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Pharmacology Exam #2 > Anti-Inflammatory, Antiarthritis, and Related Agents > Flashcards

Anti-Inflammatory, Antiarthritis, and Related Agents Flashcards

1
Q

What are the 5 cardinal signs of inflammation?

A
  • Pain
  • Heat
  • Redness
  • Swelling
  • Loss of Function
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2
Q

Lifespan Considerations for Anti-inflammatory, antiarthritis, and related agents In Children

A
  • More susceptible to GI and CNS effects
  • Parents need to check ingredients of OTC drugs to avoid overdose
  • Salicylates should NOT be used for fever or viral infection due to risk of Reye’s Syndrome
  • Acetaminophen is MOST commonly used
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3
Q

Lifespan Considerations for Anti-inflammatory, antiarthritis, and related agents In Adults

A
  • Caution about OTC products
  • Caution in pregnancy & lactation: SEVERE adverse effects on neonate and mother with salicylates, NSAIDs, and gold products
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4
Q

Lifespan Considerations for Anti-inflammatory, antiarthritis, and related agents In Older Adults

A
  • More susceptible to adverse effects
  • Dose adjustments may be needed
  • 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
Mechanism of Action

A
  • Inhibit synthesis of prostaglandin

(made from Willow Bark)

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6
Q

Salicylates
Indications

A

Mild to moderate:
* Fever
* Pain
* Inflammation

🩸Anti-coagulant

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7
Q

Salicylates
Contraindications

A

Absolute:
* Allergy
* Bleeding abnormalities
* Impaired renal function
* Chicken pox/flu in children
* Surgery within 1 week (because of anticoagulant properties)
* Pregnancy & Lactation

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8
Q

Salicylates
Adverse Effects

A
  • 🤢 GI effects: N&V, abdominal pain (due to decreased prostaglandins that protect the GI tract)
  • 🩸 Effect on clotting = has a “blood thinning” effect
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9
Q

Salicylates
Drug Interactions

A
  • Interfere with absorption of other drugs
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10
Q

Salicylates
Drug Names

A

Aspirin
MeSALamine

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11
Q

Salicylates
Assessment

A
  • Cautions and Contraindications
  • Presence of skin lesions
  • Temperature
  • CNS status; orientation & affect, reflexes, 8th cranial nerve function
  • Pulse, BP, and perfusion
  • Respirations & lung sounds
  • Liver evaluation
  • Bowel sounds
    Labs:
  • CBC
  • liver & renal function tests
  • Urinalysis
  • Stool gualac
  • Clotting times
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12
Q

Salicylates, NSAIDs, & Acetaminophen
Nursing Diagnoses

A
  • Impaired comfort (r/t CNS and GI effects)
  • Risk of altered breathing pattern (r/t toxicity)
  • Risk of altered sensory perception (r/t toxicity)
  • Knowledge deficit
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13
Q

Salicylates, NSAIDs, & Acetaminophen
Implementation/Patient Teaching

A
  • Administer with food if GI upset is severe
  • Provide small frequent meals
  • Monitor for severe reactions
  • Check all ingredients for risk of overdose
  • Comfort measures: rest, environmental control
  • Ensure pt is well hydrated
  • Monitor for excessive bleeding
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14
Q

NSAIDs: Nonsteroidal Anti-inflammatory Drugs
Mechanism of Action

A
  • BLOCK 2 enzymes that are responsible for producing prostaglandins, thromboxanes, and prostacyclins
  • COX-1: located throughout the body, involved in clotting, sodium/water balance, protecting the stomach
  • COX-2: Involved in inflammatory response

Ratio of COX-1 and COX-2 blocking properties the drug has will determine the adverse effects for that drug

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15
Q

What are the conditions of salicylate overdose?

