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Pharmacology > Ch. 8: Anti-Inflammatory Drugs > Flashcards

Ch. 8: Anti-Inflammatory Drugs Flashcards

1
Q

a drug that prevents or limits tissue and blood vessel responses to injury or invasion

A

anti-inflammatory drugs

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2
Q

drugs similar to natural cortisol that prevent or limit inflammation by slowing or stopping inflammatory mediator production

A

corticosteroids

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3
Q

an enzyme important in converting body chemicals to mediators of inflammation

A

cyclo-oxygenase (COX)

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4
Q

a chemical made by the body that binds to receptor sites and causes inflammatory responses

A

histamine

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5
Q

invasion of the body by microorganisms that disturb the normal environment and cause harm

A

infection

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6
Q

a syndrome of tissue and blood vessel responses to injury or invasion

A

inflammation

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7
Q

a group of chemicals made by the body that cause some of the signs and symptoms of inflammation, especially pain

A

kinins

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8
Q

a chemical made by the body that binds to its receptors and maintains an inflammatory response

A

leukotriene

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9
Q

body chemicals such as histamine, leukotriene, prostaglandins, and kinins that cause inflammatory responses

A

mediators

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10
Q

anti-inflammatory drugs that are not similar to cortisol but prevent or limit tissue and blood vessel responses to injury or invasion by slowing the production of one or more inflammatory mediators

A

nonsteroidal anti-inflammatory drugs (NSAIDs)

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11
Q

a family of chemicals made by the body, some of which cause the signs and symptoms of inflammation

A

prostaglandins

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12
Q

drugs that reduce inflammation by preventing the inflammatory mediator histamine from binding to its receptor site; same as histamine blockers or histamine antagonists

A

antihistamine

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13
Q

the most powerful of all the drugs used for inflammation

A

corticosteroids

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14
Q

how do corticosteroids work?

A

by slowing or stopping all known pathways of inflammatory mediator production

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15
Q

what are the types of drugs for inflammation?

A

corticosteroids, NSAIDs, antihistamines, leukotriene inhibitors

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16
Q

in which ways can corticosteroids be taken?

A

orally or parenterally, by inhalation for asthma and other inflammatory problems of the airways, topically for skin problems, injected into joints, rectally for hemorrhoids, in drops for eye problems

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17
Q

why are corticosteroids prescribed for only a short period of time?

A

because they have many side effects and adverse effects

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18
Q

how do systemic corticosteroids work?

A

by decreasing the production of all known body chemicals (mediators) that trigger inflammation. they also slow the production of WBCs in the bone marrow because these are the source of mediators that trigger inflammation

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19
Q

what are the intended responses of corticosteroids

A

swelling at the site of inflammation is reduced, redness and pain at site of inflammation reduced, the body area affected by inflammation demonstrates increased function

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20
Q

what are common side effects of systemic corticosteroids after 1 week?

A

acne, sodium and fluid retention, elevated blood pressure, sensation of nervousness, difficulty sleeping, emotional changes, crying easily

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21
Q

what are the common side effects of systemic corticosteroids after one month of therapy

A

weight gain, fat redistribution, increased risk for GI ulcers and bleeding, fragile skin that bruises easy, loss of muscle mass and strength, thinning scalp hair, increased facial and body hair, increased susceptibility to colds and other infections, stretch marks

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22
Q

when do most side effects of corticosteroids show up?

A

within 5-7 days of treatment and stop after therapy stops, although it may take a year or longer (with the exception of stretch marks, which may fade)

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23
Q

what are some important adverse effects of corticosteroids?

A

adrenal glad suppression, reduced immune function, delayed wound healing, osteoporosis, myopathy, psychological disturbances and glucointolerance - these are why corticosteroids are only taken after all other anti-inflammatories have been shown not to work

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24
Q

why do corticosteroids cause adrenal gland suppression?

