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Pharm II - Week 6
Anti-inflammatory
| Question | Answer |
|---|---|
| True or false: acetaminophen is a NSAID | False. Often lumped together with NSAIDs, but technically not one |
| ___ & ____ cause COX1 and CO2 enzymes to breakdown arachidonic ____ | Pain; inflammation; acid |
| How do COX inhibitors work to treat pain? | Inhibit cyclooxygenase (COX which converts arachidonic acid into prostaglandins and related compounds) |
| True or false: a selective COX2 inhibitor would always cause increased risk for gastric erosion | False. Gastric erosion primarily seen in inhibition of COX1. Cross-reactivity of drug may produce some side effects of COX1 inhibition however. |
| List the effects of COX1 inhibition (four) | 1) gastric erosion, 2) bleeding tendencies by inhibiting platelet aggregation, 3) decreased renal perfusion, 4) provide protection against MI/stroke |
| True or false: to prevent a pt. from having future MI/stroke, one would offer a COX2 inhibitor drug | False! Can promote MI/stroke by suppressing vasodilation |
| List the effects of COX2 inhibition (5) | 1) suppression of inflammation, 2) pain relief, 3) fever reduction, 4) decreased renal perfusion, 5) PROMOTION of MI/stroke |
| True or false: aspirin is nonselective COX inhibitor | True. Inhibits COX1 and COX2 |
| The following pt would be most likely to be at risk for renal issues r/t COX inhibitors: a) HIV+ pt., b) pregnant woman, c) teenager with pneumonia, d) healthy 62 year old | D) because kidney function decreases as person ages |
| The prototype for salicylates is ____ | Aspirin |
| The key _____ effects of aspirin are d/t inhibiting COX2 | therapeutic |
| Aspirin is ____ absorbed, has a ___ half-life, ____ protein-bound | Rapidly; short; 80% |
| At low doses, aspirin provides _____ _____ and causes _____ _______ | Pain relief; decreased coagulation |
| At high doses, aspirin decreases ________ | Inflammation |
| Most _____ come from inhibiting COX1 | Adverse |
| Baby aspirin is generally ____ mg, used to prevent MI and keep prostaglandins at bay | 80~ |
| True or false: people with arthritis often taken up to 4000 mg of aspirin a day | True. |
| True or false: aspirin is almost always given as adjunct therapy used to prevent stroke/MI | False. Can be primary therapy to prevent stroke/MI |
| Therapeutic uses of aspirin include the following | Analgesic, anti-pyretic, anti-inflammatory, antiplatelet aggregation |
| Salicylates cause ______ inhibition of ___, the enzyme that makes TXA2, which stimulates platelet aggregation | irreversible; COX1 |
| Salicylates have a ____ effect because this is the lifespan of a platelet | 8 day |
| Salicylates are category ___ and can cause the following complications: | D. Complications: anemia, postpartum hemorrhage; premature closure of fetal/newborn patent ductur arteriosis |
| True or false: a woman with clotting issues should not be given aspirin while pregnant | False. If a woman has tendency to clot, can be given aspirin therapeutically to keep pregnancy viable |
| At high doses salicylates can cause _____ ___ especialy in elderly and _____ | Renal impairment; tinnitius |
| _____ syndrome has an extremely high mortality (20-30%) and is due to high ammonia levels | Reye's |
| True or false: if a child has the flu, you would not give acetaminophen because it is a NSAID | False. Aspirin is a NSAID but acetaminophen in its own category. |
| Reye's syndrome causes _____ and _____ _______. | Encephalopathy; liver degeneration |
| 5-10% of people who take salicylates experience ______ symptoms such as _____ and will have cross-sensitivity to other NSAIDs | hypersensitivity; rash |
| The reason why many ASA products are ____-___ is because of GI distress | Enteric-coated |
| Bleeding can manifest in this type and can be seen in these two groups of people | Occult bleeding with long-term use; alcoholics and smokers |
| True or false: aspirin should not be given to people under age of 12 | False. Under age of 18 |
| Salicylates will interact with each of the following drugs. List at least one major DDI for each: alcohol, GCs, anticoagulants, ibuprofen, ACEIs | Salicylates + alcohol = destroy stomach, kidneys. With GC: stomach AE. Anticoagulants: increased bleeding. Ibuprofen: liver issues. ACEIs: renal function issues |
| Prototypes of NSAIDs include (list generic AND trade names) | 1) ibuprofen (Motrin/Advil), 2) naproxen (Naprosyn), 3) ketorolac Toradol) |
