Inflammation Flashcards
What is the goal of treatment for inflammation?
— To prevent or decrease the intensity of the inflammatory response
— To reduce fever
What is cyclooxygenase-1?
(COX-1)
- Present in all tissues
—— Reduces gastric acid secretion, promotes renal blood flow, promotes platelet aggregation.
—— Inhibition of COX-1 results in bleeding, gastric upset, reduced renal function.
What is Cyclooxygenase-2?
(COX-2)
- Formed only after tissue injury
—— Promotes inflammation, sensitizes pain receptors, mediates fever in brain.
- Inhibition of COX-2 results in suppression of inflammation
Ibuprofen mechanism of action, primary use, and side effects?
Mechanism of action: To inhibit prostaglandin synthesis
Primary use: For musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis, mild to moderate pain, reduction of fever, primary dysmenorrheal pain.
Side effects: Nausea, heartburn, epigastric pain, dizziness.
What are the effects of systemic corticosteroids?
— Effective in treating severe inflammation; can inhibit immune system to reduce inflammation
— Naturally released from adrenal cortex; suppress histamine and prostaglandins
— Serious side effects:
——Suppression of adrenal gland function, hyperglycemia, electrolyte imbalances, osteoporosis
—— Mood changes, cataracts, peptic ulcers
— Can mask infections
—— Existing infection grows rapidly and undetected
—— Contraindicated in active infections
What is the treatment with corticosteroids?
- used for short-term treatment of acute inflammation
- Long-term treatment
—— Keep dose as low as possible
—— Use alternate-day dosing
—— Cushing syndrome may result
—— Discontinue gradually
What does gout cause, what is primary and secondary gout, symptoms, cause?
— A form of acute arthritis caused by a buildup of uric acid (urate) crystals in the joints and other body tissues
— Primary gout: hereditary defect in uric acid metabolism
— Secondary gout due to:
——— Certain drugs: (thiazide diuretics, aspirin, alcohol)
——— Diseases that affect uric acid metabolism (diabetic ketoacidosis, kidney failure, leukemia)
— Symptoms of acute attacks:
——— Red, swollen tissue; in big toes, ankles, fingers, wrists, knees, elbows.
— Triggered by ingestion of alcohol, dehydration, injury, stress
— Attacks often occur at night
Pharmacotherapy of gout?
— Goal: Termination of acute attacks; prevention of future attacks
— NSAIDs for pain and inflammation; corticosteroids for severe pain and inflammation
— Prophylactic therapy:
——— Uricosurics increase excretion of uric acid by blocking reabsorption in the kidney
——— — Probenecid
———Drugs that inhibit formation of uric acid
———— Allopurinol (Zyloprim) or Febuxostat (Uloric)
——— Drugs that convert uric acid into a less toxic form
———— Rasburicase or pegloticase
Salicylates drugs, action, side effects, and nursing interventions?
Drugs: Acetylsalicylic acid (aspirin)
Action: Bind w/ COX-1 & COX-2 blocking inflammatory prostaglandins
Side effects: Epigastric pain, bleeding, heartburn
Nursing interventions: Assess for bleeding, Give w/ food, Do not give to anyone under age 19 - Reye’s syndrome
NSAIDs drugs, action, side effects, nursing interventions?
Drugs: Ibuprofen, meloxicam, Naproxen, Ketorlac
Action: Bind w/ COX-1 & COX-2 blocking inflammatory prostaglandins
Side effects: N & V
Nursing interventions: Assess for bleeding, Give w/ food, Risk of bleeding lower than aspirin, Renal impairment - give acetaminophen
Cox-2 inhibitors drugs, action, side effects, nursing interventions?
Drugs: Celecoxib
Action: Blocks COX-2 only (no effect on coagulation)
Side effects: No common
Nursing interventions: Monitor for GI bleeding, Monitor for thrombotic events, Monitor for fluid retention & edema, Monitor Hct/Hgb, LFT, BUN/Creatinine & electrolytes
Corticosteroids drugs, action, side effects, nursing interventions?
Drugs: Prednisone, betamethasone, hydrocortisone, dexamethasone.