A

how much cortisol is made by the adrenal glands is determined by how much cortisol is already in the blood. if there are more than normal levels of cortisol in the blood, the adrenal glands reduce the production of cortisol. if they have to do this often, they eventually stop producing it and the gland atrophies

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25
why could a person die if they suddenly stop taking systemic corticosteroids if they have taken the drug for a week or longer?
they have no levels of cortisol in the body and cortisol is necessary for life and their adrenal glands have atrophied, so they die from acute adrenal insufficiency.
26
s/s of acute adrenal insufficiency
acute confusion, profound muscle weakness, slow irregular pulse, hypotension, abdominal pain, nausea and vomiting, salt craving, weight loss, low blood glucose levels (
27
why does corticosteroids increase your chance of getting an infection?
because they lower WBC production and inflammatory responses are suppressed, so your body can't fight the infection as well and when you do get an infection, you don't notice it. in addition, they have delayed wound healing because inflammation initiates wound healing, so they are more likely to get an infection
28
are corticosteroids interchangeable?
no, they are not interchangeable because the strength of the drugs vary
29
what should you do before giving corticosteroids?
check s/s of infection because corticosteroids can make infections worse, check BP and wt to have a baseline because they can cause hypertension and weight gain
30
what should you do after giving corticosteroids?
check VS at least once per shift, examine skin for bruises or tears, minimize use of tape and be very gentle handling patient, weight the patient weekly to monitor for fluid retention
31
what should you teach patients about taking corticosteroids?
don't stop taking suddenly, wear a medical alert bracelet or carry a card stating that you are taking corticosteroids daily, tell them to take corticosteroids in the morning or if they are taking higher doses take 2/3 in the morning and 1/3 at night because this is closer to your body's normal pattern of secretion, avoids crowds and people who are ill because you have lowered immunity, take with food to help prevent stomach ulcers
32
why should you never apply a topical corticosteroid to an area of skin that may be infected?
because they lower the immunity in the area that they are applied
33
do you need a lot of topical corticosteroids to treat an infection?
no, you only need a thin layer
34
what are the side effects of topical corticosteroid use?
rare, but include: acne, thinning of the skin in areas where they are applied, and changes in skin color
35
can corticosteroids be taken while pregnant?
yes, even though they do cross the placenta
36
how can corticosteroids affect the fetus?
they can cause the baby to be smaller than normal
37
should a breast feeding mother take corticosteroids?
no, because it passes through the breast milk
38
what considerations should you make with an older adult taking corticosteroids?
may need to take extra precautions to avoid infection, lower strengths of topical corticosteroids because they have thinner skin, they are more likely to have diabetic complications because corticosteroids cause increased blood glucose levels
39
what are some oral corticosteroids?
betamethasone (Celestone); dexamethasone (Decadron); prednisolone; prednisone
40
what are types of parenteral corticosteroids?
cortisone acetate; hydrocortisone (Solu-Cortef); methylprednisolone (Duralone, Medalone, Solu-Medrol)
41
what are types of topical corticosteroids?
hydrocortisone (Ala-Cort, Dermacort, Lanacort); triamcinolon (Aristocort, Kenalog, Oracort, Triderm)
42
what are NSAIDs used to treat?
many health problems, including fear, arthritis, and other rheumatologic disorders, gout, systemic lupus erythematosus, pain after surgery, menstrual cramps, and blood clots
43
what are NSAIDs usually taken for?
pain and inflammation
44
what are NSAIDs?
anti-inflammatory drugs that prevent or limit the tissue and blood vessel responses to injury or invasion by slowing the production of one or more inflammatory mediators
45
what is COX-1?
an enzyme found in normal cells whose purpose is to help make many of the different types of prostaglandins inside each cell
46
what is COX-2?
an enzyme found only in inflammatory cells whose purpose is to help make mediators of the inflammatory response, including prostaglandins, leukotriente, and kinins
47
how do NSAIDs work?
they suppress both COX1 and COX2 forms of the enzyme so production of the mediators along with inflammatory mediators is slowed.
48