| Which NSAID is injectable? | ketorolac/Toradol |
| NSAIDs inhibit ____ and used therapeutically to treat ______ | COX1, COX 2. Treat mild-to-moderate pain |
| Things to watch out for with NSAIDs: (list AE and other concerns) | AE: bleeding, GI ulcers, renal insufficiency, CNS problems, hypersensitivity. May also mask fever and increase risk of MI/stroke |
| A nurse would advise to use NSAIDs at the ___ _____ dose for the _____ time | lowest effective; shortest |
| D/t increased risk of MI/stroke/dementia, now recommended for elderly that instead of giving NSAIDs for chronic pain to first use _____ and then try ____ | Acetaminophen; low dose opioids |
| The prototype for selective COX-2 inhibitors is _____. | celecoxib/Celebrex |
| True or false: Celebrex is first line for long term management of chronic pain due to decreased risk of stroke/MI as result of being a more selective drug | False! LAST drug of choice; increased risk of stroke/MI. |
| COX-2 inhibitors have less _____ ____ but they do not eliminate the risk | GI ulceration |
| Acetaminophen is a ___ COX inhibitor, not a ___ one | Central-affecting; periperhal-affecting |
| Acetaminophen is very effective for _______ | Mild to moderate pain |
| Acetaminophen has ____ and __-_____ properties; but _____significant anti-inflammatory actions | Analgesic; antipyretic; lacks |
| True or false with acetaminophen adverse effects are rare at therapeutic doses | True |
| A high dose of acetaminophen is considered greater than __ grams/day | 4 |
| True or false: renal toxicity occurs at high doses | False; liver |
| Acetaminophen has no _____ activity but may increase risk of ____ in patients taking __ | Anti-platelet; bleeding; warfarin/Coumadin |
| Acetaminophen is ____ absorbed; with ____ distribution; metabolized in _____, and is a __ with a half-life of ____ hours | Readily; wide; liver; prodrug; 2 hours |
| When a pt. has OD'd on acetaminophen, to prevent liver damage one would give ______, which is a _____ drug | acetylcysteine/Mucomyst; reversal |
| Glucocorticoids are made _____ and present at ____ _____ | Endogenously; adrenal cortex |
| When given as med, low dose GC is considered ____/day and has actions similar to _____ | 2-10mg/day; cortisol |
| When given as med, high dose GC is considered __/day and used to treat disease processes _____ to adrenocortical function | >10mg/day; unrelated (asthma, inflammation, lupus, cancer) |
| True or false: there is a standard dose for GCs, which nurses must give to pts. in morning and monitor | False. Although GC often taken in morning to mimic cortisol, GC dosage is highly individualized |
| GCs have multiple _____, thus offering more ____ effect than NSAIDs | mechanisms of action; anti-inflammatory |
| List GC's mechanisms of action (3) | 1) Suppresses synthesis of inflammatory mediators (leukotrienes, histamine, prostaglandins), 2) suppresses phagocyte activity, 3) suppresses proliferation of lymphocytes |
| What nursing implications must you consider with a pt. on long-term GCs? | GCs will 1) hide signs of infection and 2) increase pt.'s risk for infection |
| AE of INHALED GCs: | Oral fungal growth, decreased response to infection, impaired growht in children/teens, osteoporosis (debatable) |
| AE of ORAL GCs: | 1) increased serum glucose, 2) nasuea, 3) decreased bone density, 4) gastric erosion (ulcer), 4) decreased K+ (heart dysrhythmias), 5) decreased signs of infection/increased risk of infection |
| If an asthma pt. gets into a car accident and is sent to Harborview, what must the nurse consider? | Pts. need additional IV doses of GC if under serious physiological/emotional stress |
| GCs cause the body to retain ____ and excrete ____ | Na+, K+ |
| GCs can also cause ____ effects such as (list 3 major ones) | psychological; psychosis if given > 80 mg, euphoria that goes into depression, insomnia if given > 40 mg |
| As a nurse, it is critical to emphasize to a patient not to ____ when on GCs, otherwise the following may occur... | Discontinue; may result in adrenal atrophy and cessation of endogenous GC production, leading to pain and death :( |
| List some non-asthma uses of GCs: | Arthritis, Lupus, Chron's, skin problems, implants, organ transplants, cancer |
| GC effects on metabolism include (list 3) | 1) raises BG and promotes glucose storage; 2) affects protein metabolism (reduced muscle mass, decreased bone density, thin skin); 3) fat catabolism (break down and redistribute fat = moon face = Cushing's) |
