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pharm 140 > ch 16 anti-inflammatory drugs > Flashcards

ch 16 anti-inflammatory drugs Flashcards

1
Q

salicylates

A

used in managing conditions from headache to MI

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2
Q

NSAIDs

A

used primarily as anti-inflammatory drugs but are also used as analgesic

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3
Q

acetylsalicylic acid (aspirin) indications

A

mild to moderate pain
fever
prevents platelet aggregation

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4
Q

acetylsalicylic acid (aspirin) pharmacokinetics

A

absorbed in stomach/small intestine

highly protein bound

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5
Q

acetylsalicylic acid (aspirin) pharmacodynamics

A

fever: inhibits PGE2 synthesis in hypothalamus
inflammation: peripheral inhibition of prostaglandin
antiplatelet: irreversible inhibition of thromboxane A2

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6
Q

acetylsalicylic acid (aspirin) contraindications

A 
hypersensitivity
peptic ulcer disease
bleeding disorders
"children with illness"
last trimester of pregnancy
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7
Q

acetylsalicylic acid (aspirin) adverse effects

A 
renal failure
abnormal bleeding
GI upset
drowsiness
confusion
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8
Q

acetylsalicylic acid (aspirin) interactions

A

coumadin/heparin (may icnrease r/o bleeding)
beta blockers (may decrease antihypertensive effect)
anti-diabetic drugs (may increase hypoglycemic effect)
corticosteroids (may decrease aspirin effects)
other drugs that are highly protein bound

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9
Q

acetylsalicylic acid (aspirin) nursing dx

A

acute or chronic pain r/t ineffectiveness of aspirin

risk for injury (GI bleed, hepatic/renal toxicity) r/t drug therapy

disturbed sensory perception r/t blurred vision or tinnitus

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10
Q

acetylsalicylic acid (aspirin) interventions

A

max therapeutic effects: give with milk/food to avoid GI upset, use uncoated aspirin for cardiac, use coated aspirin in stomach ulcer pts

min adverse effects: stop drug 5-7 days before elective surgery to allow time for production and release of new platelets

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11
Q

acetylsalicylic acid (aspirin) assessments

A

during prolonged therapy: assess hematocrit, Hb level, PT, INR, renal function

monitor for tinnitus

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12
Q

acetylsalicylic acid (aspirin) pt education

A

do not crush enteric coated tabs
discard if strong vinegar odor
ibuprofen may decrease low dose aspirin therapy effects

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13
Q

aspirin is contraindicated in

A

children with varicella

can cause Reye syndrome (rapid worsening brain disease with flu-like symptoms, vomiting, seizures)

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14
Q

NSAIDs

A

inhibit COX and prostaglandin synthesis

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15
Q

NSAID black box warning

A

may increase risk of MI or stroke
may cause GI bleed
may cause aseptic meningitis

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16
Q

ibuprofen indications

A 
arthritis
mild to moderate pain
dysmenorrhea
migraine
fever
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17
Q

ibuprofen pharmacokinetics

A

absorbed from GI
peak 1-2 hrs
highly protein bound

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18
Q

ibuprofen pharmacodynamics

A

inhibited synthesis or release of prostaglandins

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19
Q

ibuprofen contraindications

A

GI disease

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20
Q

ibuprofen adverse effects

A 
GI upset/bleeding
hepatotoxicity, acute renal failure
increased risk of CVA/MI
fluid/electrolyte imbalances
skin rash
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21
Q

ibuprofen interactions

A

digoxin (increase risk of dig toxicity)
blood thinners (increased risk for bleeding)
cyclosporine (nephrotoxicity)

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22
Q

ibuprofen nursing dx

A

acute/chronic pain r/t ineffectiveness of ibuprofen therapy

increased risk for injury r/t incorrect self admin OR drug induced GI bleeding OR hepatic/renal toxicity

ineffective protection r/t blood dyscrasias

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23
Q

ibuprofen interventions

A

max therapeutic effect: give with food or milk to decrease GI distress

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24
Q

ibuprofen pt education

A

medication has CV risk
monitor BP; drug can cause HTN
avoid alcohol use
avoid excessive exposure to sunlight and wear sunscreen

25
Q

ibuprofen nursing interventions

A

monitor renal/hepatic function
(BUN, Cr, liver enzymes, Hg, Hct)
monitor and report vision changes in pt

