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PHARMACOLOGY > Pain and Inflammatory Agents > Flashcards

Pain and Inflammatory Agents Flashcards

1
Q

Are a class of medications designed
specifically to relieve pain.

This includes over the counter (OTC) _________ or
by prescription when combined with another drug,
and opioids (narcotics), which are only available by
prescription.

A

Analgesics

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2
Q

● _______ require a different prescription (yellow
prescription) from the usual one because they are
________.

● Not all doctors have this; only
doctors, usually psychiatrists and anesthesiologists,

A

Narcotics, addictive

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3
Q
  • The response to tissue injury and infection
  • Protective mechanism
  • Other causes: trauma, surgical interventions,
    extreme hot and cold, and caustic chemical
    agents.
A

Inflammation

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4
Q
  • An enzyme responsible for the conversion of arachidonic acid into prostaglandin
  • Synthesis of prostaglandin
A

Cyclooxygenase (COX)

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5
Q

(2) typex of COX

A

COX 1 and COX 2

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6
Q

This type of COX

  • protects stomach lining
  • regulates blood platelets
A

COX 1

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7
Q

This type of COX

  • triggers inflammation and pain.
A

COX 2

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8
Q

A part of prostaglandin inhibitors, particularly nonsteroidal anti-inflammatory drugs (NSAIDs).

A

Anti-Inflammatory Agents

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9
Q

Type of Anti-inflammatory Agents

  • relieves pain
A

analgesic

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10
Q

Type of Anti-Inflmammatory Agents

  • reduces elevated body temperature
A

antipyretic

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11
Q

Type of Anti-Inflammatory Agents

  • inhibit platelet aggregation
A

anticoagulant

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12
Q

7 Groups of NSAID

A
  1. Salicylates
  2. Para-Chlorobenzoic Acid Derivatives or Indoles
  3. Phenylacetic Acids
  4. Propionic Acid
    derivatives
  5. Fenamates
  6. Oxicams
  7. Selective Cox-2 inhibitors
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13
Q

Mnemonic for 7 Groups of NSAID

A

Some People Prefer Pain-Free Options Selectively (SPPPFOS)

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14
Q

Aspirin is also known as

A

Acetylsalicyclic Acid (ASA)

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15
Q

Therapeutic Serum Salicylate level 10-^^ mg/dl

A

10-30 mg/dl

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16
Q

Toxic Serum Salicylate Level >XX-XX mg/

A

40-50 mg/dl

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17
Q
  • This NSAID drug has Aspirin, also known as acetylsalicylic acid (ASA).
  • This drug is taken for hypertensive and high cholesterol patients
  • Lowers the risk for heart attack or stroke

Hypersensitivity to _______ products: tinnitus,
vertigo, bronchospasm

A

Salicylates

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18
Q

(3) Functions of Salicylates

A
  1. Anti-inflammatory
  2. Antiplatelet
  3. Antipyretic effects
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19
Q

(3) Drug Interactions of Salicylates

A
  1. Anticoagulants
  2. Glucocorticoids
  3. Oral hypoglycemic
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20
Q

Nursing Responsibilities for Salicylates

A
  1. Monitor for signs of bleeding
  2. Always ask for allergies
  3. Oldest anti-inflammatory NSAID.
  4. Should not be taken with any other NSAID because
    it decreases its effectiveness/
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21
Q

Key points in Salicylates:

GI Upset: Should be taken with __, water, food (__meal)

Reye Syndrome (swelling in the brain and liver: ___ be taken by children and flu symptoms.

A

Milk, Full, Not

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22
Q

Contraindications of Salicylates

A

Pregnancy in their third trimester because it can
cause premature closure of ductus arteriosus.

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23
Q

This NSAID drug can increased BP, sodium & water retention.

A

Para-Chlorobenzoic Acid

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24
Q

(2) Drugs present in Para-Chlorobenzoic Acid

A
  1. Indomethacin (Indocin)
  2. Sulindac (Clinoril
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25
Q

This NSAID drug has (3) indications of the following:

○ Rheumatoid Arthritis
○ Osteoarthritis
○ Ankylosing spondylitis

A

Phenlyacetic Acid Derivatives

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26
Q

(2) Drug of Phenylacetic Acid Derivatives

Route: ______

A
  1. Diclofenac Na (Voltaren), Topical
  2. Ketorolac, injectable
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27
Q

A Phenlyacetic acid derivative drug that is a:

  • short term management of pain, and has greater analgesic effect
A

Ketorolac

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28
Q

This NSAID drug increases the effects of warfarin,
sulfonamides, certain cephalosporin, phenytoin,
insulin, oral hypoglycemic