| DMARDs stands for ____ and as ____ categories | Disease-modifying anti-rheumatic drugs; two |
| True or false: methotrexate and etanercept are DMARD I drugs | False. Methotrexate is DMARD I, Etanercept is DMARD II |
| Main priority for pts. with RA is to ____ | Stop destruction caused by disease! Reduce inflammation from mast cells/macrophages/T lymphocytes which produce cytokines/cytotoxins |
| In RA, cytokines include (list four) which produce systemic inflammation | 1) tumor necrosis factor, 2) interleukin-1, 3) interleukin-6, 4) interferon gamma |
| Treatment goals of RA in order of priority: | 1) Delay progression of disease, 2) minimize systemic involvement, 3) relieve pain, inflammatory, 4) improve functioning of joints |
| Priority of drugs used to treat RA: | 1) DMARDs, 2) GCs, 3) NSAIDs |
| True or false: NSAIDs temporarily relieve pain and does not slow progression of RA | True |
| GCs are used in RA for _____ | flare-ups |
| DMARDs are more _____ than NSAIDs and also ____ | toxic; expensive |
| The fastest DMARD is ___, which takes ____ to show efficacy | Methotrexate (cancer drug), 3-6 weeks |
| True or false; DMARD II is the nonbiologic category | False. DMARD I is nonbiologic |
| DMARD causes ___ by reducing activity of __ & __ lymphocytes | immunosuppression; B |
| ADE of methotrexate include: | bone marrow suppression, liver damage, ulcers, pneumonitis, cancer |
| Pt. on methotrexate requires routine testing of the following labs: | Liver enzymes, CBC, Cr & BUN |
| Methotrexate is taken in this route with this frequency | PO 1x/week |
| A drug used to treat RA that may turn urine and skin yellow/orange is known as _____ (generic/trade) | Sulfasalazine/Azulfidine |
| Sulfasalazine/azulfidine's ADE include: | GI: N/V/D, abdm pain. Skin: rash, pruritis (common). Kidney damage. |
| Azulfidine is contraindicated in patients with ____ | Allergy to sulfa drugs |
| Compared to ______, sulfasalazine has less risk of _____ and ____ damage | Liver and bone marrow |
| Biologic DMARDs (II) include a TNF ___ and _____ | antagonist; antibody |
| True or false: Etanercept/Enbrel is a TNF antibody | False. It is a TNF antagonist |
| Infliximab/remicade is given ____ for over ____ or more | IV; 2 hours+ |
| Etanercept/Enbrel's route and half-life | SQ, half-life: 5 days |
| DMARDs II all pose risk of ______, are ______, and interefere with _______, which is an important immune immediator of ____ ____ | serious infections; expensive; TNF; joint injury |
| True or false: due to severity of AE, methotrexate is not often combined with etanercept/infliximab | False. Can often be combined |
| It will take Remicade ____ before benefits are felt | months |
| Before giving DMARDs II must screen for the following: (list 4) | Fungal infections; TB (PPD first), heptatitis B (test first), bacterial sepsis (Serial CBCs) |
| DMARDs may worsen other _____ diseases | Autoimmune (e.g., lupus, Gullain-Barre) |
| Pts. on biologic DMARDs II are NOT given ______ because they will otherwise get ____ | Live vaccinations; the disease they're being vaccinated against |
| True or false: when given DMARDs, a CHF pt. will display worsening cardiovascular symptoms | True |
| What two types of pts. have indications for immunosuppressant drugs? | 1) Transplant pts. (to prevent organ rejection), 2) pts. with autoimmune diseases |
| Describe in three ways how immunosuppressant drugs are toxic to the body: | 1) nephrotoxic, 20 will mask infection, 3) cause cancer |
| True or false: Immunosuppressant drugs will mask infection in 4/5 of all clients | True |
| Provide an example of an immunosuppressant drug | Cyclosporine (Sandimmune) |
| A pt. on immunosuppressant drugs tells the nurse, "I need to get more vitamin C, so I've been drinking grapefruit juice!" Why does this indicate need for further teaching? | Grapefruit juice can interact with immunosuppressant drugs to cause toxicity |
| True or false: immunosuppressant drugs like cyclosporine are category X | False. Category C (C for cyclosporine!) |
| Describe the mechanism of action for cyclosporine (sandimmune) | Acts on Helper T cells and suppresses production of cytokines, preventing proliferation of B and killer T cells |
| True or false: Sandimmune is given PO and has a well known rate of absorption. Blood levels of the drug are drawn on annual basis just in case though | False. Blood levels need to be drawn regularly |
Created by:
choel
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