ANTI INFLAMMATORIES UNIT 2 Flashcards
Which drug class is anti-inflammatory? SELECT ALL THAT APPLY
A.NSAIDS
B. ANTI GOUT
C. OPIODS
D. CALCIUM CHANNEL BLOCKERS
A.NSAIDS
B. ANTI GOUT
What is the therapeutic effect of an NSAID?
drug that decreases inflammation, decreases fever, and decreases pain
Drugs
-Celecoxib
-Ibuprofen
-Aspirin
What is COX-1 (Cyclooxygenase (COX) enzyme)-1
protects stomach lining and regulates blood platelet
What is COX-2 (Cyclooxygenase (COX) enzyme)-2
triggers pain and inflammation
Which of the Cyclooxygenase (COX) enzyme does NSAID block?
A. COX 1
B. COX 2
C. BOTH
D. NEITHER
NSAIDS block COX 1 and COX 2 resulting in
Decreased stomach lining protection (risk for ulcer) and
chance for bleeding – not desired response
* Decreased inflammation and pain – desired response
Which one of the following is a Selective NSAID and Which one COX does it inhibit?
A. Ibuprofen (COX -1 , COX-2)
B. Acetominophen (COX -1 , COX-2)
C. Aspirin (COX-1 , COX-2)
D. Celecoxib (COX-1 , COX -2)
D. Celecoxib COX -2
Which of the following is a Non-Selective NSAID And which COX does it inhibit? SELECT ALL THAT APPLY
A. Ibuprofen (COX -1 , COX-2)
B. Acetominophen (COX -1 , COX-2)
C. Aspirin (COX-1 , COX-2)
D. Celecoxib (COX-1 , COX -2)
A. Ibuprofen (COX -1 , COX-2)
C. Aspirin (COX-1 , COX-2)
What Cyclooxygenase (COX) enzyme does ASPIRIN inhibit?
(COX-1 , COX-2)
What is Aspirin used for ?
Use
* Pain and arthritic inflammation
* Analgesic, antipyretic, anti-inflammatory
* Decreases platelet aggregation (anti-platelet)
Should aspirin be taken with minimal food ?
A. No
B. Yes
B. Yes
ASPIRIN IS IRRITATING TO THE STOMACH LINING
Should Aspirin be given to children?
A. Yes
B. No
B. No
What is a Side-Effect of Aspirin?
Side effects
* Dizziness, drowsiness, headache
* GI distress
What is a Adverse-Effect of Aspirin?
Tinnitus, hearing loss (signs of toxicity)
* Bleeding, GI ulceration
* Thrombocytopenia
* Reye’s syndrome (in children)
Should you use Aspirin when a patient has been using Heparin and drinking ginger tea?
NO
Increased bleeding with anticoagulants and other
NSAIDs
* Increased gastric ulcer risk with glucocorticoids
* The 4 G’s – garlic, ginseng, ginko biloba, and green
tea – can cause an increase in bleeding
* Other protein binding drugs
Caution for ASPIRIN USE
Caution
* Do not take with other NSAIDs
* Avoid during the last trimester of pregnancy
* Do not give to children with flu or virus symptoms as
it may lead to Reye syndrome
* Children + virus + aspirin = Reye’s syndrome
* Symptoms can include N/V, change in level of
consciousness, seizures, coma, death
- A client is prescribed Aspirin . The nurse recognizes that the client needs further teaching when……
A. taken when a child is experiencing flu
B. taken when a patient is experiencing pain due to rheumatoid arthritis.
C. taken with plenty of water
D. Itaken with food
A. taken when a child is experiencing flu
- A client is prescribed Aspirin. The nurse recognizes that the client understands the drug when………
A. Ringing of the ear is a side effect
B. The patient stops aspirin 7 days before surgery.
C. Bruising is considered a side effect
D. Blood in my stool indicate hemorrhoids
B. The patient stops aspirin 7 days before surgery.
What Cyclooxygenase (COX) enzyme does IBUPROFEN inhibit?
COX -1 AND COX-2
What is the use of ibuprofen?
Pain, osteoarthritis, rheumatoid arthritis
MOST COMMONLY USE NSAID
CAUTION INTERACTION FOR IBUPROFEN
Interactions
* Other drugs & herbs that cause bleeding
* Other protein binding drugs
- Contraindications
- Bleeding disorders
What Cyclooxygenase (COX) enzyme does CELECOXIB inhibit?
