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pathopharm exam 3

chapter 71

QuestionAnswer
WHAT DO Cyclooxygenase Inhibitors DO? ASIDE FROM ASPIRIN= other NSAIDs, effects decline as soon as drug levels fall-REVERSIBLE SRR UsesSuppress inflammationRelieve painReduce fever
ADR ARE? COX 1 GBRI Adverse effects Gastric ulcerationBleedingRenal impairmenT( hypovolemia, hepatic cirrhosis, or heart failure)
MECHANISIM OF ACTION? Inhibit cyclooxygenase (COX), the enzyme that converts arachidonic acid into prostanoids(prostaglandins and related compounds) Inhibition of COX-1 (“good COX”) Gastric ulceration Bleeding Renal impairment
BENEFITS OF COX1 MEDIATE BENEFICIALS PROCESSES W/ADR Protection against myocardial infarction (MI) and stroke (secondary to reduced platelet aggregation
BENEFITS OF COX 2 -AT SITE OF TISSUE INJURY MEDIATE HAMFUL PROCESSES SARP Suppression of inflammationAlleviation of pain and reduction of feverProtection against colorectal cancer ADR= Renal impairment • Promotion of MI and stroke (secondary to suppressing vasodilation)
Classification of Cyclooxygenase Inhibitors Drugs with anti-inflammatory properties Nonsteroidal anti-inflammatory drugs (NSAIDs) •Aspirin, celecoxib, ibuprofen, and naproxen Drugs without anti-inflammatory propertiesAcetaminophen
First-Generation NSAIDs ARE? Inhibit COX-1 and COX-2  treat inflammatory disorders (rheumatoid arthritis, osteoarthritis, bursitis) Alleviate mild to moderate pain Suppress fever Relieve dysmenorrhea Suppress inflammation but pose risk of serious harm
Aspirin BAYER ONLY ONE THAT PROTECT A/G MI & STROKE Nonselective (COX 1&2) Analgesic, antipyretic, anti-inflammatory Suppression of platelet aggregation-LESS LIKELY TO CLOT •Protects in thrombotic disorders Dysmenorrhea Cancer prevention Prevention of Alzheimer’s disease
ADR (ADVERSE REACTION)ARE? INFANTS AND CHILDREN=REYES SYNDROM IS LIKELY= FATTY LIVER, ENCEPHELAPATHY= FATALITY (GI) effects Bleeding Renal impairment Salicylism: HIGH T.EFFEC LEVEL Tinnitus (ringing in the ears),sweating, headache, and dizziness Reye’s syndrome<18OLD Pregnancy•Anemia, postpartum hemorrhage; may prolong labor Hypersensitivity reaction
DRUG INTERACTION? Anticoagulants: Warfarin and heparin Glucocorticoids AlcoholIbuprofen ACE inhibitors and ARBs Acute poisoning=KIDNEY Immediate threats to life: Respiratory depression, hyperthermia, dehydration, and acidosis. Treatment is largely supportive.
Nonaspirin First-Generation NSAIDs Aspirin-like drugs w/ < GI, renal, and hemorrhagic effects than aspirin 20+ nonaspirin NSAIDs available Inhibit COX-1 and COX-2: Inhibition is reversible Principal USE: Rheumatoid arthritis and osteoarthritis Do not protect against MI and stroke
1ST GEN. NSAID IBUPROFEN IS: Advil, Motrin] Inhibits cyclooxygenase and has anti-inflammatory, analgesic, and antipyretic actions Indications: Fever, mild to moderate pain, arthritisGenerally well toleratedLow incidence of adverse effects W/FOOD
SAFETY ALERT: LACK OF PROTAGLANDING=PROTECT LINING IN STOMACH All first-generation NSAIDs are associated with an increased risk of GI bleedinG that can lead to hospitalization or death TAKE W/ FOOD Stevens-Johnson syndrome, a severe hypeRSTVTY reaction=SKIN blistering and mucous membranes= scarring, blindness
Second-Generation NSAIDs effective as traditional NSAIDs in suppressing inflammation and pain lower risk for GI side effects Can impair renal function and cause hypertension and edema Increased risk of MI and stroke
Celecoxib [Celebrex] IS: LAST LINE OF DEFENSE LIKE NAPROXEN-RELIEVE JOINT PAIN, STIFFNESS AND SWEALING COX-2 inhibitor HBP+EDMA < adverse effects than first-generation drugs Because of cardiovascular risks, last-choice drug for long-term management of pain OsteoarthritisRheumatoid arthritisAcute painDysmenorrheaFamilial adenomatous polyposis
CELECOXIB ADR ARE? Dyspepsia Abdominal pain Renal impairment Sulfonamide allergy Cardiovascular impact (stroke, MI, and other serious events) Use in pregnancy DECREASE DIURETIC + ACE AND INCREASE LITHIUM+FLUCONAZOLE
DRUG INTERACTIONS CONTRAINDICATED IN 3RD SEMESTER Warfarin May decrease diuretic effect of furosemide May decrease antihypertensive effect of ACE inhibitors May increase levels of lithiumCelecoxib levels may be increased by fluconazole
Acetaminophen [Tylenol] IS: CHILDREN CAN TAKE+IBUPROFEN Analgesic, antipyretic Does not have any anti-inflammatory or antirheumatic actions Not associated with Reye’s syndrom- Inhibits prostaglandin synthesis in central nervous system
ADR ARE? Very few at normal doses Stevens-Johnson syndrome (SJS), acute generalized exanthematous pustulosis (AGEP), andtoxic epidermal necrolysis (TEN) Hepatotoxicity •With overdose or iN patients with liver failure 4000MG/DAY
TYLENOL OVERDOSE? Absence of jaundice AFTER USING Acetylcysteine FOR AN OVERDOSE =IT IS EFFECTIVE Hepatic necrosis(DEATH LIVER TISSUE) •Signs and symptoms of hepatic failure, coma, death •Early symptoms: Nausea and vomiting, diarrhea, sweating, abdominal pain •Treatment 4 overdose: Acetylcysteine(Mucomyst) NOT DRUG W/TYLENOL TAKEN W/ THIS -ASTHMA
DRUG INTERACTION? Alcohol WarfarinP Vaccines -DECREASE EFFECT OF VACCINE+IMMUNE RESPONSE
AHA Statement on COX Inhibitors Most COX inhibitors, especially COX-2 inhibitors, increase the risk for MI and stroke American Heart Association (AHA) recommends a stepped-care approach
A patient is prescribed celecoxib [Celebrex] and warfarin [Coumadin]. The nurse should monitor the patient for what? Bleeding Celecoxib may increase the anticoagulant effects of warfarin; the risk of bleeding is increased.
