Chapter 44: Anti-inflammatory and antigout drugs

Question 1

salicylates

Answer 1

aspirin
diflunisal (Dolobid)
salsalate (Salistab)
choline salicylate (Arthropan)

Question 2

Acetic Acid Derivatives

Answer 2

diclofenac sodium (Voltaren)
indomethacin (Indocin)
sulindac (Clinoril)
tolmetin (Tolectin)
etodolac (Lodine)
ketorolac (Toradol)
meclofenamate (generic only)
mefenamic acid (Ponstel)

Question 3

Cyclooxygenase-2 Inhibitors

Answer 3

celecoxib (Celebrex)

Question 4

Enolic Acid Derivatives

Answer 4

nabumetone (Relafen)
meloxicam (Mobic)
piroxicam (Feldene)

Question 5

Propionic Acid Derivatives

Answer 5

fenoprofen (Nalfon)
flurbiprofen (Ansaid)
ibuprofen (Motrin, Advil, others)
ketoprofen (Orudis KT)
naproxen (Naprosyn, Aleve)
oxaprozin (Daypro)

Question 6

NSAIDs: FDA-APPROVED

INDICATIONS

Answer 6

• Acute gout
• Acute gouty arthritis
• Ankylosing spondylitis
• Bursitis
• Fever
• Juvenile rheumatoid arthritis
• Mild to moderate pain
• Osteoarthritis
• Primary dysmenorrhea
• Rheumatoid arthritis
• Tendinitis
• Various ophthalmic uses

Question 7

NSAIDs relieve pain, headache, and inflammation by

Answer 7

blocking
the chemical activity of the enzyme called cyclooxygenase
(COX).

Question 8

This greater enzyme specificity of the COX-2

inhibitors allows for the

Answer 8

beneficial antiinflammatory effects
while reducing the prevalence of adverse effects associated with
the nonspecific NSAIDs, such as gastrointestinal ulceration

Question 9

The leukotriene pathway is

Answer 9

inhibited by some antiinflammatory

drugs, but not by salicylates.

Question 10

All NSAIDs can be…

Answer 10

ulcerogenic and induce gastrointestinal

bleeding due to their activity against tissue COX-1.

Question 11

Aspirin has the unique property

Answer 11

irreversible inhibitor of COX-1
receptors within the platelets themselves…

reduced formation of thromboxane A2, a substance that normally
promotes platelet aggregation

Question 12

NSAIDs

are sometimes combined with an opioid

Answer 12

They tend to have an opioid-sparing effect when given together
with opioids, because the drugs attack pain using two different
mechanisms. This often allows less opioids to be used

Question 13

NSAIDs show a ceiling effect

Answer 13

limits their effectiveness;
that is, any further increase in the dosage beyond a certain
level increases the risk for adverse effects without a corresponding
increase in the therapeutic effect

Question 14

Contraindications to NSAIDs

Answer 14

Contraindications to NSAIDs include known drug allergy and
conditions that place the patient at risk for bleeding, such as rhinitis
(risk for epistaxis [nosebleed]), vitamin K deficiency, and
peptic ulcer disease. Patients with documented aspirin allergy
must not receive NSAIDs.

Question 15

adverse effects of the NSAIDs is their effect

on the gastrointestinal tract

Answer 15

Symptoms can range from mild
symptoms such as heartburn to the most severe gastrointestinal
complication, gastrointestinal bleeding. Most fatalities associated
with NSAID use are related to gastrointestinal bleeding.

Question 16

black box warning per wilkipedia

Answer 16

It is the strongest warning that the FDA requires, and signifies that medical studies indicate that the drug carries a significant risk of serious or even life-threatening adverse effects

Question 17

The drug

misoprostol (Cytotec)

Answer 17

has proved successful
in preventing the gastric ulcers and hence gastrointestinal
bleeding that can occur in patients receiving NSAIDs. Misoprostol
is a synthetic prostaglandin E1 analogue that inhibits
gastric acid secretion and also has a cytoprotective component

Question 18

NSAIDs can compromise existing renal function

Answer 18

Renal toxicity
can occur in patients who are dehydrated, those with heart failure
or liver dysfunction, and those taking diuretics or angiotensin-
converting enzyme inhibitors.

Question 19

NSAIDs: ADVERSE EFFECTS

Answer 19

Cardiovascular
Moderate to severe noncardiogenic pulmonary edema
Gastrointestinal Dyspepsia, heartburn, epigastric distress, nausea, vomiting, anorexia, abdominal pain, gastrointestinal bleeding, mucosal lesions (erosions or ulcerations)
Hematologic Altered hemostasis through effects on platelet function
Hepatic Acute reversible hepatotoxicity
Renal Reduction in creatinine clearance, acute tubular
necrosis with renal failure
Other Skin eruption, sensitivity reactions, tinnitus, hearing
loss

Question 20

salicylism

Answer 20

Salicylate toxicity, usually from aspirin

Chronic salicylate intoxication is also
known as salicylism and results from either short-term administration
of high dosages or prolonged therapy with high or even
lower dosages

Question 21

ACUTE OR CHRONIC
SALICYLATE INTOXICATION:
SIGNS AND SYMPTOMS

Answer 21

Cardiovascular Increased heart rate
Central nervous Tinnitus, hearing loss, dimness of vision, headache,
dizziness, mental confusion, lassitude,
drowsiness
Gastrointestinal Nausea, vomiting, diarrhea
Metabolic Sweating, thirst, hyperventilation, hypoglycemia
or hyperglycemia

Question 22

The most common manifestations of chronic salicylate

intoxication in adults

Answer 22

tinnitus and hearing loss.

children are hyperventilation and central nervous system
(CNS) effects such as dizziness, drowsiness, and behavioral
changes.

