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3. Nursing Pharmacology > D. Anti-inflammatory > Flashcards

D. Anti-inflammatory Flashcards

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1
Q

anti-inflammatory drugs:

Pathophysiology

A

•Inflammation

  • Reaction to tissue injury
  • Caused by release of chemical mediators
  • Leads to a vascular response
  • Fluid and WBCs migrate to injured site

•Chemical mediators

  • Histamines
  • Kinins
  • Prostaglandins
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2
Q

signs of inflammation

A
  • erythema ( redness)
  • edema (swelling)
  • heat
  • pain
  • loss of function
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3
Q

cyclo-oxygenase (COX)

A

COX-1 platelets/GI protective effect

COX-2 Pain

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4
Q

anti-inflammatory

Ind/Contra

A
  • Indications or Uses
  • Reduce inflammation and pain
  • Gout, inflammation, fever, platelet

inhibition, rheumatoid & osteoarthritis

  • Not recommended for fever or headaches
  • Except aspirin, ibuprofen
  • Contraindications: allergy and pts at risk of

bleeding

•EX: low platelet ct

, peptic ulcer disease

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5
Q

1st generation NSAID

A

•Salicylates

•Aspirin*

•Propionic

acid derivatives

•Ibuprofen (Advil)*

•Naproxen (Naprosyn)

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6
Q

NSAID effects/action

A

Effects:

Anti-inflammatory,

Analgesic, Antipyretic*(Aspirin and Advil only),

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7
Q

Second generation NSAID

A
  • COX-2 inhibitors
    1. Celecoxib (Celebrex)
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8
Q

salicylates-lab-food interactions

A

•Drugs

  • Anticoagulants (Coumadin & warfarin) Increases anticoagulation= bleed, bleed, bleed
  • ↑ hypoglycemia with oral hypoglycemic drugs
  • ↑ gastric ulcer risk with glucocorticoids

•Lab

  • Increase PT, INR, bleeding time, uric acid
  • Decrease potassium, cholesterol, T3 and T4 levels
  • Foods containing salicylates
  • Prunes, raisins, licorice, certain

spices

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9
Q

Salicylates -Aspirin

Caution

A
  • Do not take with other NSAIDs
  • Avoid during third trimester of pregnancy
  • Do not give to children with flu or virus

symptoms–Reyes’ syndrome

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10
Q

Aspirin SE/AR

A

•Side effects/adverse reactions

•Tinnitus(ringing ears)

  • Gastric distress (heartburn); Peptic ulcer
  • Urticaria
  • Life threatening: Agranulocytosis, hemolytic

anemia, Anaphylaxis, Thrombocytopenia, Hepatotoxicity, Bronchospasm, Renal Failure

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11
Q

salicytes severe reactions

A
  • Hypersensitivity
  • Tinnitus, dizziness, bronchospasm
  • Salicylism (mild)
  • Tinnitus, dizziness, headache, confusion, sweating, drowsy, thirst, nausea, vomiting, diarrhea
  • Severe salicylate poisoning
  • Convulsions, cardiovascular collapse, coma
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12
Q

nsaid ibuprofen &

Naproxen

A
  • Ibuprofen
  • Nonselective COX inhibitors (blocks both)
  • Brand/trade names •Ibuprofen (Motrin, Advil)

•Drug interactions

•Increase effects of warfarin, phenytoin

•Side effects

•Gastric

distress

•Naproxen (Naprosyn)

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13
Q

COX-2 Inhibitors

action/use

A

•Action

•Selectively inhibits COX-2 enzyme without

inhibition of COX-1 (reduces GI distress)

•Use

  • Decrease inflammation and pain
  • Drug agents
  • Celecoxib (Celebrex)
  • Similar agents
  • Nabumetone (Relafen), meloxicam (Mobic)
  • Some COX-1 inhibition
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14
Q

COX-2 inhibitors

caution/SE

A

•Caution

•Avoid during third trimester of pregnancy

Side Effects

•Mild: headache, dizziness, nausea, diarrhea,

sinusitis, peripheral edema

•Assess renal function and GI

status (can cause kidney damage with long-term use)

