Unit 2:Ch 16 (Kach 7th Ed) - Anti-inflammatory, Antiarthritis, and Related Agents Flashcards
A nurse has admitted a 10-year-old child to the short-stay unit. The child has complained of chronic
headaches and his or her mother reports that he or she gives him or her acetaminophen (Tylenol) at
least twice a day. What will the nurse evaluate?
A) Renal function
B) Hepatic function
C) Respiratory function
D) Cardiac function
Ans: B
Feedback:
The nurse should evaluate the patient’s hepatic function. Severe hepatotoxicity can occur from overuse
of acetaminophen. Significant interferences do not occur in the kidney, heart, or lung with
acetaminophen.
The nurse is discussing ethnic differences in response to medication with your nursing students. What
group of people would the nurse tell the students may have a decreased sensitivity to pain-relieving
effects of anti-inflammatory drugs and should be educated concerning signs and symptoms of
gastrointestinal bleeding from use of these drugs?
A) African Americans
B) White Americans
C) Hispanics
D) Asians
Ans: A
Feedback:
African Americans have a documented decreased sensitivity to pain-relieving effects of many antiinflammatory
drugs. They also have an increased risk of developing GI adverse effects to these drugs.
In general, White Americans, Hispanics, and Asians are at lower risk for these problems.
A patient, newly diagnosed with ulcerative colitis, has been admitted to the short-stay unit. What salicylates does the nurse anticipate will be ordered for this patient?
A) Balsalazide (Colazal)
B) Sodium thiosalicylate (generic)
C) Choline magnesium trisalicylate (Tricosal)
D) Salsalate (Argesic)
Ans: A
Feedback:
Balsalazide is delivered intact to the colon, where it delivers a local anti-inflammatory effect that is
most effective for patients with ulcerative colitis. Choline salicylate and salsalate are used to treat pain,
fever, and inflammation. Sodium thiosalicylate is used mainly for episodes of acute gout, for muscular
pain, and to treat rheumatic fever.
The nurse is caring for a 66-pound child with orders for choline magnesium trisalicylate (Tricosal). The
orders read 50 mg/kg/d PO in two divided doses. How many milligram will the patient receive per
dose?
A) 250 mg
B) 500 mg
C) 750 mg
D) 1,000 mg
Ans: C
Feedback:
First, the nurse must determine the child’s weight in kilogram. One kg is equal to 2.2 pounds. Divide
2.2 into 66 to equal 30 kg. Multiply 50 mg times 30 kg to equal 1,500 mg. Divide 1,500 by 2 for the
divided doses, which will equal 750 mg per dose.
A nurse is caring for a patient with severe rheumatoid arthritis who takes anti-inflammatory agents on a
regular basis. What medication should the nurse question if ordered by the physician to be taken in
addition to the anti-inflammatory agent?
A) Oral antidiabetic agent
B) Calcium channel blocker
C) Beta-blocker
D) Antibiotic
Ans: C
Feedback:
Nonsteroidal anti-inflammatory drugs have the potential to decrease antihypertensive effects from beta
blockers if these drugs are taken at the same time. Patients who receive these combinations should be
monitored closely and appropriate dosage adjustments made if needed. Drug interactions do not usually
occur with oral antidiabetic agents, calcium channel blocking medications, or antibiotics.
A nurse is assessing a patient who has been taking nonsteroidal anti-inflammatory drugs (NSAID).
What statement by the patient indicates to the nurse that the patient has a good understanding of the use
of this therapy?
A) I drink a glass of wine just about every night.
B) I asked my doctor to check for blood in my stool regularly.
C) I do not like to swallow tablets so I crush them.
D) I drink as little water as possible when I take my medication.
Ans: B
Feedback:
Taking certain anti-inflammatory drugs can irritate the gastric mucosa and increase the risk of bleeding;
therefore, by asking his or her doctor to check his or her stool for bleeding, the nurse knows that the
patient is aware of this. Alcohol and crushing the tablets can interfere with anti-inflammatory
metabolism. A full glass of water should be taken with this medication to increase absorption.
A salicylate has been prescribed for a 15-year-old patient who has been diagnosed with arthritis. The
mother is concerned about giving her child a salicylate. What salicylates could the nurse tell this mother
are recommended for use in children?
A) Salsalate (Argesic)
B) Olsalazine (Dipentum)
C) Sodium thiosalicylate (generic)
D) Choline magnesium trisalicylate (Tricosal)
Ans: D
Feedback:
Aspirin and choline magnesium trisalicylate are the only salicylates recommended for use in children.
They should not be used when any risk of Reye’s syndrome exists. Salsalate (Argesic), olsalazine
(Dipentum), and sodium thiosalicylate (generic) have not been approved for pediatric use and do not
provide pediatric dosing guidelines as a result.
A mother has brought her 6-year-old child to the clinic. The child has a fever of 102.8ºF and is
diagnosed with the flu. What medication will the nurse suggest for this child?
A) Etanercept (Enbrel)
B) Penicillamine (Depen)
C) Acetaminophen (Tylenol)
D) Aspirin (Bayer)
Ans: C
Feedback:
Acetaminophen would be the suggested medication. It is prescribed for relief of pain and fever for
influenza in children. Aspirin would be contraindicated because it increases the risk for Reye’s
syndrome. Etanercept and penicillamine are given for severe rheumatoid arthritis therapy.