A patient drinks five to six alcoholic beverages per day and takes acetaminophen [Tylenol] for pain relief. The nurse should caution the patient to do what? Patients who drink three or more alcoholic beverages per day -should limit their acetaminophen dosage to less than 2000 mg/day to prevent hepatic injury.
Nonaspirin NSAIDs differ from aspirin in all but which way? They are safe to use in children with chickenpox or influenza.
COX IN STOMACH-PROSTAGLADINS 1&2 they act locally promotes synthesis of PGE2 and PGI2,= help protect the gastric mucosa. Three mechanisms are involved: reduced secretion of gastric acid, increased secretion of bicarbonate cytoprotective mucus, maintenance of submucosal blood flow.
In platelets, COX promotes synthesis of TXA2,( prostacyclin, thromboxane A2) which stimulates platelet aggregation. In blood vessels, COX promote synthesis of prostacyclin, which causes vasodilation
kidney= COX catalyzes synthesis of PGE2 and PGI2, which promote vasodilation and thereby maintain renal blood flow. In the brain, COX-derived prostaglandins mediate fever and contribute to perception of pain. I
In the uterus, COX-derived prostaglandins help promote contractions at term.
FACTORS INCREASING RISK OF ULCERATION(ASPIRIN) • Advanced age • A history of peptic ulcer disease • Previous intolerance to aspirin or other NSAIDs • Cigarette smoking • History of alcohol abuse (Alcohol intensifies the irritant effects of aspirin and should not be consumed.)
Precautions and Contraindications(ASPIRIN) asthma, hay fever, chronic urticaria, nasal polyps. ASPIRIN WITHDRAWM 1 WEEK B4 SURGERY peptic ulcer disease, hemophilia, vitamin K deficiency, hypoprothrombinemia), hypersensitivity to aspirin NSAIDs. caution pregnant women + children W/ chickenpox or influenza. smokeR heart failure, hepatic cirrhosis, hypovolemia,
MANAGING PAIN IN CARDIOVACSCULAR PATIENT 81MG/DAY TRY CELECOXIB LAST=GREATEST RISK 1-nondrug measures. p.THERAPY. exer.,wt loss, +heat or cold PADS. 2-If don’t work,USE TYLENOL or aspirin, NO RISK. an opioid or tramadol can be tried, only short term. Step 3. If step 2 drugs are ineffective ,TRY nonselective NSAIDs:naproxen, ibup
PRE-ASSESSMENT ADMISSION LIST OF ALLERGIES-NSAID INTOLERANCE MEDICALS CONDITIONS(AVOID PT W, PEPTIC ULCER -RECREATIONAL USE-ALCOHOL-SMOKING -SUPRESS INFLAMMATION,RELIEF PAIN, REDUCE FEVER TREAT ARTHRITIS, OSTEARTHRITIS PREVENT STROKE AND MI H.RISK-PT 2-CELECOXIB NOT W/ ALLERGIC TO SULFA, HYPERSENSITIVITY ASPIRIN NOT W/ <18, & CHICKEN AND INFLUENZA WATCH PT. ON ANTICOAGULANT PREGNANT-
IMPLEMENT-ADMINISTRATION ORAL ALL NSAIDS IV IBUPROFEN RECTAL-ASPIRIN ADVISE-W/ FOOD, MILK,H20 <GI UPSET NOT CRUSH DISCRAD ASPIRIN IF SMELL LIKE VINEGAR
MINIMIZING ADVERSE EFFETS -GI EFFECT(DYSPEPSIA, NAUSEA, ABDOMINAL PAIN) TAKE W/ SOMETHG ON STOMACH -DON'T WANT PT TOO LONG ONN IT-FIND NONDRUGS MEASURES TEST AND ELIMINATE H.PYLORI BEFORE LONG-TERM THERAPY
ASPIRIN POISONING? and mechanical ventilation=respiration is severely depressed Absorption of aspirin can be reduced by gastric lavage and by giving activated charcoal. If necessary, hemodialysis or peritoneal dialysis can accelerate salicylate removaL External cooling (eg, sponging with tepid water), infusion of fluids (to correct dehydration and electrolyte loss), infusion of bicarbonate (to reverse acidosis and promote renal excretion of salicylates),
DISCONTINUE ASPIRIN = High-dose aspirin should be discontinued 1 week before elective surgery (cholecystectomy, hysterectomy
Created by: Seka_nurse
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