what are the intended responses for NSAIDs?
redness and pain at the site of inflammation are reduced, swelling and warmth at the site are reduced, body function in the area that is affected by inflammation is increased, fever is reduced
49
what do all COX-1 NSAIDs reduce? what does this mean for the body?
reduce platelet clumping and blood clotting. therefore, anyone taking these is at higher risk for bleeding in response to slight injuries, surgery or dental work
50
when do COX-1 NSAIDs irritate the stomach lining and GI tract?
when they touch it directly and again when they are absorbed into the blood. this can lead to a serious bleeding ulcers (because of the decrease in blood clotting) and pain in the GI tract
51
which organ do all NSAIDs (with the exception of aspirin) reduce blood flow to? what can this result in?
reduce blood flow to the kidney. this can lead to high blood pressure and kidney damage
52
what drug do COX-1 NSAIDs decrease the effectiveness of?
ACE inhibitors because they have the opposite effect on the kidneys
53
how do COX-1 and COX-2 NSAIDs differ in side-effects? what if you take too much COX-2?
COX-2 have less side effects and don't have the anti-coagulant effects, unless you take more than prescribed. in this case, you get the same side effects as COX-1
54
what is likely if a person is sensitive to one NSAID?
they will be sensitive to them all
55
what are the adverse effects of NSAIDs?
kidney damage, asthma, and allergic reactions
56
what should you never take long term NSAIDs with? what will happen?
acetaminophen increases risk for kidney and liver damage. taking two or more NSAIDs at the same time, side effects and the risk for adverse effects are increased
57
what drug should you not take if you are allergic to sulfa?
celecoxib (Celebrex)
58
what is a major adverse reaction of COX-2 NSAIDS? why?
increase in heart attacks in strokes because these appear to increase clot formation in the small arteries of the heart and brain
59
why is it not recommended to take NSAIDs longer than 1 week?
the longer you use them, the more at risk you are for adverse effects (with the exception of low-dose aspirin)
60
what should you urge the patient to do if NSAIDs are needed for long-term use?
find the lowest dose that still reduces the patients pain and inflammation
61
what is the only NSAID approved for IV usage?
ketorolac (Toradol)
62
what should you do before giving NSAIDs?
ask if the patient has had any problems with aspirin or any other OTC NSAIDs because they will likely have a problem with another, give with meals or directly afterward, when possible have a full glass of water or milk with the drug, check BP to obtain baseline
63
what should you do after giving NSAIDs?
examin gums, mucous membranes, open skin area, urine, stool, or emesis for indications of bleeding; look for bruises and petechiae; check BP, breathing pattern, and O2 sats hourly after the first dose to make sure they don't have a sensitivity
64
what are signs of hypersensitivity to an NSAID?
difficulty breathing, drop in BP, and decrease of 5% or more of O2 sat
65
what should you teach the patient about taking NSAIDs?
take with food or on full stomach, don't chew it if capsule or coated, how to check bowel movements for blood - report any suspicions immediately, check gums for bleeding, tell dentist they take NSAIDs before procedures, don't take with warfarin, weigh themselves at least twice a week in the morning - tell prescriber of weight gain more than 3 lbs in the week could be indicatins of heart failure
66
what is the most important precaution to teach patients taking celecoxib (Celebrex)
take the drug EXACTLY as prescribed. high doses can inhibit COX-1 enzymes which can make adverse reactions and side effects the same as COX-1
67
are NSAIDs recommended for children?
no, the only one they can take is ibuprofen
68
what can aspirin cause in children?
Reye's syndrome - a liver disease that can lead to coma, brain damage, or death
69
what are considerations for pregnant and breast feeding women regarding NSAIDs?
category C and D, should be avoided especially in the last 3 months of pregnancy (indomethacin and celecoxib are the main ones). this causes the ductus arteriosus which is important to fetal circulation and oxygenation to close early
70
what are considerations for older adults with regard to NSAIDs?
they are at risk for fluid overload and high blood pressure because these drugs cause sodium and water retention. they are at risk for heart attack and heart failure because of this. tell them to carefully monitor their weight, pulse, and urine output and teach them the signs of heart failure so they can look for them
71