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15
Q

NSAID Patient teaching

A
  • Inform of Drug & Herbal interactions
  • Avoid Alcohol
  • Inform surgeon and dentist before procedures of

NSAID use

  • Avoid NSAIDs 1-2 days prior to menstruation
  • Do not take if pregnant
  • Inform of SE
  • Take with food to ↓ GI upset
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16
Q

NSAID dosage meaning

A
  • dose of > 325- 650 is for pain
  • dose < than or equal ro 325 is for the anti-platelet effect
17
Q

disease -modifying antirheumatic drugs

DMARDS

A
  • Immunosuppressive agents
  • Immunomodulators •Antimalarials
  • Gold drug therapy
18
Q

immunosuppressive agents

A
  • Used to treat RA unresponsive to anti- inflammatory drugs
  • Also used to treat cancer and prevent rejection after organ transplant
  • Examples: Azathioprine (Imuran); Cyclophosphamide (Cytoxan); Methotrexate
  • Many serious side effects:
  • Bone marrow suppression, hepatic

fibrosis, GI ulcers

19
Q

immunomodulators

A
  • Interleukin (IL-1) receptor antagonists • Anakinra (Kineret)
  • Action: reduces synovial inflammation and joint destruction by blocking IL-1 at receptor

•Tumor necrosis factor (TNF) blockers • Infliximab (Remicade) given IV
• Entanercept (Enbrel) given SQ
• Adalimumab (Humira) given SQ

  • Action: disrupts the inflammatory process by neutralizing TNF
  • Delay disease progression
20
Q

immunomodulator infliximab (Remicade)

A
  • Infliximab (Remicade)
  • Side effects/adverse reactions
  • Headache, dizziness, chills, hot flashes, depression, N&V, diarrhea, urinary frequency
  • Hypotension, hypertension, altered liver enzymes, severe infections
  • Contraindications
  • Renal or hepatic disease
  • Immunosuppression, infection

**Predisposes the client to severe infections

21
Q

DMARD’s Nursing Implications

A

• Administration:
• Monitor labs for CBC, renal & liver function
• observe for side/adverse effects pre & post-infusion specifically acute infusion reaction

• Teaching:

  • report signs of bleeding, infection and skin reactions as medication will need to be stopped.
  • Encourage pts to keep all follow up appointments and have scheduled lab testing.
  • Avoid live vaccines
  • Assess for Side Effects/Adverse Effects
  • Instruct patient regarding side effects
  • Instruct patient to report symptoms of toxicity
22
Q

Antigout drugs

A
  • Gout pathophysiology
  • Inflammatory disease of joints, tendons
  • Usually occurs in great toe
  • Defect in purine metabolism leads to uric

acid accumulation

•Purine-containing foods: salmon, liver, sardines, alcohol

  • Antigout drugs
  • Colchicine
  • Uric acid inhibitors
  • Allopurinol
  • Uricosurics
23
Q

Colchicine

A

•Inhibit migration of leukocytes to

inflamed site

•Side effects

•N&V, Diarrhea, abdominal pain •Taken with food to avoid GI distress

• Contraindications

•Severe renal, cardiac, or GI problem

Used for an acute attack

24
Q

uric acid inhibitors

A

•Allopurinol (Zyloprim) Not a NSAID

• Action

  • Decreases uric acid levels
  • Used to prevent gout attacks

• Nursing Interventions

Monitor CBC, liver enzymes, renal function

Yearly eye exams for visual changes

Client to avoid alcohol, caffeine, and thiazide diuretics that increase uric acid level

Increase fluid intake to increase uric acid excretion

25
Q

uricosurics

A
  • Probenecid (Benemid)
  • Used for Chronic gout NOT acute attacks
  • Side effects
  • Gastric irritation; take with food

•Nursing Interventions

  • Increase fluid intake to increase uric acid excretion
  • Not to be given with other highly protein- bound drugs
26
Q

antigout: patient teaching

A
  • Regular scheduled lab tests
  • Assess kidney, liver function & CBC

•Increase fluid intake •Report SE
•Dietary changes

  • Low purine diet
  • Alcohol
  • Do not take large doses of Vit. C (acidifies urine. slows excretion of uroc acid)

3. Nursing Pharmacology (22 decks)

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