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Pharmacology > EXAM 4: Anti-inflammatory > Flashcards

EXAM 4: Anti-inflammatory Flashcards

1
Q

What are the four Pharmacotherapy options for anti-inflammatory drugs?

A

1) NSAID2) Corticosteriods 3) Disease-Modifying Antirheumatic Drugs (DMARDs) 4) Antigout drugs

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2
Q

1) Define Immunocompromised (immunodeficient) 2) What is an example of illness? 3) What is an example medication used?

A

1) unable to defend the body against pathogens 2) HIV 3) Tacrolimus

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3
Q

1) Define two features that qualfiy as autoimmune disease 2) List 6 autoimmune diseases

A

1) abnormally robust response to antigens OR recognition of one’s own antigen as foreign 2) Allergies, astham, RA, SLE (lupus), scleroderma (skin becomes hard), polymyositis (inflammation of many muscles)

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4
Q

1) Define inflammation 2) What two key things can excessive inflammatory response cause?

A

1) a normal part of innate immunity 2) tissue damage and autoimmune disorders

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5
Q

Inflammation is caused by tissue injury. List 6 examples.

A

1) infection 2) trauma 3) surgery 4) heat & cold 5) chemicals 6) radiation

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6
Q

During inflammation, when the release of chemical mediators occurs, what two things happen to blood vessels?

A

vasodilation and INCREASED permeability

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7
Q

What are the FIVE cardinal signs of inflammation?

A

1) erythema (redness) 2) swelling (edema) 3) pain 4) heat 5) loss of function

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8
Q

What do anti-inflammtory drugs do?

A

DECREASE inflammatory process

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9
Q

What are the 4 NSAIDs of focus for anti-inflammatory drugs?

A

1) aspirin (ASA) 2) ibuprofen 3) Ketorolac 4) naproxen

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10
Q

What is the MOA of NSAID?

A

Prevents prostaglandin production buy inhibiting COX, so COX enzyme inhibitor

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11
Q

Since prostaglandin causes inflammation - what are three characteristics of NSAIDS?

A

1) Anti-inflammatory 2) Analgesic (decrease pain) 3) Antipyretic (decrease fever)

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12
Q

Because prostaglandin also increases circulation to brain, kidney, and coronary arteries - what ADVERSE REACTION can an NSAID have in blocking this function of the prostaglandin? Name three.

A

1) Renal Failure 2) CVA 3) MI

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13
Q

Because prostaglandin also increases gastric bicarb - what SIDE EFFECT can an NSAID have in blocking this function of the prostaglandin?

A

GI bleed

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14
Q

Because prostaglandin also increases platelet aggregation - what SIDE EFFECT can the secondary use of the NSAID aspirin (ASA) have in blocking this function of the prostaglandin?

A

bleeding

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15
Q

In 2005, the FDA issued a Block Box Warning against NSAIDS. What high risk event was the warning for? List up to 6 types of that event.

A

High risk for serious thrombotic events: sudden death, MI, unstabble angina, ischemic CVA, TIA, & peripheral thromboses

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16
Q

List 3 NSAID indications

A

1) Mild pain (analgesic) - ex: joint & bone injury, muscle pain, toothache, HA 2) Fever 3) Inflammation - ex: osteoarthritis (OA), RA, gouty arthritis, lupus, dysmenorrhea

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17
Q

List 5 NSAID contraindications

A

1) Pregnancy (Cat. D - risk to human fetus) 2) PUD 3) RF 4) bleeding disorders 5) ETOH

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18
Q

What 5 situations should you use caution with when administering NSAIDs?

A

1) AC 2) glucocorticoid 3) ACE & ARB 4) history of ischemic CVA 5) MI

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19
Q

When administering a parenteral form of NSAID, this route can put the patient at risk for what?

A

RF

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20
Q

What giving ibuprofen parenteral - what method should be used a which two methods should NEVER be used?

A

Method: IV gtt.
NEVER: IV push or IM

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21
Q

What giving ketorolac parenteral - what two methods should be used?