where are H1 receptors located? what happens when histamine binds to these receptors?
in blood vessels and respiratory mucous membranes. when histamine binds to these receptors, tissue changes occur, causing blood vessel dilation, swelling, decreased BP, poor heart contractions, narrowed airways, increased mucus production, and the formation of hives on the skin
72
where are H2 receptors located and wheat happens when histamine binds to them?
they are located in the stomach lining and when histamine binds to them, stomach acid production increases - greatly increasing the risk for stomach ulcers
73
what is histamine the main mediator of?
inflammation and capillary leak
74
do most histamines bind to H1 or H2 receptors?
H1
75
what are the most popular anti-histamine drugs
cetrizine (Zyrtec); diphenhydramine (Benadryl); loratadine (Claratin)
76
how do antihistamines work?
they bind to H1 receptor sites and prevent the normal histamine of the body from binding there. this slows or stops the tissue effects on inflammation
77
what are the intended responses of histamines?
blood vessels don't dilate, swelling is reduced, mucous and other nasal eye and respiratory secretions are reduced, narrowed airways are widened, hives decrease in size and itchiness
78
what are the side effects of antihistamines?
drowsiness, dry mouth and dry throat, increase heart rate, irregular heart beat, high BP, eye and vision changes (dilated pupils and blurry vision), urinary retention
79
what are the common adverse effects of antihistamines?
seizures, increased intraocular pressure which can worsen glaucoma and even lead to blindness, allergic reactions
80
why should antihistamines not be given to someone with an acute asthma attack?
because it has a sedative effect and can make the patient so drowsy they cannot work at breathing
81
who do you not give antihistamines to?
patients with glaucoma, prostate enlargement, hypertension, or urinary retention because it can make all these things worse
82
what should you do before giving antihistamines?
make sure they are not given within four hours of opiates, sedatives, muscle relaxants, and barbituates because of the sedative reactions of these drugs. you should try to avoid them at all.
83
what do you do after giving antihistamines?
fall risk preventions; check pulse, BP and RR q4h; if HR becomes irregular, BP changes significantly from patient baseline, or RR falls below 10 breaths per min, contact the provider
84
what do you teach a patient using antihistamines?
do not use alcohol, don't operate machinery or drive, use candy or drink more water with dry throat, contact prescriber if vision changes or pain above eye brows, monitor urination if they have prostate problems - notify provider if decrease in urine output or urge to urinate but inability; don't take it for acute asthma attacks
85
how does zileuton (Zyflo) work?
it prevents leukotriene production within WBCs
86
how do montelukast (Singulair) and zafirlukast (Accolate) work?
they block leukotriene receptors on cellsd
87
what are the intended responses for leukotriene inhibitors?
swelling of oral, nasal, eye, and respiratory mucous membranes is reduced; secretions are reduced; narrowed airways are opened
88
what is leukotriene?
another body chemical that triggers and sustains inflammatory responses. it is found inside many types of WBCs. when it is released, it binds to receptors and triggers symptoms of inflammation
89
what are the side effects of leukotriene inhibitors?
headache and abdominal pain
90
what are the adverse effects of leukotriene inhibitors?
liver impairment, allergic reactions, hives, anaphylaxis
91
what should you do before giving leukotriene inhibitors?
ask pt about previous liver problems, nausea or fatigue. check base-line liver function
92
what should you do after giving leukotriene inhibitors?
look for signs and symptoms of liver decline. with Singulair look for mood changes such as depression and suicidal thoughts
93
what should you teach a pt taking leukotriene inhibitors?
if they have skin yellowing, pain over liver, or darkening urine report these symptoms to the prescriber or if they have any mood changes or thoughts of suicide
94
are leukotriene inhibitors prescribed to children?
yes, just be careful to calculate the dose carefully to avoid accidental overdose
95
what is the difference between inflammation vs infection?
infection is the result of an invasion by disease-causing organisms, whereas inflammation is a result of injury or invasion by non-disease-causing agents or organisms
96
what are the 5 major s/s of inflammation
warmth, redness, swelling, pain, and decreased function

Pharmacology (6 decks)

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