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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
**Acetaminophen** Drug Interactions
* Oral anticoagulants *(increased bleeding)* * Barbituates, Carbamazepine, hydantoins, rifampin *(increased risk of hepatotoxicity)*
26
**Acetaminophen** Antidote
**Acetylcysteine** *(Replenishes glutathione so it can bind to the toxic metabolites of acetaminophen)*
27
**NSAID & Acetaminophen** Assessment
**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
**Gold Compounds** Mechanism of Action
* Absorbed by macrophages which results in inhibition of phagocytosis * Tissue destruction is decreased
29
**Gold Compound** Drug Name
**Auranofin**
30
**Gold Compounds** Contraindications
* Allergy * Diabetes * Congestive Heart Failure * Renal or hepatic impairment * Blood dyscrasias * Pregnancy & Lactation
31
**Gold Compounds** Indications
**Anti-arthritis** *(only when other traditional treatments haven't worked)*
32
**Gold Compounds** Adverse Effects
* Stomatitis * Glossitis * Gingivitis * Bone marrow depression * Dermatitis * Interstitial pneumonitis * Anaphylactic shock
33
**Gold Compounds** Drug Interactions
*(Causes severe toxicity)* * Penicillamine * Antimalarials * Cytotoxic drugs * Immunosuppressants
34
What are Disease Modifying Antirheumatic Drugs (DMARDs)?
* 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
**DMARD: Tumor Necrosis Factor (TNF) Blockers** Mechanism of Action
* 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
**DMARD: Tumor Necrosis Factor (TNF) Blockers** Indications
* Rheumatoid Arthritis * Polyarticular juvenile arthritis * psoriatic arthritis * plaque psoriasis * ankylosing spondylitis *(Often the first line used with progressing arthritis)*
37
**DMARD: Tumor Necrosis Factor (TNF) Blockers** Drug Names
* **Adalimumab** *(monoclonal antibody)* * **Etanercept** *(receptor fusion protein)* * **Infliximab** *(monoclonal antibody)*
38
**DMARD: Tumor Necrosis Factor (TNF) Blockers** Contraindications
**Absolute:** * Acute infection * Cancer * Sepsis * Tuberculosis * Hepatitis * Myelosuppression or demyelinating disorders **Cautions:** * Pregnancy & Lactation * Hepatic & renal disorders
39
**DMARD: Tumor Necrosis Factor (TNF) Blockers** Adverse Effects
* **Black Box warning**: development of lymphomas & other cancers, serious to fatal infections * Injection site irritation
40
**DMARD: Tumor Necrosis Factor (TNF) Blockers** Drug Interactions
* Immune suppressants * Live vaccines
41
**DMARD: Tumor Necrosis Factor (TNF) Blockers** Assessment
**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
**DMARD: Tumor Necrosis Factor (TNF) Blockers** Nursing Diagnoses
* 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
**DMARD: Tumor Necrosis Factor (TNF) Blockers** Implementation/Patient Teaching
* 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
**Antigout agents** Drug Names
* **Allopurinol** *(long-term)* * **Colchicine** *(acute)*
45
**Antigout agents** Indications
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
**Antigout agents** Mechanism of Action
* **Colchicine**: Decreases inflammation by blocking the action of neutrophils * **Allopurinol**: Inhibits xanthine oxidase, an enzyme needed to convert xanthine to uric acid
47
**Antigout agents** Contraindications
**Absolute:** * Allergy **Caution:** * Severe renal and hepatic disease
48
**Antigout agents** Adverse Effects
* GI distress * Hepatic & renal dysfunction * **Colchicine**: blood dyscrasias & rhabdomyolysis
49
**Antigout agents** Drug Interactions
**Colchicine**: Numerous **Allopurinol**: Warfarin

Pharmacology Exam #2 (14 decks)

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