Question 23

• Little or no toxicity: less than 150 mg/kg
• Mild to moderate toxicity: 150 to 300 mg/kg
• Severe toxicity: 300 to 500 mg/kg
• Life-threatening toxicity: over 500 mg/kg

Answer 23

A serum salicylate concentration measured 6 hours or
longer after the ingestion may be used in conjunction with the
Done nomogram to estimate the severity of intoxication and
help guide treatment

Question 24

NSAID-induced

hyperkalemia or hyponatremia can also occur.

Answer 24

pg 711 ?

Question 25

Ketorolac (Toradol) is somewhat unique

Answer 25

some antiinflammatory activity, it is used primarily
for its powerful analgesic effects

indicated for short-term use (up to 5 days)
because of its potential adverse effects
on the kidney and gastrointestinal tract.

Question 26

Celecoxib (Celebrex) was the first COX-2 inhibitor and is the
only one remaining on the market

Answer 26

indicated for the treatment
of osteoarthritis, rheumatoid arthritis, acute pain symptoms,
ankylosing spondylitis, and primary dysmenorrhea

Question 27

Gout is caused by the

Answer 27

overproduction of uric acid or decreased
uric acid excretion, or both. This overproduction and/or
decreased excretion can often result in hyperuricemia (too
much uric acid in the blood).

Question 28

allopurinol (Zyloprim)

Answer 28

relief of gout is the inhibition of the enzyme xanthine oxidase, which thereby prevents uric acid production

purine (DNA/RNA) (DIET) metabolizes…… hypoxanthine
to xanthine and eventually to uric acid.

Question 29

assess and document the duration, onset,
location, and type of inflammation and/or pain the patient
is experiencing as well as any precipitating, exacerbating, or relieving factors.

Answer 29

With aspirin, NSAIDs, other antiinflammatory drugs, and

antigout drugs,

Question 30

aspirin triad

Answer 30

includes asthma, nasal
polyps, and rhinitis. These conditions are considered to put the
patient at risk for reactions to aspirin

Question 31

allopurinol, assess the integrity of the

skin due to

Answer 31

potentially life-threatening skin adverse effects of
exfoliative dermatitis, Stevens-Johnson syndrome, and toxic
epidermal necrolysis. Assess blood counts because of the potential
for aplastic anemia and agranulocytosis

Question 32

NURSING DIAGNOSES pg 716

Answer 32

1. Acute pain related to the disease process or injury to joints
   and other disease-affected areas
2. Deficient knowledge related to first-time drug therapy for
   treatment of a disease process
3. Risk for injury related to the effects of the disease and treatment
   on mobility and the performance of ADLs

Question 33

To reduce the risk for

Reye’s syndrome,

Answer 33

aspirin or medications that contain aspirin must not be given
to children or teenagers to treat viral illnesses or fever.

Question 34

Some changes noted in elderly patients that effect drug treatment include

Answer 34

changes in renal elimination, protein binding, body composition, drug distribution,
drug clearance, and sensitivity to drugs, as well as an increased incidence
of adverse reactions to all types of medications.

Question 35

NSAIDs work by blocking

Answer 35

cyclooxygenase, the enzyme responsible for conversion of arachidonic acid into prostaglandins. Decreasing the synthesis of prostaglandins results in decreased pain and inflammation.

Question 36

When teaching a patient about potential side effects of NSAID therapy, the nurse will teach the patient to promptly report which effect?

Answer 36

A major side effect of NSAID therapy is gastrointestinal (GI) distress with potential GI bleeding. Black tarry stools are indicative of a GI bleed.

Question 37

The nurse is administering probenecid (Benemid) to a patient with recurrent strep throat. The nurse teaches the patient that the most likely reason for taking this medication is to

Answer 37

Besides its use for the treatment of the hyperuricemia associated with gout and gouty arthritis, probenecid also has the ability to delay the renal excretion of penicillin, thus increasing serum levels of penicillin and prolonging its effect.

Question 38

The nurse assesses for therapeutic effects of colchicine based on knowledge that colchicine

Answer 38

Colchicine works by decreasing the mobility and migration of leukocytes into joints affected by gout, thus resulting in decreased inflammation.

Colchicine is administered on an hourly basis until pain is resolved or the patient develops diarrhea. Hemorrhagic colitis is a potential life-threatening side effect of colchicine.

Question 39

Patient teaching for a patient receiving allopurinol (Zyloprim) should include which information?

Answer 39

Patients taking allopurinol should be informed to increase fluid intake to 3 L per day, avoid hazardous activities if dizziness or drowsiness occurs with the medication, and avoid the use of alcohol and caffeine because these drugs will increase uric acid levels and decrease the levels of allopurinol.