A

IV, IM

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22
Q

What educating & monitoring should a nurse give a patient on NSAIDs when considering the high risk for ACS & CVA? (two things)

A

1) Never take more than one type of NSAID, take the smallest dose, limit the length of NSAID use 2) Call 911 with any chest pain or neurological deficits

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23
Q

What educating & monitoring should a nurse give a patient on NSAIDs when considering the high risk for RF? (two things)

A

1) monitor for worsening fluid retention (HF symptoms, I & O imbalance) 2) Avoid with Hx. of RF, HTN, HF

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24
Q

What educating & monitoring should a nurse give a patient on NSAIDs when considering the high risk for GI Bleed & PUD? (four things)

A

1) ALWAYS take with food 2) Avoid other gastric irritants (ETOH or multi-agent therapy) 3) Monitor for bleeding, caution with ACs 4) High rish in elderly (PUD 4x more common in older adults)

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25
Q

Knowing that ASA (aspiring) is not included in the FDA Black Box Warning for NSAIDS. What is its common MOA in a small scheduled dose? Name two conditions what warrant this MOA use?

A

Antiplatelet: MI and CVA prophylaxis

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26
Q

Nursing considerations for ASA: 1) when should a patient stop taking ASA to clear from body (after consulting the provider) 2) what can ASA be taken with to further the antiplatelet effect?) 3) When using ASA as an emergency medicine for acute MI - how should the medication be taken?

A

1) 7 2) clopidogrel 3) MUST be chewed (large dose!)

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27
Q

List 2 contraindications for the use of ASA

A

1) younger than 19 2) potential for fatal Reye Syndrome (swelling of liver and brain)

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28
Q

To avoid GI bleed with ASA: 1) when should a patient take 2) If Hx of PUD, GERD, or GI bleed - what two forms of ASA are okay to take?

A

1) take WITH food 2) enteric coated (EC) aspirin (DO NOT crush or break) and buffered aspirin (aspirin + calcium carbonate (or other antacid))

29
Q

What two Corticosteroids (=Glucocorticoids) are potent anti-inflammatory drugs?

A

PrednisONE and MethylprednisolONE

30
Q

What indication are corticosteroids (glucocorticoids) used for in immune system dysregulation?

A

inflammatory disorders

31
Q

What are two contraindications for the use of corticosteroids (glucocorticoids)?

A

1) fungal & viral infections 2) live attenuated virus vaccine (intranasal influenze, small pox)

32
Q

What can Corticosteroids (=Glucocorticoids) cause in DM patients?

A

hyperglycemia

33
Q

What can Corticosteroids (=Glucocorticoids) do to WBC count even if a patient is taking this immunosuppressant?

A

Leukocytosis (HIGH white blood cell count)

34
Q

Since Corticosteroids (=Glucocorticoids) is an immunosuppressant, what can happen to the body do to its anti-inflammatory mechanism?

A

put at higher risk of infection

35
Q

What do Corticosteroids (=Glucocorticoids) cause water/Na to do? and what side effects can happen due to this?

A

Cause water & Na RETENTION, resulting in: the worsening of HF, edema, and HTN. Which can then result in hypokalemia and cause a dysrhythmia.

36
Q

Since Corticosteroids (=Glucocorticoids) causes water & Na retention - what can happen to the eye?

A

Increased IOP, therefore worsening of glaucoma

37
Q

With chronic use of Corticosteroids (=Glucocorticoids) - what can happen to the skin?

A

causes SubQ tissue loss = paper-skin or steroid skin

38
Q

What do Corticosteroids (=Glucocorticoids) do to the adrenal?

A

Cause adrenal suppression - NEVER stop abruptly to avoid adrenal crisis (requires weaning!)

39
Q

What can Corticosteroids (=Glucocorticoids) do the muscoloskeletal system? what three things can help negate this?

A

osteoporosis: take Vit D, Ca++, and exercise

40
Q

Name the five DMARDs

A

1) methotrexate 2) hydroxychloroquine 3) azathioprine 4) cyclosporine 5) tacrolimus

41
Q

What indication are DMARDs used for in immune system dysregulation?

A

slow down the progression of autoimmune diseases

42
Q

When do DMARDs take peak effect?

A

3-6 weeks

43
Q

What is the contraindication for DMARDs?

A

NEVER during acute infection

44
Q

What is the Immunomodulators (cytotoxic agent) DMARD?

A

methotrexate

45
Q

What two things are a patient at hish risk for when taking methotrexate?