● SE: gastric upset (to be taken with food)

A

Propionic Acid Derivatives

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29
Q

(1) Drug of Propionic Acid Derivatives

● Medications that usually ends with -fen

A

Ibuprofens (Alaxan, Advil, and Medicol)

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30
Q

Propionic Acid Derivatives should NOT BE TAKEN with _____ channel ______ such as amlo____ because it can increase the risk of ________

A

calcium channel blockers, amlodipine, toxicity

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31
Q

This NSAID drug has indications of: Acute & chronic arthritic conditions

● SE: Gastric irritation

● C/I: Patient with peptic ulcer

A

Fenamates

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32
Q

(2) Drugs of Fenamates

A
  1. Mefenamic Acid (Ponstel) (Ponstan)
  2. Meclofenamate Na Monohydrate (Meclomen)
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33
Q

This NSAID drug has indication: Long term arthritic conditions

● S/E: lower incidence of gastric problems;
ulceration; epigastric distress

● Should NOT BE TAKEN with aspirin; other NSAIDs
because it can decrease its effectiveness.

A

Oxicams

34
Q

(2) Drugs of Oxicams

A
  1. Piroxicam (Feldene Flash)
  2. Meloxicam
35
Q

This NSAID drug has (3) Drug agents namely:

  1. Celecoxib (Celebrex)
  2. Rofecosib (Vioxx)
  3. Nabumetone (Relafen)

Also, it is NSAIDS in the elderly, and need for assessment of renal function - creatinine.

It is 2ND generation NSAID

This NSAID dose may need to be decreased.

A

COX-2 Inhibitors

36
Q

(3) Drug Agents for COX -2 Inhibitors.

  1. ________(Celebrex) - usually prescribed and can be taken in empty stomach
  2. ________ (Vioxx) - no longer available
    in the market due to manifestation of Heart disease.
  3. ________(Relafen)
A
  1. Celecoxib
  2. Rofecoxib
  3. Nabumetone
37
Q

NURSING CONSIDERATIONS OF NSAIDs (WOF)

N -
S -
A -
I -
D -

A

(N) - Not good for
the body
● GI Bleed, Bronchospasm, Heart dse., Kidney clogging, Blood clot

(S) - Sticky Blood (EXCEPT ASA)
● Increase risk for thrombosis
● MI, Stroke, DVT

(A) - Asthma Attack
● Bronchospasm

(I) - Increase Bleeding Risk
● Easy bruising, Tarry stool, Coffee ground
emesis
● AVOID PEPTIC ULCER

(D) - Dysfunctional Kidneys
● Creatinine - 1.3, UO <30cc
● KETOROLAC - kills kidneys
● NOT given CHF - Na

38
Q

This drug suppress and prevents many of the components of the inflammatory process at the
injured site.

  • Widely prescribed for patients with arthritis but not a drug of choice due to many side effects
A

CORTICOSTEROIDS

39
Q

(3) drugs of corticosteroids

A
  1. Dexamethasone
  2. Prednisone
  3. Prednisolone
40
Q

This drug is for the
1. inflammation of the joints

  1. Uric Acid.
A

Antigout drugs

41
Q

(4) Antigout Drugs

A
  1. Colchicine
  2. Allopurinol (Uric Acid Inhibitor)
  3. Thiazide Diuretics (Uric Acid Inhibitor)
  4. Uricosurics
42
Q

This antigout drug

  • Inhibit leukocytes on the inflamed site; effective
    against acute symptoms of gout but is not effective
    in decreasing inflammation of other inflammatory
    disorders
A

COLCHICINE

43
Q

This antigout drug

  • Inhibit final steps of uric acid synthesis.
  • No caffeine and alcohol.
  • Indicated gout patients with renal impairment.
  • Prevents the increase of uric acid.
  • Drug of choice for chronic gout.
A

Allopurinol (Uric Acid Inhibitor)

44
Q

This antigout drug

  • increases the level of uric acid
A

Thiazide Diuretics (Uric Acid Inhibitor)

45
Q

This antigout drug

  • alleviates chronic gout

SE: Sore gums, headache, flushed skin

A

Uricosurics

46
Q

Under uricosurics have (1) sub drug

  • that increases the rate of uric acid excretions in the kidneys
A

Probenecid

47
Q

Analgesics are divided into (2) Opioid:

A

Non-Opioid and Opioid

48
Q

Choose between CNS or PNS

  1. NON-OPIOID acts on ___
  2. Opioid acts on ____
A
  1. PNS
  2. CNS
49
Q

Unpleasant sensory and emotional experience
related to tissue injury.