26
Q

para-aminophenol derivatives

A

analgesic/antipyretic

prototype acetaminophen

27
Q

acetaminophen indications

A

fever

mild pain

28
Q

acetaminophen pharmacokinetics

A

given PO, absorbed GI
peak 60 min
half life 1-3.5 hrs

29
Q

acetaminophen action

A

primarily centrally acting

inhibits prostaglandin synthesis in CNS

30
Q

acetaminophen contraindications

A

hepatic disease
viral hepatitis
alcoholism
warfarin/heparin

31
Q

acetaminophen adverse effects

A

overdose can be fatal

hypoxia, dyspnea, atelectasis, pleural effusion, pulmonary edema, stridor

32
Q

acetaminophen interactions

A 
activated charcoal
antacids
ethanol (alcohol) (liver damage)
hydantoins
warfarin
sulfinpyrazone (risk for liver damage)
33
Q

acetaminophen pregnancy category

A

category B

34
Q

acetaminophen nursing dx

A

acute/chronic pain r/t ineffectiveness of acetaminophen

risk for injury r/t drug induced hepatic and renal toxicity

ineffective protection r/t potential blood dyscrasias

35
Q

acetaminophen interventions

A

max therapeutic effect: given without regard to meals

min adverse effect: periodic CBC, platelet count, liver and renal function tests for pts on long term therapy, monitor IV infusions closely

36
Q

acetaminophen pt education

A

pay attention to dose limit

seek medical attention if rash or other reactions occur

37
Q

acetaminophen in children

A

use with children under 2 should be checked with provider first

appears in breastmilk in low levels

38
Q

tylenol is contraindicated in

A

pt with hepatitis

39
Q

serotonin-selective drugs

A

used to relieve pain and inflammation r/t migraine headaches
not useful for other headaches or other pain/inflammation
-triptans

40
Q

sumatriptan (Imitrex) indications

A

migraine headache, cluster headache

41
Q

sumatriptan (Imitrex) pharmacokinetics

A

given PO, intranasally, subQ

met in liver, excreted by kidneys

42
Q

sumatriptan (Imitrex) action

A

selective for 5-HT1B/1D receptors located on cranial blood vessels and sensory nerves of trigeminovascular system

stimulation of receptors results in vasoconstriction

43
Q

sumatriptan (Imitrex) contraindications

A

CAD

ischemic cardiac diseases

44
Q

sumatriptan (Imitrex) adverse effects

A 
coronary artery vasospasm
cardiac dysrhythmias
angina
myocardial ischemia
dizziness
45
Q

sumatriptan (Imitrex) interactions

A

SSRIs: risk for serotonin syndrome
MAOIs: may reduce Imitrex clearance and use within 2 weeks of MAOI is contraindicated

46
Q

sumatriptan (Imitrex) pregnancy category

A

category C

47
Q

sumatriptan (Imitrex) nursing dx

A

risk for impaired tissue perfusion r/t cardiovascular or cerebrovascular events

risk for injury r/t weakness, dizziness, lightheadedness

48
Q

sumatriptan (Imitrex) interventions

A

max therapeutic effect: confirm diagnosis of migraine, administer as soon as headache begins

min adverse effect: assess for CV history, monitor for s/s allergy or vasospasm

monitor for seizures

49
Q

sumatriptan (Imitrex) pt education

A

identify migraine triggers

drug will only treat migraines and will not prevent them

50
Q

fever

A

temperature reg = hypothalamus
pyrogens: substances that cause fever
fever causes activation of monocytes/macrophages that secrete cytokines
cytokines increase synthesis and secretion of prostaglandins in hypothalamus

51
Q

inflammation

A

local: warmth. swelling, redness, pain, LOF

acute inflammation is divided into cellular and vascular responses

52
Q

cellular inflammation response

A
  1. margination of WBC to periphery of blood vessels
  2. emigration of WBC to tissue spaces
  3. chemotaxis; cellular debris becomes more “attractive” to WBC
  4. phagocytosis; neutrophils and macrophages engulf cellular debris
53
Q

prostaglandin

A

modulates some components of inflammation, body temp, pain transmission, platelet aggregation

derived from arachidonic acid and covnerted by cyclooxygenase (COX)

54
Q

COX-1

A

synthesizes prostaglandins that are involved in the regulation of normal cell activity

55
Q

COX-2

A

appears to produce prostaglandins mainly at sites of inflammation

56
Q

platelet aggregation

A

first temp in sequence of events that leads to a thrombus (clot)

platelet aggregation is increased in smokers and hypercholesterolemia

57
Q

migraine headache

A

2 types:

migraine with aura: sensory disturbances like light flashes and blind spots
migraine without aura

58
Q

migraine pathology

A

it is postulated that migraine begins when intracranial blood vessels dilate

this dilation stimulates the trigeminovascular system resulting in abnormally excitable neurons that send pain impulses to the brain’s pain receptors

pharm 140 (18 decks)

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