Pharm: anti-inflammatories and analgesics

Question 1

______ can come from trauma, surgery, extreme heat or cold, caustic chemical agents, infection

Answer 1

inflammation

Question 2

what are the 2 inflammatory phases?

Answer 2

vascular phase and delayed phase

Question 3

vessels vasodilate allowing blood and fluid to move to the site of injury (swelling)

Answer 3

vascular phase

Question 4

Leukocytes move into the site of injury

Answer 4

delayed phase

Question 5

cyclooxygenase enzyme

Answer 5

COX

Question 6

converts arachidonic acid into prostaglandins which causes inflammation and pain at injury site (histamine, kinin, and prostaglandin (cause inflammation))

Answer 6

COX

Question 7

What are the 2 forms of COX enzymes?

Answer 7

COX-1 and COX-2

Question 8

protects stomach lining and regulates blood platelets

Answer 8

COX-1

Question 9

triggers inflammation and pain

Answer 9

COX-2

Question 10

cardinal signs of inflammation

Answer 10

redness, warmth, swelling, pain, loss of function

Question 11

nonsteroidal antiinflammatory drugs

Answer 11

NSAIDs

Question 12

NSAIDs do what?

Answer 12

-decrease inflammation
-antipyretic properties (prevent/reduce fever)

Question 13

-inhibit COX enzyme needed for prostaglandin synthesis
-relieve pain
-reduce elevated body temp
-inhibit platelet aggregation
-mimic effects of corticosteroids

Answer 13

NSAIDs

Question 14

common 1st generation NSAIDs (nonspecific inhibitor of COX enzymes)

Answer 14

-aspirin
-ibuprofen

Question 15

second generation NSAID (selective and only inhibits COX-2) not as much effect on GI (ulcer risk/history may benefit)

Answer 15

celecoxib (Celebrex)

Question 16

true or false: NSAIDs increase the risk of bleeding

Answer 16

true

Question 17

acetylsalicylic acid (ASA): antiinflammatory, antiplatelet, antipyretic effects

Answer 17

aspirin

Question 18

Why no give children aspirin?

Answer 18

Reye’s syndrome

Question 19

toxic serum salicylate lvl?

Answer 19

> 300 mcg/mL

Question 20

Why take NSAIDs w/ food?

Answer 20

can cause GI upset

Question 21

What kind of coating protects GI tract because it does not absorb until small intestine?

Answer 21

enteric coated

Question 22

2 issues that need to be watch when patient is on NSAIDs

Answer 22

-watch for bleeding
-increased risk of hypoglycemia when on ORAL DIABETIC MEDS

Question 23

adult aspirin

Answer 23

325mg

Question 24

baby aspirin

Answer 24

81mg

Question 25

aspirin changes what lab values

Answer 25

-prolonged prothrombin time -decrease cholesterol and potassium

Question 26

foods that contain salicylates

Answer 26

-prunes, raisins, licorice -certain spices (curry, paprika)

Question 27

DO NOT take other NSAIDs with _____ (unless ordered)

Answer 27

aspirin

Question 28

Is Reye's syndrome a side effect or an adverse reaction?

Answer 28

adverse reaction

Question 29

side effects of aspirin?

Answer 29

-dizziness -lethargy -headache -GI upset

Question 30

why would we monitor serum salicylate lvl?

Answer 30

overdose (x10 therapeutic lvl)

Question 31

why warn parents not to give aspirin for virus or flu symptoms to children to avoid risk of ______?

Answer 31

Reye's syndrome

Question 32

para-chlorobenzoic acid

Answer 32

indomethicin

Question 33

indomethicin inhibits what enzyme/enzymes

Answer 33

COX-1 and COX-2

Question 34

what is para-chlorobenzoic acid (indomethicin) used for?

Answer 34

arthritis (rheumatoid, osteo, and gouty)

Question 35

propionic acid derivative

Answer 35

ibuprofen

Question 36

ibuprofen inhibits which enzyme/enzymes

Answer 36

COX-1 and COX-2 (blocking arachidonate binding)

Question 37

what is ibuprofen used for?

Answer 37

pain, osteo and rheumatoid arthritis, febrile illness

Question 38

where are NSAIDs metabolized and secreted?

Answer 38

metabolized in liver and excreted by kidneys

Question 39

what labs would you want to monitor when patient is on NSAID therapy

Answer 39

LFTs, BUN, and creatinine

Question 40

propionic acid derivatives (ibuprofen) increases bleeding with which drug?

Answer 40

warfarin (Coumadin)

Question 41

onset of ibuprofen is around _____

Answer 41

1 hour

Question 42

selective COX-2 inhibitors are _____ and ______

Answer 42

nabumetone and meloxicam

Question 43

Selective COX-2 inhibitors have fewer ___ side effects

Answer 43

GI

Question 44

analgesics are used for ____

Answer 44

pain

Question 45

the fifth vital sign is ____

Answer 45

pain

Question 46

level of stimulus required to create a painful sensation

Answer 46

pain threshold

Question 47

amount of pain one can endure w/o interfering with ADLs (different from one person to the next)

Answer 47

pain tolerance

Question 48

2 forms of analgesics

Answer 48

-opioid -nonopioid

Question 49

used to relieve moderate-severe pain

Answer 49

opioid (e.g. morphine)

Question 50

used to relieve mild-moderate pain

Answer 50

nonopioid (NSAIDs)

Question 51

pain receptors from tissue injury

Answer 51

nociceptors

Question 52

injury to nerves

Answer 52

neuropathic pain

Question 53

distraction (close gate on pathways then pain can be controlled)

Answer 53

gate theory

Question 54

effect of unrelieved pain

Answer 54

depression

Question 55

why do 80% of patients have unrelieved pain in the US

Answer 55

-pts don't like to report pain -narcotic crisis

Question 56

less potent than opioid analgesics

Answer 56

nonopioid analgesics (mild - moderate pain)

Question 57

nonopioid analgesic: no antiinflammatory properties (not NSAID), inhibits prostaglandin synthesis (pain and fever)

Answer 57

acetaminophen (Tylenol) max dose (4g/day) frequently taken (2g/day)

Question 58

take acetaminophen and ibuprofen _____ apart

Answer 58

2 hours

Question 59

antidote to opioid overdose

Answer 59

naloxone (Narcan)

Question 60

antidote for acetaminophen

Answer 60

mucomyst

Question 61

moderate to severe pain, act on CNS (antitussive and antidiarrheal effects)

Answer 61

opioid anagesics

Question 62

main side effects of opioids

Answer 62

-constipation -dyspnea/respiratory depression

Question 63

how can morphine be given?

Answer 63

-suspension -tablet -IM -IV (rapid onset)

Question 64

when giving morphine IV, what may occur?

Answer 64

itching along vein

Question 65

PCA

Answer 65

patient-controlled analgesia

Question 66

what does PCA do?

Answer 66

give patient button to get drugs PRN (there is a cap to avoid OD)