A

Pain

50
Q

Relief of Pain

A

Analgesics

51
Q

This type of pain if less than 3 months

A

Acute Pain

52
Q

This type of pain if more than 3 months

A

Chronic pain

53
Q

Non-Opioid Analgesics includes (2) drugs

A
  1. NSAIDS (7 Types)
  2. Acetaminophen
54
Q

Opioid Analgesics includes (6) drugs

A
  1. Tramadol
  2. Morphine
  3. Meperidine (Demerol)
  4. Hydromorphone
  5. Oxycodone
  6. Fentanyl
55
Q

Type of Non opioid drug:

● Safe, effective analgesic and antipyretic drug used
for muscular aches, pains and fever caused by viral
infections

● Hepatotoxic; little to no GI distress

● Therapeutic serum range: 5-20 mcg/ml

● ANTIDOTE: Acetylcysteine (Mucomyst or
Fluimucil)

A

Acetaminophen

56
Q

This class of opioid:

● Can cause addiction
● Analgesia, respiratory depression, euphoria, and sedation
● Cough suppression
● Antidiarrheal effect
● S/E: nausea, vomiting, constipation, decrease in BP,
urinary retention, antitussive effects

● Nursing Responsibilities:
○ Monitor RR
○ Promote free from injury (Risk for injury
and fall r/t effect of the drug)

A

Opioid Analgesics

57
Q

This type of opioid analgesics has:

● Pain medicine similar to an opioid. It acts in the
central nervous system (CNS) to relieve pain.
● SEIZURES have been reported in patients taking this. Your risk of seizures is higher if you are
taking higher doses than recommended.

● Maximum dose: 400 mg per day.

● Tramadol (TDL HCL) 50 mg/cap

● Tramadol HCL 37.5 mg, Paracetamol 325 mg
(DOLCET)

● Nursing Responsibilities:
○ Monitor RR (should be above 12, DO
NOT give the dose if the respiration is
below 12)

A

TRAMADOL

58
Q

This type of opioid analgesics has:

● AMI, CA, pulmonary edema
● Given for post op clients and with Myocardial
infarction
● As pre op medication- relieve anxiety
● Oral; IV; IM; SUBQ
● ANTIDOTE: NALOXONE (NARCAN)

A

MORPHINE

59
Q

This type of opioid analgesics has:

● Shorter duration of action than Morphine.
● Route: Oral, IM, IV
● No antitussive property
● Less S/E than morphine
● Neurotoxic
● Can decrease BP

● DRUG OF CHOICE FOR PATIENTS WITH ACUTE PANCREATITIS

A

MEPEREDINE (DEMEROL)

60
Q

This type of opioid analgesics has:

● More potent than morphine.

● Faster onset, shorter duration of action than
Morphine

● Route: Oral, rectal, subcutaneous, IM, IV

● SIVP (Slow Intravenous Push)

● Withdrawal syndrome – irritability, diaphoresis,
muscle twitching, increase in PR and BP.

A

HYDROMORPHONE

61
Q

What is the migraine and cluster preventive treatment for headaches?

A

● Beta-adrenergic blockers (Propranolol & Atenolol)

● Anticonvulsant (Valproic Acid & Gabapentin)

● TCA (amitriptyline & imipramine)

● Treatment/ cessation of attack
○ Opioid analgesics
○ Ergot alkaloids
○ Selective serotonin (Triptans)

62
Q

Type of opioid is Oxycodone. Fill in the blanks:

  1. _________ - long acting opioid analgesic
    medications for round the clock for acute and
    chronic pain.
  2. ________immediate acting opioid analgesic
    medications for breakthrough pain.
    ● Available in oral and IV.
  3. ______(Oxycodone + Naloxone) – this is for the management of moderate to severe chronic pain
    unresponsive to non-narcotic analgesia.
    ● Treatment and/or Prophylaxis of OPIOID-Induced
    constipation.
A
  1. Oxycontin
  2. Oxynorm
  3. TARGIN
63
Q

Which of the following examples of NSAID is a potent inhibitor of prostaglandin synthesis and is usually given to patients with arthritic pain which may cause hypertension and sodium and water retention?

Question 1Answer

a.Celecoxib

b.Indomethacin

c.Mefenamic Acid

d.Aspirin

A

b.Indomethacin

64
Q

All of the following are considered cardinal signs of inflammation EXCEPT:

Question 2Answer

a.Dolor

b.Rubor

c.Calor

d.Cyanosis

A

d. Cyanosis

65
Q

Which of the following opioid analgesics is considered the drug of choice for patients with Acute Pancreatitis?

