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NURS 424 > Week 11 - Arthritis drugs > Flashcards

Week 11 - Arthritis drugs Flashcards

1
Q

Acetaminophen: indications

A

Mild to moderate OA

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2
Q

Acetaminophen: MOA

A

Exerts action on CNS which results in decreased prostaglandin synthesis

  • Does NOT affect COX, so does not affect platelet aggregating or cause GI irritation

Active as analgesic and antipyretic

  • Reduces fevers by direct actions on the hypothalamic heat-regulating centers
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3
Q

Acetaminophen: caution and contraindications

A
  • Avoid in severe hepatic impairment and severe active liver disease
  • D/c if skin reaction develops
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4
Q

Acetaminophen: ADR

A
  • Skin rash
  • Dizziness
  • Hypersensitivity reactions (rare)
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5
Q

NSAIDs: examples

A
  • Ibuprofen
  • Naproxen
  • Voltaren gel
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6
Q

NSAIDs: indications

A

Mild to moderate OA, RA

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7
Q

NSAIDs: MOA

A

Exerts anti-inflammatory action by inhibiting conversion of arachiconic acid to prostaglandin, prostacyclin, and thromboxanes (all mediators of pain and inflammation)

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8
Q

NSAIDs: caution and contraindications

A
  • Caution in cardiovascular disease
  • Avoid in pregnancy
  • Caution in elderly patients
  • Caution in renal and hepatic impairment
  • Avoid use if GFR <30 mL/minute
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9
Q

NSAIDs: ADR

A

Peripheral edema, dizziness, skin rash, GI disturbances, elevated transaminases, dyspepsia, HTN, bleeding d/t reversibly impacting platelet aggregation

“Coffee ground” emesis

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10
Q

Tramadol: indications

A

Considered when pain associated w/ OA progresses past responsiveness to acetaminophen and NSAIDs

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11
Q

Tramadol: MOA

A

Mu opioid receptor agonist that when binds, ascending pain pathways are inhibited

Inhibits reuptake of serotonin and norepinephrine

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12
Q

Tramadol: caution and contraindications

A
  • Caution in patients w/ substance abuse history
  • Avoid in patients w/ history of seizures d/t lowering of seizure threshold
  • Caution in renal and hepatic impairment
  • Caution in pediatrics, elderly
  • Caution using w/ other CNS depressants
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13
Q

Tramadol: ADR

A
  • Dizziness, nausea, drowsiness, sweating
  • Constipation, dependecy, euphoria, respiratory depression
  • Risk of serotonin syndrome when combined with other serotonergic agents
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14
Q

Methotrexate: indications

A

Antirheumatic

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15
Q

Methotrexate: MOA

A

Folic acid antagonist

Thought to affect leukocyte suppression, decreasing the inflammation that results from immunologic by products

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16
Q

Methotrexate: ADR

A

N/D, arthralgias, oral ulcers, alopecia, photosensitivity, skin rash, dizziness, increased serum transaminases

17
Q

Methotrexate: caution and contraindications

A
  • Avoid in pregnancy and lactation
  • Avoid in patients w/ blood dyscrasias
  • Caution in renal and hepatic impairment

Black box warning

  • Risk of hepatotoxicity, renal impairment, pneumonitis, bone marrow suppression, GI toxicity, active stomatitis, dermatology reactions, opportunistic infections
18
Q

TNF inhibitors: examples

A

Rituximab (Rituxan)

Abatacept (Orencia)

19
Q

TNF inhibitors: MOA

A

Binds to circulating TNF-alpha making it inactive

Reduces chemotactic effect of TNF-alpha by reducing IL-6 and CRP –> reduced infiltation of inflammatory cells into joint

Cell lysis

20
Q

TNF inhibitors: caution and contraindications

A

Caution in patients w/ new/recurrent infections

21
Q

TNF inhibitors: patient educations

A

Must be up to date on immunizations before initiation

22
Q

TNF inhibitors: ADR

A

Injection site reactions, infusion reaction, infections, dizziness, HA, nausea

23
Q

Acetaminophen: pharmacokinetics

A
  • Metabolized by the liver
  • When taken regularly or in large doses, stores of glutathione become depleted –> hepatic necrosis
24
Q

Indomethacin (NSAID): ADR

A

May aggravate depression or other psychiatric disturbances

25
Q

NSAIDs for rheumatoid arthritis

A

Use NSAIDs or celecoxib to reduce joint pain and swelling

26
Q

NSAIDs for osteoarthritis

A

Acetaminophen or NSAIDs can be used for pain

27
Q

NSAIDs used for gout

A

Indomethacin

Naproxen

28
Q

NSAID and acetaminophen: monitoring

A

NSAIDs

  • Renal function w/ long term therapy
  • GI ulcer or GI bleed
    • CBC prior to initiation of therapy and annually thereafter

Acetaminophen

  • Liver function if on high dose or long term therapy
29
Q

What is the maximum dose acceptable for acetaminophen?

A

3g / 24 hours

30
Q

NSAIDs: black box warning

A

Black box warning

  • Increased risk for thrombotic events
  • Risk of heart attack or stroke
  • Serious GI bleeding, ulcerations, perforations

NURS 424 (35 decks)

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