A

infection and hepatotoxicity

46
Q

Since methotrexate is a cytotoxic agent - what is a sign of toxicity and what should a nurse check for when assessing a patient?

A

Ulcerative stomatitis. Nurse should inspect and assess mouth, gums, and throat daily.

47
Q

What does methotexate do to bone marrow and what should a nurse monitor for?

A

Bone marrow suppression. Nurse should monitor CBC trend (see code phrases)

48
Q

What is a contraindication for methotrexate?

A

pregnancy & lactation - class X teratogenic! (therefore, pediatrics too)

49
Q

Give two patient education points when taking methotrexate?

A

1) take on an EMPTY stomach 2) avoid sunlight

50
Q

What is the Antimalarials (anthelmintic) DMARD?

A

hydroxychloroquine

51
Q

Hydroxychloroquine has side effects on a particular organ - what is this organ and what should you monitor for (including any actions)?

A

Eye: 1) retinal damage 2) monitor vision and eye examinations 3) STOP with blurry vision (hints: FALL risk)

52
Q

What are the Immunosuppressants DMARDs?

A

1) azathioprine 2) cyclosporine 3) tacrolimus

53
Q

What are the three main side effects of azathioprine, cyclosporine, and tacrolimus?

A

1) RF (hepatotoxicity, blood dyscrasia (manipulated shape, size, function), and bleeding) 2) Hirsutism (reversible with discontiniung the medication) 3) Gingival Hperplasia (need good dental hygiene and routine check-ups)

54
Q

What are the two main Antigout drugs? What two additional drugs are used during an acute attack?

A

Colchicine and Allopurinol. Acute attack: Glucocorticoids and NSAIDS

55
Q

What are two inflammatory conditions due to hyperuricemia (excess of uric acid in the blood)?

A

1) gouty arthritis: joints, tendons, subQ tissue 2) gouty nephropathy: RF, nephrolithiasis (forming a kidney stone), side note: tophi

56
Q

What antigout drug is only for gout and is a scheduled drug?

A

colchicine (PO)

57
Q

What are the three main side effects of colchicine and what should a nurse do for each?

A

1) GI Distress: take with food, avoid grapefruit juice 2) Suppressed bone barrow: monitor CBC 3) Rhabdomyolysis (muscle damage): monitor for muscle pain and RF

58
Q

What antigout drug lowers serum uric acid and TREATS the disease?

A

allopurinal (PO & IV)

59
Q

What are the two main side effects of allopurinol and what should the nurse do for both collectively?

A

Hepatotoxicity and higher risk of nephrolithiasis. The nurse should monitor labs and I & O balance.

60
Q

What should the nurse increase the daily fluid to for a patient is taking antigout drugs?

A

2-3 L per day and monitor i/o

61
Q

List four foods high in purine and two liquids that increases uric acid that a patient taking antigout drugs should avoid.

A

red meat, organ meat, scallops, aged cheese. ETOH and caffiene

62
Q

What is the contraindication for antigouts?

A

pregnancy (cat. C)

63
Q

Describe three characteristics of pain.

A

1) sensory & emotiobnal experience 2) subjective and personal 3) with & without tissue injury

64
Q

List 4 nursing implications on pain managemennt?

A

1) Planning MUST include the patient 2) Assess and document PROPERLY 3) reassess after admin. analgesic for improvement, side effects, adverse effects 4) manage with non-pharmcological along with pharmacological

65
Q

What is the assessment acronym FLACC and when is this assessment used?

A

Face, Legs, Arms, Crying, Consolability - used with infants unable to vervablize pain

66
Q

What two scales are used to help children communiate their level of pain?

A

Oucher Scale and Wong-Baker Faces

67
Q

What is the assessment acronym PAINAD, when is it used, and how do you interpret the score?

A

It is a scale used for dementia that looks at: Breathing, Vocalization, Face, Body Language, and Consolabiltiy. The scale is on a 0-10 range, with the previous listed five sections; a score of 4 or greater must be treated.

68
Q

What is the of treatment pain when patients are on palliative care? What is the main tool for ensuring patient is comfortable during palliative pain management?

A

the goal is to achieve comfortable and dignified death; the main tool is to assess breathing and facial & body langauge - VS are NOT checked.

Pharmacology (7 decks)

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