Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
71 Cards in this Set
- Front
- Back
Inflammatory response
|
necessary for the body's survival when faced with stressors from the environment
|
|
What triggers inflammatory response
|
infectious agents, ischemia, antigen-antibody interactions, burns, other injury.
|
|
Three phases of inflammatory response
|
1) acute, brief, local vasodilation and increased cap permeability
2) a delayed, subacute infiltration of leukocytes and phagocytic cells into the tissue 3) chronic proliferative tissue degeneration and fibrosis |
|
Symptoms of inflammatory response
|
erythema (redness or irritation), edema, tenderness, and pain
|
|
Prostaglandins
|
cause erythema and an increase in local blood flow and remove the vasoconstrictor effects of norepinephrine. NOT GOOD
|
|
How is prostaglandins produced
|
they are produced by Cyclooxygenase (enzyme that changes arachidonic acid into prostaglandins).
|
|
Cyclooxygenase
|
COX 1 & COX 2
harmful if not controlled. Most antiimflammatory drugs block the actions of COX 1 & COX 2 |
|
COX 2 Inhibitors
|
developed to reduce the inflammatory response in some tissue without destroying the tissue of the GI tract.
But might cause heart attack and stroke if prolong use. |
|
Asprin
|
-Acetylsalicylic acid (ASA)
-1st line of therapy for arthritis (rheumatoid, osteoarthritis, DJD) -Stops the production of prostaglandins -blocks Cyclooxygenase (which produces prostaglandins) -platelet anti aggregative - |
|
Salicylates
|
analgesics, antipyretic, antiinflammatory
|
|
Adverse reactions to antiinflammatory analgesics
|
tinnitus, visual distubances, edema, urticaria (hives), rashes, anorecia, epigastric discomfort, and nausea. GI bleeds.
-estimated that person on ASA loses 10 ml o blood every day from minor GI irritation |
|
Over dosage of antiinflammatory analgesics
|
hyperventilation, diaphoresis, thirst, headache, drowsiness, stupor, convulsions and coma, tachycardia, and respiratory insufficiency
|
|
Salicylates: antiinflammatory analgesics
Drug interactions |
-alcohol increases chance of GI bleed
-increses effect of anticoagulants, sulfonylureas, sulfonamides -asorbic acid increases the effect of salicylates -interact with NSAIDs increase effects, side effects, and toxicities -increase phenytoin -can affect lab test results |
|
antiinflammatory analgesics
|
-should not be used in pts with hepatic disease
-use with caution in pts with symptoms suggesting TIAs -should not be used in during pregnancy -children under 12, not recommended |
|
Reye syndrome
|
acute, life-threatening problem that produces vomiting and lethargy that may go on to delirium and coma with permanent brain damage and possible death.
|
|
Reye syndrome
|
use of aspirin after influenza, chicken pox or other viral conditions in children seems to be closely related to the development of Reye Syndrome and should be avoided.
