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2514 Patho/phys/assess > Week 6 Musculoskeletal pharm 2 > Flashcards

Week 6 Musculoskeletal pharm 2 Flashcards

1
Q

What NSAIDS blocks cox 1

A

Advil (Ibuprophin)
Alieve (naproxin)
ASA

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2
Q

What NSAIDS block cox 2

A

Celebrex (Celecoxib)

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3
Q

What is unique about how ASA blocks cox 1?

A

it helps prevent MI and stroke by preventing platelet aggregation

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4
Q

What is ASA contraindicated in?

A

<18 - not for children
Pregnancy

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5
Q

What is unique about 2nd generation NSAIDS?

A
  • blocks prostaglandin in a diff way so a bit more GI protection - but still has a risk of GI bleed
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6
Q

Do Cox 1 and Cox 2 have a risk of GI bleed? If so, which is higher risk of bleed?

A

Yes both do
Cox 1 has a higher risk (Advil, naproxen)

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7
Q

What drugs are Celecoxib closely related to that can cause a hypersensitive reaction?

A

Sulfa

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8
Q

What is MOA of NSAIDS?

A

they block prostaglandin via cox 1 and cox 2

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9
Q

What are the adverse effects of first generation Cox-1?

A

GI - Erosion
- ulcers

Integ- bleeding (bruising, etc)

Kidney - renal impairment

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10
Q

What are the adverse effects of second generation Cox-2 and why?

A

Cardiac- MI and stroke - b/c it blocks vasodilation. So vasoconstriction occurs (still happens with ASA but because it blocks platelet aggregation it cancels out the vasoconstriction consequence)

Kidney - renal impairment

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11
Q

What life threatening affect can Ibuprofen have (cox-1) ?

A

Stevens-Johnson syndrome - blistering of skin and mucous membranes

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12
Q

What are the nursing considerations with NSAIDS and why?

A

GI- give with food - protect the stomach lining
Monitor kidney function - harms kidney
Monitor cardiac- HTN, signs of MI, signs of stroke
Monitor circulation- signs of bleeding

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13
Q

What are all NSAIDS contraindicated in?

A

Pregnancy - no preggers

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14
Q

Do NSAIDS slow the progression of Rheumatoid Arthritis?

A

No - just helps with symptoms

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15
Q

What 3 things are NSAIDS indicated for?

A

Pain
Inflammation
Fever

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16
Q

What kind of drug is Prednisone (Deltasone)?

A

Corticosteroid/steroid/glucocortoicoid

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17
Q

What is the MOA of prednisone?

A
  • mimics cortisol that our adrenal glands produce
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18
Q

What are the therapeutic effects of Prednisone?

A
  1. potent -antiinflammatory
  2. immunosuppresant
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19
Q

Does Prednisone work quickly or slowly?

A

quickly

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20
Q

Is predinisone used long term or short term and why?

A

short term
to avoid adrenal suppression

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21
Q

What are 2 main adverse effects of prednisone?

A
  1. Raises blood sugar - b/c of cortisol
  2. Increases blood pressure - b/c of Na and fluid retention
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22
Q

What are the other many adverse effects of prednisone?

A

CNS
- mood swings
- psychological/behaviour changes
- can be light such as insomnia or severe like hallucinations

Cardiac
- fluid retention
- hypokalemia
- hypocalcemia (poor absorption)
- HTN

Metabolic
-weight gain due to changes that cortisol typically creates in the body

Blood sugar
- hyperglycemia

Hematological
- slow wound healing
- bruising
- infection (masked & increased risk)

GI
- Peptic ulcers

Skeletal
- osteoporosis

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23
Q

What is prednisone contraindicated in?

A
  • patients with an active infection
  • patients with peptic ulcer
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24
Q

What are nursing considerations for predinisone and why?

A
  1. monitor I/O daily - because Na and fluid are retained
  2. monitor for Edema - because Na and fluids are retained
  3. Weigh daily - because Na and fluids are retained
  4. Auscultate lungs - to check for Pulmonary Edema
  5. Skin assessment - bleedig
  6. Monitor electrolytes - Na, Ca, BS, K+
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25
Q

Why do we administer prednisone with meals?

A

To prevent GI irritation

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26
Q

What is important to tell patients when taking prednisone?

A
  1. Do not stop abruptly, must taper
  2. Do not skip doses
  3. Eat more Calcium (bone loss) and Potassium (because it will be flushed from the body)
  4. for DM watch blood sugar closely, could raise BS
27
Q

When is prednisone indicated, in chronic RA or acute exacerbations?

A

acute exacerbations

28
Q

When is prednisone indicated?

A
  • acute exacerbations of RA
  • When pain and inflammation need to be reduced
29
Q

What meds does prednisone go along with for RA?

A

DMRs

30
Q

Injections of Prednisone can be given locally. What is the benefit of this?

A

Less adverse affects locally over systemically

31
Q

What can a patient experience if they stop prednisone suddenly or miss doeses?

A
  • Same symptoms of adrenal suppression
  • everything slows down and does opposite of excess cortisol
  • anorexia
  • N&V
  • weak/fatigue
  • dyspnea
  • low BP
  • hypoglycemia
32
Q

How do we assess if Prednisone is working in RA patients?