COX-2
What is the use for Celecoxib
- Use
Osteoarthritis, rheumatoid arthritis,
ankylosing spondylitis, pain, dysmenorrhea
Side effects of Celecoxib
Dizziness, headache
Adverse reactions of Celecoxib
Adverse reactions
GI distress/ulceration, hypertension
Peripheral edema, renal dysfunction
Should you give a patient Celecoxib if the pt has cardiac disease?
A. Yes
B. No
B. No
Contraindication
History of heart disease
Assessment for NSAIDS AND ASPIRIN
Assessment
* Obtain a drug and herbal history and report any
possible drug-drug or herb-drug interactions. These
drugs are highly protein binding
* Assess for GI distress and peripheral edema, which
are common side effects of NSAIDs.
* Determine patient’s medical history (bleeding
problems/ulcer)
* Allergies
NURSING INTERVENTION/TEACHING ASPIRIN AND NSAID
Nursing interventions/Teaching
Observe the patient for bleeding gums, petechiae,
ecchymoses, or black tarry stools (less common with
celecoxib)
Report if patient has GI discomfort.
Advise patient to avoid alcohol when taking NSAIDs.
Alert patient that many complementary and alternative
therapies may interact with NSAIDs and could cause
bleeding.
* Take it with food to decrease stomach upset
Instruct patient to discontinue aspirin approximately 7
days before surgery to reduce risk of bleeding.
* Warn parents not to give aspirin for virus or flu symptoms
to children to avoid risk of Reye syndrome
A patient has been advised to take ibuprofen. When
teaching the patient about ibuprofen, which instruction
should the nurse include? (Select all that apply.)
A. Avoid taking aspirin with ibuprofen.
B. Take with food to reduce GI upset.
C. Monitor for bleeding gums, nosebleeds, black tarry stools.
D. Take herbs, ginkgo and garlic, with ibuprofen.
E. Take NSAIDs 2 days before menstruation to decrease discomfort.
ANS: A, B, C
One should avoid aspirin with NSAIDs. Food may be
taken with NSAIDs to reduce GI upset. Patients should
be taught to monitor for bruising and bleeding. Many
herbs, such as ginkgo, garlic, and ginger, should be
avoided because bleeding may increase. Female patients
should avoid NSAIDs for 1 to 2 days before menses to
prevent excessive bleeding.
An older adult patient takes aspirin for
arthritis pain. Which statement made by the
patient is of most concern to the nurse?
A. “I feel like I am coming down with a cold.”
B. “My stomach aches and burns.”
C. “I have a bad headache.”
D. “I feel dizzy when I get up fast.”
B. “My stomach aches and burns.”
Older adults frequently use NSAIDs to treat pain
associated with inflammation caused by
osteoarthritis, rheumatoid arthritis, and
neuromuscular-skeletal disorders. With use of
NSAIDs, gastrointestinal distress (including
ulceration) is four times more common in older
adults; hospitalization is often necessary.
A 65-year-old man has been diagnosed
with chronic gout. The nurse anticipates
that the patient will be treated with
A. allopurinol.
B. colchicine.
C. adalimumab.
D. infliximab.
A. allopurinol.
Allopurinol (Zyloprim) inhibits the final steps of uric acid
biosynthesis and therefore lowers serum uric acid levels,
preventing the precipitation of an attack. This drug is
frequently used in the treatment of chronic gout as a
prophylactic to prevent reoccurrences. Colchicine is effective
in alleviating acute symptoms of gout.
Infliximab (Remicade)
and adalimumab (Humira) are immunomodulators used to
treat moderate to severe rheumatoid arthritis by disrupting the
inflammatory process and delaying the disease progression.
Allupurinol Use
Anti gout medication, maintainence drug to prevent gout attack. Uric acid inhibitor ( BLOCKER)
Assessment for Pt’s taking Allupurinol
Assessment
•Assess serum uric acid value for future comparisons
•Pain level
•For swelling associated with uric crystal formation
Adverse Reaction for Allupurinol
Adverse reactions
•Liver or kidney damage
Nursing Interventions/Teaching for Allupurinol
Record urine output.
➢Monitor lab tests for renal and hepatic function.
➢Instruct patient to increase fluid intake to increase drug and uric acid excretion.
➢Advise patient to have a yearly eye exam as visual changes can result from prolonged use of allopurinol.
➢Decrease intake of high uric acid foods
What food are high in Uric Acid ?
Purine-containing foods: organ meats, sardines, salmon, gravy, herring, liver,
Meat soups, and alcohol (especially beer)