Question 3Answer

a.Meperidine

b.Morphine

c.Fentanyl

d.Oxycodone

A

a. Meperidine

66
Q

Which of the following is an example of Corticosteroid?

Question 4Answer

a.Sulindac

b.Piroxicam

c.Dexamethasone

d.Ketorolac

A

c. Dexamethasone

67
Q

All of the following are the mechanisms of action of anti-inflammatory agents EXCEPT:

Question 5Answer

a.None of the above

b.Anticoagulant

c.Antipyretic

d.Analgesic

A

a.None of the above

68
Q

Which of the following instructions should the nurse give to patients taking NSAIDs?

Question 6Answer

a.It should be taken with meals

b.Avoid direct sunlight

c.It is advisable for pregnant women

d.Avoid dairy products

A

a. It should be taken with meals

69
Q

Which of the following should the nurse prepare at the bedside of the patient who is being given with IV Morphine Sulfate?

Question 7Answer

a.Naloxone

b.Kidney basin

c.Urinal

d.Tongue depressor

A

a.Naloxone

70
Q

Which of the following opioid analgesics is usually given to Cancer patients as part of their palliative care?

Question 8Answer

a.Oxycodone

b.Tramadol

c.Fentanyl

d.Morphine

A

d.Morphine

71
Q

Which of the following NSAIDs should not be given to children with flu as it is associated with developing Reye’s Syndrome?

Question 9Answer

a.Ibuprofen

b.Celecoxib

c.Acetylsalicylic Acid

d.Acetaminophen

A

c. Acetylsalicylic Acid

72
Q

A 72-year-old male patient with Osteoarthritis was prescribed with Celecoxib 200mg cap OD x pain. Which of the following is a common side effect of this drug?

Question 10Answer

a.Diarrhea

b.Tinnitus

c.Hypotension

d.Bradypnea

A

a. Diarrhea

73
Q

Which type of NSAID is indicated for patients with Ankylosing Spondylitis?

Question 11Answer

a.Proprionic Acid Derivatives

b.Phenylacetic Acid Derivatives

c.Selective COX-2 Inhibitor

d.Fenamates

A

b.Phenylacetic Acid Derivatives

74
Q

Which of the following chemical mediators is responsible for inflammation from tissue injury?

Question 12Answer

a.Histamine

b.All of the above

c.Kinins

d.Prostaglandin

A

b.All of the above

75
Q

Which of the following enzymes is inhibited by NSAIDs to manage arthritic pain?

Question 13Answer

a.Cyclooxygenase

b.Aminotransferase

c.Amylase

d.Lipase

A

a.Cyclooxygenase

76
Q

Which of the following nursing considerations should the nurse remember for a patient on opioid medication?

Question 14Answer

a. Encourage ambulation after giving the medication

b. Check the capillary blood glucose (CBG) before meals

c.Increase oral fluid intake

d. Monitor the vital signs before and after giving the medication

A

d. Monitor the vital signs before and after giving the medication

77
Q

Patients taking Tramadol have a higher risk of developing which of the following side effects due to an increase in serotonin levels?

Question 15Answer

a.Hallucination

b.Seizure

c.Hypersensitivity

d.Lethargy

A

b.Seizure

78
Q

Which of the following antigout drugs is used to treat and prevent gout attacks by reducing inflammation?

Question 16Answer

a.Colchicine

b.Probenecid

c.Allopurinol

d.Hydrochlorothiazide

A

a.Colchicine

79
Q

Long term use of corticosteroids will lead to developing which of the following conditions?

Question 17Answer

a.Red Neck Syndrome

b.Reye’s Syndrome

c.Raynaud’s Disease

d.Cushing’s Syndrome

A

d.Cushing’s Syndrome

80
Q

Which of the following antigout drugs inhibit final steps of uric acid synthesis thereby lowering blood uric acid levels?

Question 18Answer

a.Hydrochlorothiazide

b.Colchicine

c.Allopurinol

d.Probenecid

A

c.Allopurinol

81
Q

Which of the following medications is given as an antidote for acetaminophen toxicity?

Question 19Answer

a.Erdosteine

b.Acetylcysteine

c.None of the above

d.Carbocysteine

A

b.Acetylcysteine

82
Q

Which of the following antigout drugs is considered as a uricosuric which causes atypical side effect of sore gums, flushed skin, and headache?

Question 20Answer

a.Hydrochlorothiazide

b.Probenecid

c.Allopurinol

d.Colchicine

A

b.Probenecid

PHARMACOLOGY (6 decks)

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