N365 Anti-Inflammatory Flashcards
What classification is Aspirin?
Salicylates
What is the action of a Salicyclate?
Probably inhibits cyclooxygenase (enzyme required to make prostaglandins).
What classification is ASA?
Saliccyclate
What is the Action of ASA on analgesia?
Main is perpheral affect by preventing sensitization of pain receptors by inhibiting prostaglandin synthesis.
Also centrally in small amounts on the hypothalmus by modifying perception of pain.
What is the affect of ASA as an antipyretic?
acts on hypithalmus
How is ASA an anticoagulant?
it irreversibly inhibts platelet aggregation, weakly inhibits prothrombin synthesis, and prolongs bleeding time.
What are the uses of ASA?
to relieve pain associated with inflamation, not effective with sharp pain associated with direct stimulation of sensory nerves. Also as an antipyretic as prostaglandins are pyrogenic by themselves. anti-inflammatory, and antiplatelet!
What are the effects of ASA on the GI system?
epigastric distress, N/V, ulceration
What are the effects of ASA on the respiratory system?
respiratory stimulation due to increased O2 consumption.
What are the effects of ASA on the cardiovascular system?
in large doses it causes peripheral dilation.
What are the effects of ASA on the blood?
Anemia and iron defficiency from bleeding, thrombocytopenia due to bone marrow depression or low platelets. Coagulation effect, increased capillary permeabiility and prolonged bleeding time, interferes with some clotting factors.
What are the effects of ASA on the CNS system?
Tremmors, headaches, vertigo, tinnitus, diplopia, agitation, can be ototoxic to the 8th cranial nerve.
What are the effects of ASA on the metabolism?
toxic doses increase metabolic rate protein bound iodine is displaces affects plasma corticosteroid leves increased plasma insulin levels uricosuric - acidic urine high doses interfere with ascorbic acid availability.
What classification is acetaminophen?
non-antiinflammatory anagesic - non opiod
What is the action of non-inflammatory analgesic non opiods like tylenol?
uncertain but has both central and peripheral action.
What are the ADR’s of acetaminophen?
remarkably free of them, but is extremely toxic to liver in large doses, chronic use can lead to kidney damage.
What is the antidote to tylennol?
acetylcystine (Mucomyst)
Tylenol No 2
acetaminophen 325mg + 15mg codine.
Tylenol No 3
acetominophen 325mg + 30mg codeine
Tylenol No 4
acetominophen 325mg + 60mg codeine
What class is Indomethacin (Indocin)?
non steroidal anti-inflammatory
What is the action of an Indocin?
potent inhibitor of prostaglandin synthesis.
What are the ADR’s of Indocin?
GI, NV, peptic ulcer and hemmorage, headache, dizzyness, tinnitus, skin rash, aggrivate psychiatric disturbances, parkinonism, epilesy, and occular changes 1/2 to 1/3 have side effects.
Special Information for Indocin
side effects can mask symptoms of infection.
What are some drung interactions with indocin?
probenecid increases plasma levels of indocin, reduces the naturiuretic and antihypertensive effects of lasix. can cause an increase in levels of lithium and reduce excretion of lithium, ASA may inhibit the absorption of indocin.
How should Indocin be given
give with food, milk, or antacid to slow absorption and decrease side effects.
How is indocin used with premature infants?
it’s used to close a patent ductus arteriosus.
What class of drugs is ibuprofen?
NSAID
What is the action of ibuprofen?
non known, inhibits synthesius and release of prostaglandins.
What are the ADR’s with ibuprofen?
NV, diarrhea, constipation, heartburn, skin eruptions, pruritus, dizziness, blurred vision, fluid retention, headache.
How long does it take for ibuprofen to become theraputically active with chronic illness?
2 weeks for osetoarthritis.
Who is ibuprofen contraindicated with?
patients with a history of ASA induced bronchospasm, asthma, rhinitis, nasal polyps, angioedema, urticaria (Hives).
What should a patient on ibuprofen do who has sudden vision problems?
see doctor immediately stop use.
What is a ‘possible class effect’ of NSAIDS?
increased risk of cardiovascular events.
What is the classification of Celecoxib (Celebrex)?
Cox-2 inhibitor, 2nd generation NSAID
What is the action of celebrex?
selectively inhibits cox 2
What are the ADR’s of celebrex?
