Anti-inflammatory_arthritis_gout Flashcards
Name two salicylates examples
Aspirin
81mg-baby asprin
325mg-fever reducer
-EC, PO, Chewable
Aspirin-acetaminophen-caffeine (Excedrin)-(migraine)
Bismuth subsalicylate (Pepto-Bismol)-upset stomach, diarrhea
What is chewable salicylate aspirin used for?
Chewable aspirin is given for MI, and has a faster effect than swallowing.
Salicylates MOA
inhibit synthesis of prostaglandin.
Salicylates indication is?
treat mild to moderate pain/ fever
MI’s and prevention by inhibition of platelet aggregation
What other reasons may salicylates be used for?
Salicylates can be given for MI prevention, stroke prevention
What are the side effects of salicylates
Nausea, dyspepsia (indegestion),
-clotting systems (prolonged bleeding time),
-Reye’s syndrome in children*
What are the adverse effects of aspirin due to asprin toxicity?
Salicylism- (dizziness, mental confusion, tinnitus*, sweating, hyperventilation/respiratory alkalosis.
What do salicylates interreact with?
NSAIDS
Blood thinners (Warfarin)
What can contraindicate salicylates?
bleeding abnormalities (ASA prolongs bleeding/interacts with blood thinners)
impaired renal function
What would you educate a patient about salicylates
·Patient ed:
· Stop one week before surgery
· Monitor for bruising, bleeding gums, coffee-ground emesis, Dark tarry stool
· -Do NOT give to children and teens with recent viral infection or fever- (Reyes syndrome)
· Can take with food, milk or antacid to avoid GI irritation.
NSAIDs examples
- Ibuprofen
- Naproxen
- Diclofenac
- Ketorolac
- Indomethacin (PO, R, or IV)
- nabumetone (Relafen)
- meloxicam (Mobic)
- Cyclooxygenase-2 Inhibitors (Celecoxib)
NSAIDs MOA
non-selective inhibition of cyclooxygenase
enzyme that controls pain, fever, inflammation
as well as thromboxane which stimulated the clotting of blood.
Ibuprofen indication
inflammation and pain, dysmenorrhea, musculoskeletal disorders
Naproxen indications
Joint and arthritis pain
Indomethacin indication
- acute gout,
- tendonitis, pericarditis
- neonates to promote closure of the duct between the pulmonary artery and aorta
Ketorolac Indications
*short term use (5 days), mod-severe pain & inflammation-post-op
Nabumetone indication
(Relafen)- mild-mod OA, RA and gouty arthritis
*Celecoxib indication
- Celecoxib- OA, RA, pain
NSAIDS side effects and adverse effects
Nausea & vomiting (most common),*
dyspepsia (mucosal lesion-ulcer),* burring!
GI bleed, (impacts GI a lot)* GI pain*
acute renal failure*
platelet inhibition, blood clotting issues*
-report allll the above
What should you be aware of for patients on NSAIDs about their condition?
Ask for any stomach or kidney disorders (cuz of peptic ulcer, GI pain/bleeding,
NSAIDS are hard on the stomach and kidneys (renal failure)
NSAIDS interactions
Anticoagulants
Corticosteroids
diuretics,
decrease
the antihypertensive effect of beta-blockers
(Heart meds) (aspirin)
NSAIDs contraindications
Peptic Uclers (indesgestion),*
GI bleeding*
Pregnancy D,*
bleeding disorders,*
Renal and hepatic dysfunction,*
Vit K deficiency,*
(Stomach or kidney problems)
What are all the nursing implications for NSAIDS
· NSAIDs can compromise existing renal function
· Renal toxicity can occur in patients with dehydration, heart failure, liver dysfunction, or use of diuretics or ACE inhibitors.
· Assess: CBC (to monitor for blood loss/ blood clotting ability), liver and renal function, GI disorders - bleeding or peptic ulcer
which drug decreases inflammation, fever, and pain but does not decrease platelet aggregation
COX-2
what should a nurse monitor for patients on NSAIDs
Renal function
dehydration, heart failure
liver function,
diuretics or ace inhibitors
Assess CBC -monitor bleeding disorders
Assess GI issues like peptic ulcers
Acetominophen MOA
Acts directly on the thermoregulatory cells of the hypothalamus
Acetominophen indication
Used as analgesic & antipyretic, Relief of musculoskeletal pain associated with arthritis
Acetominophen SE/AE
Acute toxicity- N/V, diarrhea, sweating, GI pain, to liver failure, coma & death
Hepatotoxicity usually associated with chronic use and overdose
hard on the liver
acetominophen interactions
with Oral anticoagulants increase bleeding
Acetaminophen contraindications
Hepatic/liver dysfunction or chronic alcoholism
What is the antidote for acetaminophen?
Acetylcysteine
Acetylcysteine AE
- can cause allergic reaction (rash, itching, angioedema, bronchospasm, hypotension) most often in response to the first dose
Nursing Implications of acetaminophen
metabolized in the liver, assess liver function test,
assess for renal disease
Max does 3,000
The absolute max is 4,000
antigout examples
Colchicine
Allopurinol
colchicine indication
acute gout attack 7-10
acute gout attack.
chronic gout
colchicine SE AE
diarrhea, sudden onset of muscle pain/tenderness, renal dysfunction
what can colchicine interact with?
grapefruit/grapefruit juice
Nursing Implications for monitoring evaluation of colchicine?
how do you know the drug is working?
Nursing Implications: Evaluation:
Improvement of pain
Decreased gout attacks
Decreased uric acid level*
Decreased swelling, pain, stiffness, and tenderness of a joint or muscle area
allopurinol SE AE
Kidney injury, hepatitis
what is a nursing implication to look out for when monitoring allopurinol pt.
Rhabdomyolysis
-dark urine color and muscle pain
what labs would a nurse monitor for a patient on allopurinol?
Uric acid levels
CBC
LFT’s
Renal function
What would you educate a pt using allopurinol on doing frequently?
Pt ed: drinking 2 L of water/day*
water decreases kidney injury and rhabdo
flush out uric acid
give examples of herbal remedies
Glucosamine
Chondroitin
what do these herbal remedies treat?
Treats pain of Osteoarthritis
Herbal remedies SE AE
GI discomfort, headache
Herbal remedies interactions
May increase insulin resistance (glucosamine),
Enhances effects of warfarin
Herbal remedies nursing implications?
Nursing Implications: Those with A-fib or anyone on warfarin should not use.