A
  • Salicylism: excessive salicylate intake; Symptoms: lethargy, N&V, ringing in ears, diarrhea, confusion, fever
  • Salicylate Toxicity: Poisoning from too much salicylates; Symptoms: pulmonary edema, convulsions, fever, renal & respiratory failure, tetany, coma, tachycardia, dehydration
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16
Q

NSAIDs: Nonsteroidal Anti-inflammatory Drugs
Indications

A
  • Inflammation (anti-inflammatory)
  • Pain (analgesic)
  • Fever (antipyretic)
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17
Q

NSAIDs: Nonsteroidal Anti-inflammatory Drugs
Drug Names

A

Propionic Acids
Ibuprofen
Naproxen
Acetic Acids
Indomethacin
Ketolorac
Oxicam Derivatives
Meloxicam
Cyclooxygenase-2 inhibitors
Celecoxib

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18
Q

NSAIDs: Nonsteroidal Anti-inflammatory Drugs
Adverse Effects

A
  • GI effects (Bleeding)
  • CNS effects
  • CV effects - HTN
  • Bone marrow depression (from the depressed prostaglandins); (3 or more months of daily use)
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19
Q

NSAIDs: Nonsteroidal Anti-inflammatory Drugs
Contraindications

A

Absolute:
* Allergy to any NSAID or salicylate
* Celecoxib is also contraindicated in presence of an allergy to sulfonamides
* CV dysfunction or hypertension
* Peptic Ulcer
* GI Bleeding
* Pregnancy & lactation

Cautions:
* Renal & hepatic dysfunction

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20
Q

NSAIDs: Nonsteroidal Anti-inflammatory Drugs
Drug Interactions

A
  • Loop Diuretics - Makes them less effective
  • Beta Blockers - Makes them less effective
  • Lithium - leads to lithium toxicity

Take diuretics, then several hours later take NSAID

21
Q

Acetaminophen
Mechanism of Action

A
  • Acts directly on the thermoregulatory cells of the hypothalamus: causes vasodilation & sweating = cooling effect
  • Analgesic mechanism of action unknown
22
Q

Acetaminophen
Indications

A
  • Pain (analgesic)
  • Fever (antipyretic)
  • Prophylactic for children receiving diphtheria-pertussis-tetanus immunizations
  • Relief of musculoskelatal pain associated with arthritis
23
Q

Acetaminophen
Contraindications

A

Absolute:
* Allergy

Cautions:
* Pregnancy & Lactation
* Hepatic dysfunction or chronic alcoholism

24
Q

Acetaminophen
Adverse Effects

A
  • Rebound headaches
  • RARE: hemolytic anemia
  • Renal dysfunction
  • Skin rash & fever
  • Hepatotoxicity usually associated with chronic use & overdose
25
Q

Acetaminophen
Drug Interactions

A
  • Oral anticoagulants (increased bleeding)
  • Barbituates, Carbamazepine, hydantoins, rifampin (increased risk of hepatotoxicity)
26
Q

Acetaminophen
Antidote

A

Acetylcysteine
(Replenishes glutathione so it can bind to the toxic metabolites of acetaminophen)

27
Q

NSAID & Acetaminophen
Assessment

A

History:
* Contraindications & Cautions

Physical:
* skin lesions
* Temperature
* Orientation, reflexes, affect
* Pulse, BP, perfusion
* Respirations & lung sounds
* liver evaluation
* bowel sounds

Labs:
* CBC
* liver & renal function tests
* Urinalysis
* stool guaiac
* electrolyte levels

28
Q

Gold Compounds
Mechanism of Action

A
  • Absorbed by macrophages which results in inhibition of phagocytosis
  • Tissue destruction is decreased
29
Q

Gold Compound
Drug Name

A

Auranofin

30
Q

Gold Compounds
Contraindications

A
  • Allergy
  • Diabetes
  • Congestive Heart Failure
  • Renal or hepatic impairment
  • Blood dyscrasias
  • Pregnancy & Lactation
31
Q

Gold Compounds
Indications

A

Anti-arthritis
(only when other traditional treatments haven’t worked)

32
Q

Gold Compounds
Adverse Effects

A
  • Stomatitis
  • Glossitis
  • Gingivitis
  • Bone marrow depression
  • Dermatitis
  • Interstitial pneumonitis
  • Anaphylactic shock
33
Q

Gold Compounds
Drug Interactions

A

(Causes severe toxicity)
* Penicillamine
* Antimalarials
* Cytotoxic drugs
* Immunosuppressants

34
Q

What are Disease Modifying Antirheumatic Drugs (DMARDs)?