A nurse is presenting an educational event for a group of new parents. One topic that the nurse
addresses is the overuse of acetaminophen, which can cause liver toxicity. What would the nurse tell
the parents it is important to do?
A) Do not give acetaminophen (Tylenol) unless you receive a doctor’s order.
B) Check the label of over-the-counter (OTC) medications carefully to watch for inclusions of
acetaminophen in the ingredients.
C) Monitor their child’s temperature carefully and regulate the Tylenol dose based on the fever.
D) Mix OTC children’s medications to get the best coverage for their child’s symptoms.
Ans: B
Feedback:
Inadvertent overdose with acetaminophen frequently occurs because of the combining of OTC drugs
that contain the same ingredients. Parents should be taught to carefully check the labels of OTC
products and follow the dosage guidelines. A prescription is not required for acetaminophen. Dosage
guidelines are the best guide to follow to prevent overdose.
A mother asks the nurse how acetaminophen works. What statement best describes the therapeutic
action of acetaminophen?
A) Acetaminophen (Tylenol) works by blocking the increase of interleukin-1.
B) Acetaminophen reacts with free-floating tumor necrosis (TNF) factor released by active
leukocytes.
C) Acetaminophen acts directly on the hypothalamus to cause vasodilation and sweating.
D) Acetaminophen is taken up by macrophages, thus inhibiting phagocytosis and release of lysosomal
enzymes.
Ans: C
Feedback:
Acetaminophen acts on the hypothalamus to cause vasodilation and sweating to reduce fever. The
mechanism of action as an analgesic is not understood. Anakinra (Kineret) blocks the increased
interleukin-1, which is responsible for the degradation of cartilage in rheumatoid arthritis. Etanercept
(Enbrel) reacts with free-floating TNF released by active leukocytes in autoimmune inflammatory
disease to prevent the damage caused by TNF. Gold compounds are taken up by macrophages, which,
in turn, inhibits phagocytosis and releases lysosomal enzymes, which causes damage associated with
inflammation.
Antipyretic drugs (e.g., aspirin, ibuprofen, acetaminophen) often are used to alleviate the discomforts of
fever and to protect vulnerable organs, such as the brain, from extreme elevations in body temperature.
However, the use of aspirin in children is limited due to the possibility of what disease?
A) Munchausen’s syndrome
B) Guillain-Barré syndrome
C) Angelman’s syndrome
D) Reye’s syndrome
Ans: D
Feedback:
Salicylates like aspirin are contraindicated for the treatment of childhood fevers because of the risk of
Reye’s syndrome in children and teenagers. Munchausen’s syndrome is an unusual condition
characterized by habitual pleas for treatment and hospitalization for a symptomatic but imaginary acute
illness. Guillain-Barré syndrome is an idiopathic, peripheral polyneuritis that occurs 1 to 3 weeks after
a mild episode of fever associated with a viral infection or with immunization. Angelman’s syndrome is
an autosomal recessive syndrome characterized by jerky puppet-like movements, frequent laughter,
mental and motor retardation, a peculiar open-mouthed facial expression, and seizures. Salicylates like
aspirin are not contraindicated for patients with Munchausen’s syndrome, Guillain-Barré syndrome, or
Angelman’s syndrome.
A patient has been diagnosed with severe rheumatoid arthritis and hylan G-F 20 has been ordered. How is this drug given? A) Injected into the joint B) Orally C) IM D) Sub Q
Ans: A
Feedback:
Hyaluronidase derivatives (e.g., hylan G-F 20, sodium hyaluronate) have elastic and viscous properties.
These drugs are injected directly into the joints of patients with severe rheumatoid arthritis of the knee.
They seem to cushion and lubricate the joint and relieve the pain associated with degenerative arthritis.
They are given weekly for 3 to 5 weeks and are not given by any other route.
A nurse is caring for a patient in the early stage of rheumatoid arthritis. The nurse would expect what
medication classification to be used in the treatment of this patient?
A) Antimalarial agents
B) Nonsteroidal anti-inflammatory drugs (NSAIDs)
C) Xanthine oxidase inhibitors
D) Uricosuric agents
Ans: B
Feedback:
NSAIDs are indicated for relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis, for
relief of mild to moderate pain, for treatment of primary dysmenorrhea, and for fever reduction.
Antimalarial agents are used in the treatment of systemic lupus erythematosus. Xanthine oxidase
inhibitors and uricosuric agents are used in the treatment of gout.
The nurse is caring for a patient who receives anakinra (Kineret) for arthritis. By what route will the nurse administer this medication? A) Into the affected joint directly B) Oral C) Intramuscular D) Subcutaneous
Ans: D
Feedback:
Anakinra is administered subcutaneously every day and is often used in combination with other
antiarthritis drugs. No other route is appropriate.
The nurse is preparing to administer a nonsteroidal anti-inflammatory drug (NSAID) to an older
patient. What NSAID is associated with increased toxicity and should be avoided if possible?
A) Naproxen (Aleve)
B) Ibuprofen (Motrin)
C) Indomethacin (Indocin)
D) Etodolac (Lodine)
Ans: A
Feedback:
Geriatric warnings have been associated with naproxen, ketorolac, and ketoprofen because of reports of
increased toxicity when they are used by older patients. These NSAIDs should be avoided in this
population if possible. No such warnings exist for ibuprofen, indomethacin, or etodolac.