Abdominal pain, diarrhea, dyspepsia, renal toxicity, fluid retention, edema.
Special information about celbrex.
Appears to be as effective as older NSAIDS with fewer GI ulcers.
Who might celbrex be contraindicated for?
possible patients with allergies to sulfa as it contains a small sulfur molecule. patients with cardiac risks.
What classification of drug is Piroxicam (Feldene)?
Analgesic, anti inflammatory (oxicam derivative).
What is the action of piroxicam?
it inhibits biosynthesis of prostaglandins.
What are the ADR’s for piroxicam?
GI, edema, dizzyness, rashes, renal disease, hematalogic changes, no documented ocular effects.
Special information Piroxicam
May potentiate anticoagulants, ASA interferes with piroxicam absorption, be aware of other protein bound drugs. EVALUATE FOR RENAL DISEASE, the FDA has ONLY approved use of piroxicam for use with arthritis.
What category of drug is Ketorolac (Formerly Toradol)?
Analgesic, antiinflamatory
Action of ketorolac
Inhibits prostaglandin synthesis, most likely COX inhibitor.
ADR Ketorolac?
Drowsiness, sedation, dissiness, headache, swelling, edema, hypertension, dysrhythmiaas, nausea, GI pain, diahrrhea, peptic ulceration, decreased platelet aggregation, hypERKalemia, pain at injection site.
What is ketorolac used for?
for SHORT term oain management (up to 5 days) of pain, effective for post op musculosKeletal condition. Can be as effective as morphine.
How many drug interactions are there for ketorolac?
tons
What classification is Entanercept (Enbrel)?
Antiinflamatory, TNF blocker, anti rheumatic.
What is the action of Entanercept (Enbrel)?
Biologic that suppresses inflamation by neutralizing TNF by binding to it and preventing it from interacting with normal receptors.
ADR’s for Entenercept (Enbrel)?
Injection site reactions, siginificant concert regarding increased infections. Rare cases of CNS disorders as MS, some hematologic disorders.
Special information regarding Entenercept
Really expensive $15,000/year. MUST ASSSESS patient for S/S of infection, CXR and TB screening. Taken early in RA can prevent deformity.
What classification is Hydroxychloroquinine (Plaquenil)
Antimalarial
antiinflamatory use of hydroxychloroquinine
unknown
What are the ADR’s for hydroxychloroquinine?
GI upset, nausea, mild transient headache, bone marrow depression, dermatitis, rash, pruritis, ocular gets bad and is irreversible but progression can be halted if medication stopped.
What are the nursing considerations for Hydroxychloroquine
Give with Milk or Meals, educate about having eyes examined annually, often used with drugs like methotrexate.
What classification is Azathioprine (Imuran)?
Immunosuppressive, anti-inflammatory.
What is the action of Azathioprine (Imuran)?
Inhibits cell proliferation by interfering with DNA and RNA synthesis by inhibiting cells response, Affects purine metabolism.
What are the ADR’s with Azathioprine?
Bone marrow depression, GI (NV, Anorexia), alopecia, hemmorrhagic cystitis, increased incidence of infection, and neoplasm (cancer).
What classification is allopurinon(Zyloprim, Lopurin)
Anti-gout
What is the action of allopurinol
inhibits the process of purine degredation before BEFORE uric acid is formed so it’s PREVENTATIVE. specifically it inhibits xanthine oxidase.
what are the ADR’s with allopurinol?
Drug rashes, bone marrow depression, reversible hepatotoxicity, drowsiness.
Special Considerations with Allopurinol
HIGH INTAKE OF WATER, use with care with anticoagulants, interferes with hepatic function.
What classification of drug is Colchicine (colerys)?
anti gout
What is the action of colchicine?
Unknown, doesn’t affect uric acid levels, thought to affect the inflammatory response to deposited urate crystals by inhibiting leukocyte phagocytosis.
What are the ADR’s of colchicine?
Peripheral neuritis, bone marrrow depression, agranulocytosis, aplastic anemia, acute poisoning and pain, NV, diarrhea that may become bloody, hypovolemic shock from dilation of the capillaries.
Special information about colchicine?
second choice for ACUTE gout attack after NSAIDs.