A
  • Treat arthritis: aggressively affects the process of inflammation
  • Two types: Biologic (TNF blockers) and Nonbiologic
  • Drug side effects can be severe to life threatening (due to inhibition of any inflammation response)
  • Used early in diagnosis before damage to the joint has occurred
35
Q

DMARD: Tumor Necrosis Factor (TNF) Blockers
Mechanism of Action

A
  • Decreases 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
36
Q

DMARD: Tumor Necrosis Factor (TNF) Blockers
Indications

A
  • Rheumatoid Arthritis
  • Polyarticular juvenile arthritis
  • psoriatic arthritis
  • plaque psoriasis
  • ankylosing spondylitis

(Often the first line used with progressing arthritis)

37
Q

DMARD: Tumor Necrosis Factor (TNF) Blockers
Drug Names

A
  • Adalimumab (monoclonal antibody)
  • Etanercept (receptor fusion protein)
  • Infliximab (monoclonal antibody)
38
Q

DMARD: Tumor Necrosis Factor (TNF) Blockers
Contraindications

A

Absolute:
* Acute infection
* Cancer
* Sepsis
* Tuberculosis
* Hepatitis
* Myelosuppression or demyelinating disorders

Cautions:
* Pregnancy & Lactation
* Hepatic & renal disorders

39
Q

DMARD: Tumor Necrosis Factor (TNF) Blockers
Adverse Effects

A
  • Black Box warning: development of lymphomas & other cancers, serious to fatal infections
  • Injection site irritation
40
Q

DMARD: Tumor Necrosis Factor (TNF) Blockers
Drug Interactions

A
  • Immune suppressants
  • Live vaccines
41
Q

DMARD: Tumor Necrosis Factor (TNF) Blockers
Assessment

A

History:
* Contraindications & Cautions

Physical:
* skin lesions
* Temperature, any sign of infection
* Delayed wound healing
* CNS status: orientation, reflexes, affect, 8th cranial nerve function
* Arrange cancer screenings before and during
* Monitor range of motion, movement, & pain levels
* Respirations & lung sounds

Labs:
* CBC
* Liver & Renal function tests
* TB Test

42
Q

DMARD: Tumor Necrosis Factor (TNF) Blockers
Nursing Diagnoses

A
  • Acute pain (r/t disease process & CNS)
  • Risk of infection (r/t drug effects)
  • Risk of fear and anxiety (r/t disease process and drug effects)
  • Knowledge deficit
43
Q

DMARD: Tumor Necrosis Factor (TNF) Blockers
Implementation/Patient Teaching

A
  • Teach pt proper administration; subq injections; safe disposal of needles and syringes
  • Monitor for immune suppression reactions
  • Monitor for CNS toxicity
  • Arrange for continuation of nondrug therapies
  • Ensure that pt has routine cancer screening and regular follow ups
44
Q

Antigout agents
Drug Names

A
  • Allopurinol (long-term)
  • Colchicine (acute)
45
Q

Antigout agents
Indications

A

Treatment of gout

  • Elevated uric acid levels and urate crystal deposits in kidneys and joints
  • Extremely painful due to the crystal deposits causing local acute inflammation
46
Q

Antigout agents
Mechanism of Action

A
  • Colchicine: Decreases inflammation by blocking the action of neutrophils
  • Allopurinol: Inhibits xanthine oxidase, an enzyme needed to convert xanthine to uric acid
47
Q

Antigout agents
Contraindications

A

Absolute:
* Allergy

Caution:
* Severe renal and hepatic disease

48
Q

Antigout agents
Adverse Effects

A
  • GI distress
  • Hepatic & renal dysfunction
  • Colchicine: blood dyscrasias & rhabdomyolysis
49
Q

Antigout agents
Drug Interactions

A

Colchicine: Numerous

Allopurinol: Warfarin

Pharmacology Exam #2 (14 decks)

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