Module 4 Flashcards
What are prostaglandins?
group of lipids with hormone-like actions that your body makes primarily at the site of tissue damage or infection
What do the COX-1 and COX-2 produce?
Prostaglandins
COX-1 is __________, meaning it runs no matter what the cellular needs are.
Constitutive
COX-2 is ________, which means it needs a _______.
Inducible, inflammatory stimuli
COX-1 is responsible for:
Platelet regulation, kidney function, and regulating stomach acid/mucous production
COX-2 is responsible for:
Inflammation responses: swelling, pain, heat
COX-1 has a constant _____ level of prostaglandin production
Low
COX-2 has a constant _____ level of prostaglandin production
High
Aspirin inhibits COX _______
1 and 2
What is another name for aspirin?
Acetylsalicylic acid
ASA is another name for?
Aspirin
Function of aspirin?
Suppresses inflammation, pain, and fever; causes irreversible inactivation of COX 1 and 2
What condition can aspirin cause in children with viral illnesses?
Reye’s syndrome
What kind of medication is aspirin?
Antiplatelet (prevents clots, platelet aggregation)
Side and adverse effects of aspirin?
GI distress, bleeding, renal impairment, salicylism , Reye’s syndrome , and can be nephrotoxic in high doses
What kind of pt is aspirin contraindicated for?
Risk for or actively bleeding, children with viral illnesses, renal impairment/failure
Drug interactions for aspirin?
Warfarin(and other anticoagulants) and alcohol (increased risk for bleeding as well)
What forms does aspirin come in?
Chewable, plain, enteric coated, time released, and rectal
Dosage for aspirin is ______ and ____ dependent
Age and condition
Nursing interventions for aspirin:
Decrease risks for bleeding (precautions), monitor for s/s bleeding, give with food, dont crush or allow pt to chew enteric coated, be aware of children and if have viral illness
What is salicylism?
Aspirin toxicity
What is the antidote for Salicylism?
Activated charcoal to inhibit absorption, hemodialysis if needed, gastric lavage( if needed)
S/S for salicylism
Tinnitus, vertigo, HA, fever, ALOC, sweating
Ibuprofen inhibits_______
COX-1 and COX-2
How do aspirin and ibuprofen differ?
Ibuprofen does not have anti-inflammatory properties like aspirin does and it is not cardio protection. Ibuprofen has a black box warning for risk of a cardiovascular event and GI bleeding
Side/adverse effects of ibuprofen?
N/V, GI injury (ulcers, bleeding), can be nephrotocxic and/or hepatotoxic, prolonged bleeding (but not as much as aspirin); BLACK BOX warning: cardiovascular event, GI bleeding
Ibuprofen nursing interventions
Teach to take with food and to increase fluids, avoid alcohol and “G” herbs(ginger, ginseng, ginkgo, garlic), report s/s bleeding, teach and report s/s of MI and stroke, do not crush, cut, chew ER/enteric coated tabs, teach that Ketorolac can cause kidney damage if used for about 5 days
What interventions should be used for older adults and NSAIDs?
Monitor renal function beforehand, encourage adequate fluid intake, and use lower dose to decrease the risks of complications
Corticosteroids
“-one”; anti-inflammatory and used for pain; used to suppress immune system (i.e. transplant pts)
Long half-life, taper off over several days
May cause: edema, hyperglycemia, increased appetite, weight gain, neutropenia
Etanercept, infliximab, adalimumab are all examples of a __________
DMARDs (disease-modifying anti-rheumatic drugs )
Prednisone, prednisolone, and dexamethasone are all _______
Corticosteroids
When are disease modifying anti-rheumatic drugs used?
When NSAIDs are unsuccessful in treating rheumatoid arthritis pain, prevents progression by suppressing prostaglandin activity and slowing degeneration of joints; delayed effect (3-6 weeks)
How long do DMARDs take to become therapeutic?