Action: Inhibit the biosynthesis of prostaglandins
Use: Hyperglycemia, mood changes, cataracts, peptic ulcers, electrolyte imbalances, osteoporosis
Nursing interventions: Give w/ food, mask infection.
Classification of Meloxicam (Mobic)?
NSAID
Contraindications of Meloxicam?
GI bleeding
hepatic disease
Uses/action of meloxicam (mobic)?
Inhibits COX-1 & COX-2 necessary for synthesis of prostaglandins, part of the inflammatory response
Uses: Analgesic, anti-inflammatory, RA
Before/after giving meloxicam?
Before: Assess for bleeding (inhibition of COX-1 can interfere with coagulation)
After: Continue to assess for bleeding
Interactions with meloxicam?
ACE inhibitors
Diuretics
Aspirin
Anticoagulants
feverfew
garlic
Ginger
Ginkgo
Side effects of meloxicam?
None common
Nursing interventions for meloxicam?
Monitor for S/S of GI ulceration or bleeding
Kepatotoxicity
Skin rash
Weight gain
Edema
Monitor for S/S of CV thrombotic events
Monitor Hct/Hgb, CBC w/ diff, LFTs, electrolytes, BUN/creatinine within 3 months of beginning therapy & every 6-12 months thereafter
Take w/ milk or food
Classification of Ketorolac (Toradol)?
NSAID
Contraindications of Ketorolac?
Labor/delivery, surgery
Renal impairment
Hemorrhage
GI bleeding
Peptic ulcer
Uses/action of Ketorolac?
Inhibits COX-1 & COX-2, peripherally acting analgesic, inhibits platelet aggregation
Uses: Short-term management of pain, ocular itching
Interactions with Ketorolac?
Methotrexate
ACE inhibitors
Feverfew
Garlic, ginger, ginkgo
Side effects of Ketorolac?
Drowsiness
Nausea
Nursing interventions for Ketorolac?
Monitor for urine output
Monitor for S/S GI distress including bleeding
Monitor for S/S of CV thrombotic events
Monitor for fluid retention & edema
Monitor electrolytes, LFTs, urinalysis w/ long-term use
CNS side effects: dizziness, drowsiness, light-headedness
Do not use w/ other NSAIDs
Classification of prednisone?
Corticosteroid
Contraindications of prednisone?
Fungal infections
Cataracts
Live attenuated vaccines
Uses/action of prednisone?
Synthetic hydrocortisone w/ corticosteroid properties
Uses: in conjunction w/ antineoplastics, MG, inflammatory conditions, immunosuppressant, ARDS, Addison’s disease, gouty arthritis, hemolytic anemia, sarcoidosis, anemia
Interactions with prednisone?
Barbiturates
Rifampin
Amthotericin B
Diuretics (K+ loss)
Side effects of prednisone?
Few common w/ short term use
Long term use: hyperglycemia, osteoporosis, muscle weakness, bruising
Often given w/ PPI or H2 receptor blockers
Nursing interventions of prednisone?
Monitor BP, I&O, weight, FBS, sleep patterns
Monitor for hypocalcemia, electrolytes
Monitor for masked infection & delayed healing
Extended therapy - oral candida
Monitor bone density
Watch for changes in mood, behavior, psychotic episodes
Do not abruptly discontinue
Avoid alcohol
Report GI distress, give w/ food
Do not use aspirin or OTC drugs w/o approval of HCP
Classification of allopurinol (Zyloprim)?
Anti gout
Contraindications of allopurinol?
None
Uses/action of allopurinol?
Reduces amount of uric acid synthesis
Uses: Hyperuricemia, gout, nephrolithiasis, renal calculus, uric acid nephropathy
Interactions with allopurinol?
Alcohol
Ampicillin
Amoxicillin
Warfarin
Thiazide diuretics
ACE inhibitors
Vitamin C
Nursing interventions for allopurinol?
Monitor loft acute gout attack - 1st 6 weeks
Monitor renal function
Report rash or fever immediately
Monitor serum uric acid levels, CBC, liver, renal function monthly & every few months
Drink 3 L fluids daily
Minimize sun exposure
