflammation

Question 12

Which COX enzymes do aspirin and ibuprofen inhibit?

Answer 12

both COX-1 and Cox-2

Question 13

Which COX enzyme does celecoxib block?

Answer 13

Only COX-2 enzyme.

It is classified as a COX-2 inhibitor.

Question 14

What is the abbreviation of Salicylates?

Answer 14

ASA

Question 15

What do anti-inflammatory agents do?

Answer 15

1) Relieves pain
2) Reduce fever
3) Anticoagulant
4) Reduces inflammation

Question 16

Should we take ASA with any other NSAIDs?

Answer 16

No! Taking both would decrease blood levels and effectiveness of NSAIDs.

Question 17

What is another name for Salicylates and ASA?

Answer 17

Aspirin.

Question 18

What is the function of Aspirin?

Answer 18

It is a prostaglandin inhibitor that decreases inflammatory process.

It is also an anti-platelet aggregation drug. It decreases blood clotting.

Question 19

Can ASA be given to cardiac/CVA patients?

Answer 19

Yes.

Question 20

What is the MOA of Aspirin?

Answer 20

Inhibits prostaglandin synthesis and inhibits hypothalamic heat regulator.

Question 21

What are the uses for Aspirin?

Answer 21

1) Reduce pain, inflammation and fever.
2) Inhibits platelet aggregation
3) Can be used for Osteoarthritis and rheumatoid arthritis

Question 22

What are the adverse effects of Aspirin?

Answer 22

1) Tinnitus
2) GI bleed
3) Agranulocytosis (Severe and dangerous low levels of leukocytes)
4) Hemolytic anemia
5) Thrombocytopenia (low platelet count)
6) Hepatotoxicity

Question 23

What is Reye’s Syndrome?

Answer 23

A rare but serious condition which causes swelling in the brain and liver in children and teenagers.

Question 24

What can cause Reye’s syndrome?

Answer 24

Administering ASA to children who have flu like symptoms

Question 25

What are the symptoms of Reye's Syndrome?

Answer 25

Vomiting, Lethargy, delirium, and coma.

Question 26

Are ibuprofen and naproxen are highly protein bound?

Answer 26

Yes.

Question 27

What is the MOA of Ibuprofen?

Answer 27

Inhibition of prostaglandin synthesis. This causes relief pain and inflammation

Question 28

What are the adverse effects of Ibuprofen?

Answer 28

Hearing loss, tinnitus.

Question 29

What are the life threatening adverse effects of ibuprofen?

Answer 29

Anemia, neutropenia, thrombocytopenia, nephrotoxicity, anaphylaxis

Question 30

What is the contraindication for Ibuprofen?

Answer 30

Coronary Artery Bypass Grating (CABG) due to increased heart attacks from ibuprofen.

Question 31

What do you take Ibuprofen for?

Answer 31

To reduce inflammatory process; relieve pain; reduce fever; for arthritic conditions

Question 32

A patient has severe arthritis and wants to relieved of their pain with medication. What NSAID would you give to the patient?

Answer 32

COX-2 inhibitor; celecoxib

Question 33

What is the MOA of celecoxib?

Answer 33

Inhibits COX-2, which normally promotes prostaglandin synthesis and inflammatory response but does not inhibit COX-1.

Question 34

What is celecoxib taken for?

Answer 34

Osteoarthritis, rheumatoid arthritis, moderate to severe pain, ankylosing spondylitis

Question 35

What are the adverse reactions to celecoxib?

Answer 35

Peripheral edema, bleeding, HTN (hypertension)

Question 36

What is the life threatening adverse reaction to celecoxib?

Answer 36

CVA

Question 37

If NSAIDs do not control immune mediated arthritic pain, what type of medication should we use?

Answer 37

DMARDS (disease modifying antirheumatic drugs)

Question 38

What drugs are classified as DMARDS?

Answer 38

Immunosuppressants, immunomodulators, and antimalarials

Question 39

What is the main function of DMARDS?

Answer 39

To alleviate symptoms of RA (psoriatic arthritis, Chrohn's and ulcerative colitis)

Question 40

How do immunomodulators work?

Answer 40

They disrupt inflammatory process and delay disease progression in severe RA. Neutralizes TNF that is a contributor to synovitis.

Question 41

What is the MOA of Infliximab?

Answer 41

Binds to TNF and prevents it from attaching to TNF receptors on synovial cell surfaces Reduces infiltration of inflammatory cells and delays inflammatory process

Question 42

What uses does Infliximab have?

Answer 42

Works against RA, psoriatic arthritis, spondylitis, ulcerative colitis, Crohn disease, psoriasis

Question 43

What adverse effects can come from Infliximab?

Answer 43

Severe infections, blood pressure fluctuation, seizures, elevated liver enzymes, Steven-Johnson Syndrome, anemia

Question 44

What are the contraindications for Infliximab?

Answer 44

Heart Failure

Question 45

What is Gout?

Answer 45

Inflammatory condition that attacks joints, tendons and other tissues.

Question 46

How does Gout work?

Answer 46

Uric acid accumulation leads to developing uric acid crystals in joints.

Question 47

What should you do if the patient has an acute gout attack?

Answer 47

Increase fluid intake, avoid foods high in purines like organ meats, liver, gravy, and beer, and NSAIDs.

Question 48

What could you do to prevent infections for a patient taking Infliximab?

Answer 48

Making sure the patient is up to date on their vaccines.

Question 49

what is Steven-Johnson Syndrome?

Answer 49

A rare but serious disorder of the skin and m mucus membrane. It is a reaction to taking a medication while having flu-like symptoms. It starts out as a rash all over the skin. Steven-Johnson Syndrome becomes Toxic Epidermal Necrolysis when the painful rash covers more than 30% of the total body surface area.

Question 50

What is the goal of a nurse who has a patient with Steven-Johnson Syndrome?

Answer 50

Pain management Finding out which medication caused the syndrome Wound Care. This is a medical emergency.

Question 51

What is the MOA of Allopurinol?

Answer 51

Inhibits the final step of uric acid biosynthesis and lowers serum uric acid levels.

Question 52

What is Allopurinol used for?

Answer 52

Prophylactic (prevent from forming) for gout, chronic tophaceous gout.

Question 53

What are the adverse reactions for Allopurinol?

Answer 53

Hepatic impairment, angioedema, hyperglycemia, hyperlipidemia.

Question 54

Can you use Allopurinol in a patient with acute gout attack?

Answer 54

No. Before giving allopurinol, get the pain under control.

Question 55

What adverse effect are you most concerned about when the patient is taking ibuprofen?

Answer 55

Poor renal clearance Nephrotoxicity