May take several months
A/E for disease modifying anti-rheumatic drugs
Injection site pain, risk for infection, blood dyscrasias, skin reactions(stevens-Johnson), HF
Nursing interventions for DMARDs
Monitor injection site, watch for s/s infection and skin reactions as well as HF, obtain CBC and look for blood dyscrasias
Drug interactions for DMARDs
Live virus vaccines (avoid)
Methotrexate
DMARD, immunomodulator used to slow or delay the worsening of rheumatoid arthritis , can take 3-6 weeks to see full effects
A/e of methotrexate
Infection, hepatotoxicity, bone marrow suppression, ulcerative stomatitis, fetal death
Nursing interventions for methotrexate
Monitor for s/s infection, labs and hepatotoxicity, give folic acid, monitor stomatitis, give with food, and educate about a need for contraceptives (fetal harm); educate to avoid crowds, trauma, sick ppl.
Pregnancy category for methotrexate
Category X: contraindicated
Contraindications for methotrexate
Liver failure, alcohol use, pregnancy, blood dyscrasias
What should a nurse do before administering DMARDs?
Check for infection
Pt teaching for DMARDs
Phototoxic- sunscreen s/s stevens-Johnson, s/s HF, s/s infection
gout
Extremely painful inflammatory condition that affects joints, tendons, and other tissues; increased Uric acid levels, tophi
Tophi
chunks of uric acid developed around and within joints- advanced gout
Gout pt should avoid foods high in ________
Purine (red meats, alcohol, fish, scallops
Gout pts should increase fluid intake to prevent
Kidney stones (nephrolithiasis)
How is acute gout treated?
Colchicine, NSAIDs, intra-Articular glucocorticoids
What kind of gout attack is colchicine given for?
Acute
What is allopurinol?
Urate-lowering agent; works by inhibiting the production of uric acid, used prophylactically; tx for hyperuricemia for chronic gout- avoid alcohol and increase fluids; causes a metallic taste (normal s/e)
A/e for allopurinol
Hypersensitivity, kidney injury,hepatitis, GI distress, increase in gout attacks for first months of treatment, CNS effect
Anti-gout medications
Pregnancy category C
Colchicine decreases inflammation, used for acute attack
Decreases inflammation
A/e= GI distress, bone marrow suppression , rhabdomyolysis
Contraindications in those with severe renal, cardiac, hepatic , or GI dysfunction
What is probenecid?
An anti-gout medication that inhibits uric acid reabsorption, used prophylactically (prevent gout)
A/e= kidney calculi, GI effects, hypersensitivity
Anti-gout medication drug/food interactions
Grapefruit juice (increases med effect), avoid salicylates with probenecid
Nursing interventions for anti-gout medications
Teach them to take it with food, avoid grapefruit juice and alcohol; monitor uric acid, CBC LFT and RFT, monitor for bleeding and infection, teach them to avoid foods high in purine, increase fluids, and allopurinol causes a metallic taste ( not concerning)
What type of drug is acetaminophen?
Non-opioid analgesic
How does acetaminophen work?
Analgesic and antipyretic actions, but no anti-inflammatory or anti thrombotic actions, does not cause GI upset,but liver damage can be fatal; used to treat fever and minor pain, drug of choice for older adults (initial mild-operate musculoskeletal pains) and children
What’s is the antidote for acetaminophen?
Acetylcysteine (oral, IV)
Pharmacokinetics of acetaminophen
Metabolized by liver and excreted by kidneys
Drug interactions for acetaminophen
Alcohol (damages liver as well) and warfarin (increases INR) monitor the pt
What is the max daily dose for acetaminophen in someone with a healthy liver?
4 g per day
In someone who drinks ______ or more drinks in a day, the max dose of acetaminophen is _______ per day
3; 2g
What two factors increases the risk for acute toxicity of acetaminophen?
Fasting and alcohol
S/s of acetaminophen toxicity
N/V/D, swearing, abd pain, coma, death, liver damage (within 48 hours)