A
  1. assess MSK system
    - ROM with the affected joints
    - pain scale
    - changes in redness, swelling and warmth over the joint
33
Q

What does glucocorticoid therapy tend to impair/not metabolize properly?

A
  • impairs carbohydrate tolerance
  • impairs glucose tolerance
34
Q

What drug class is Methotrexate (Rheumatrex)?

A

DMARD (disease modifying antirheumatic drug)
non-biological

35
Q

What is the MOA of Methotrexate?

A
  • it interferes with folic acid metabolism (can’t turn into active form)
  • it inhibits DNA synthesis and cell reproduction, causes cell death
  • T and B lymphocytes are reduced because of cell death . This leads to immunosuppression (impacts WBC)
36
Q

DMARDS take a while to work. But which is the fastest of the DMARDS?

A

Methotrexate

37
Q

How long can it take to see the effects of Methotrexate?

A

weeks to months

38
Q

What is the % of patients that will improve on DMARDS?

A

80% of patients

39
Q

When should patients start on DMARDS?

A

Early on in RA
Within 3 months of diagnosis

40
Q

What is the main reason why Methotrexate is so effective for RA? patho/MOA relationship

A

RA is an autoimmune disease where the body attacks itself.
Methotrexate suppresses the immune system so that the body can stop attacking itself further.

41
Q

What is Methotrexate contraindicated in and why?

A
  • already on immunosuppressant med - too much immunosuppression
  • active infection - because body cannot fight with a suppressed immune system
  • liver disease
  • pregnant
  • breastfeeding
42
Q

When should we be careful giving Methotrexate?

A
  1. patients with altered kidney function -
43
Q

What are the adverse effects of Methotrexate and why?

A
  1. Respiratory
    - *Pneumonitis - inflamed lung tissue = scaring and lung infection
    - infection (systemic) - immunosuppression
  2. GI
    - *ulcers - b/c GI mucosa usually rapidly divide
  3. *Liver fibrosis - b/c scaring in liver= decreased function
  4. Skeletal/hematalogical
    - *bone marrow suppression - b/c this is where cells proliferate
    - bleed risk - less RBC and platelets
    - anemia
44
Q

What are the two take home points for Methatrexate?

A
  • it affects anything that requires cell division/growth
  • it affects anything that has to do with the immune system
45
Q

What would we see in a patient who is experiencing adverse effects of Methotrexate?

A

Respiratory
- SOB
- new cough* early sign for pulmonary toxicity
- O2 decrease

GI
- diarrhea
- pain
-stomatitis - mouth red/swell/ulcers
- entire GI tract - due to slow cell division

Hematological
- Bone marrow suppression
- infection - vitals, low grade fever
- bleeding gums
- bruising
- petechiae
- melena
- hematuria
- hematemesis
- fatigue

GU
- I&O
- weight

46
Q

Is methotrexate toxic?

A

Yes!

47
Q

What is a very common side effect of Methotrexate?

A

Nausea and vomitting

48
Q

What med should be given prophylactically with Methotrexate?

A

Antiemetics

49
Q

What blood work should be monitored often with patients on Methotrexate?

A
  • CBC
  • liver enzymes
50
Q

What drug class is Infliximab (Remicade)

A

DMARD
biological
Tumor necrosis factor (TNF) antagonist

51
Q

What is the MOA of Inflixamab (Remicade)

A

neutralizes TNF
TNF causes joint inflammation in RA so stopping it suppresses joint inflammation

52
Q

What is Infliximab (Remicade) indicated in?

A
  1. *Active RA
  2. *Active crohn’s
53
Q

Does Infliximab (Remicade) decrease joint destruction?

A

yes

54
Q

How do we know Infliximab is working?

A
  1. decrease pain and swelling
  2. decrease rate of joint destruction
  3. increase in physical function
55
Q

What medication is Infliximab (Remicade) often given with?

A

Methotrexate

56
Q

What is the administration route of Infliximab?

A

IV administered

57
Q

What is the MAJOR thing to worry about with Infliximab?

A

serious infection!

58
Q

What infections do we worry about with Infliximab?

A
  1. ones caused by M. Tuberculosis
  2. Fungal infections
  3. opportunistic infections
59
Q

What 3 types of patients are at greater risk for adverse effects from Infliximab?

A
  1. DM
  2. HIV
  3. already using other immunosuppressant drug
60
Q

What is a major adverse affect for Infliximab besides infection and how do we identify it?

A

Heart failure
- Edema - weight changes
- crackles in the lungs
- SOB

61
Q

What are the 4 main things to monitor with Infliximab?

A
  1. Infusion reaction - monitor iv site
  2. Infection
  3. Neutropenia - low WBC neutrophils - CBC frequently
  4. Heart failure
62
Q

what are common minor infusion reactions?

A
  1. Fever
  2. light itching
  3. chills
63
Q

What is a severe infusion reaction (anaphlaxis) ?

A
  1. sudden drop in BP
  2. SOB
  3. hives/welts on skin

2514 Patho/phys/assess (27 decks)

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