|
|
Nonsteroidal antiinflammatory drugs
|
Ibuprofen
-advil -motrin -nuprin Naproxen -aleve -anaprox -naprosyn |
|
Acetominophen
|
-used to decrease fever and mild pain
-does not have the antiinflammatory effect or an impact on platelet aggregation |
|
Adverse reactions: Acetaminophen
|
-skin eruptions
-urticaris (hives) -erythema -fever other but rare: -liver toxicity -jaundice |
|
Drug interactions: Acetaminophen
|
use with following drugs may increase the risk of hepatotoxicity:
-barbiturates -hydantoin -carbamazepine -rifampin -sulfinpyrazone -ethanol |
|
Acetaminophen
|
-activated charcoal reduces acetaminophen absorption
-acetylycysteine (Mucommyst) is used as an antidote in overdose |
|
NSAIDs
|
have analgesic, antiinflammatory, and antipyrectic effects and are used to treat rheumatic diseases, DJD, osteoarthirits, and acute musculoskeletal problems
|
|
NSAID's: Action
|
-stop production of prostaglandins
-inhibit COX 1 & COX2 |
|
NSAID's: Uses
|
-rheumatoid arthritis
-osteoarthritis -used in treatment of pain associated with dental extraction, imnor surgery, and soft tissue athletic injuries. |
|
NSAID's: adverse reaction
|
-asthma
-fluid retention -hypertension -confusion -dizziness -malaise -tinnitus -puritus -ab pain -annorexia - constipation or diarrhea -excessive gas in the GI tract -GI bleeding -heartburn -nausea -vomiting -hemturia |
|
NSAID's: Geriatric Considerations
|
-incidence of perforated peptic ulcers or bleeding is more common
-elderly pts with renal impairment may be at higher risk for hepatotoxicity or nephrotoxicity - |
|
NSAID's: Pt and Family teaching
|
-take exactly as ordered
-take with milk or meals -if a sode is missed, it should be taken as soon as possible. if to close to next dose, just take next dose -pt should not take aspirin or any other antiinflammatory drug while using nsaid's. |
|
Skeletal Muscle relaxants
|
limit the transmission or movement of impulses in the motor pathways at the level of the spinal cord and brainstem, or they interfere with the mechanism that shortens skeletal muscle fibers so they contract
|
|
Skeletal muscle relaxants: Action
|
-reduce muscle tone and involuntary movement without loss of voluntry motor function
-mild dedation -reduction of anxiety and tension -changes in pain perception |
|
Skeletal muscle relaxants: Uses
|
usd to relieve pain in musculoskeletal and neurologic disorders involving peripheral injury and inflammation, such as muscle strain or sprain, arthritis, bursitis, low back syndrome, cervical syndrome, tension headaches, cerebral palsy, and MS and aching muscles
|
|
Skeletal muscle relaxants: Adverse reactions
|
-flushing
-hypotension -syncope (light headedness and fainting) -tachycardia -ataxia (poor coordination) -blurred vision -confusion -drowsiness -headache -ab pain -anorexia -bleeding -anaphylactic shock -dysuria -dyspnea -SOB -metallic taste -tremors HABIT FORMING |
|
Skeletal muscle relaxants:
|
known to increase the effect of CNS depressants, including sedatives, narcotic analgesics, antianxiety agents, hypnotics and alcohol, general anesthetics, MAOI, tricyclic antidepressants
|
|
Skeletal muscle relaxants:
|
not recommended for pts with history of alcoholism because of increase of action
|
|
Skeletal Muscle Relaxants: Evaluation
|
hepatotoxicity, nephrotocicity and blood dyscrasias have been reported with the use of skeletal muscle relaxants.
S/S include: ab pain, high fever, sausea and diarrhea Most common side effects: drowsiness, diplopia, dizziness, weakness, mild muscular incoordination, anorexia, nausea, vomiting, syncope and hypotension |
|
Rheumatoid arthritis
|
-systemic disease that involves the autoimmune response caused by failure of the body to recognize its own tissue, this results in the destruction of joints
-permanent changes that produce deformities and immobility |
|
Osteoarthritis
|
localized form of joint destruction, particularly in weight bearing joints or stressed joints, that progresses gradually over time from overuse and increasing age
|
|
S/S of Arthritis
|
-swelling
-pain -stiffness |
|
Antiarthritis Medications:
|
salicylates and NSAID's are fist line drugs for the treatment of arthritis
but when they dont work, antiarthritis meds are used when it is confirmed it is rheumatoid arthritis. |
|
Slow-acting Antiarthritis drugs (SAARD's)
|
are useful in treating significant cases of rheumatoid arthritis include:
-hydroxychloroquine sulfate -penicillamine -methotrexate -gold compounds meds are designed to reduce pain, swelling, and inflammation |
|
(SAARD's): Gold compounds, AKA (chrysotherapy)
|
thought that if may inhibit lysosomal enzyme activity in macrophages and decrease their phagocytic activity. it is possible that gold affects antigen formation in the autoimmune response of pts with RA. it apperar to stop the synovitis (inflammation of the joint synovium) of active RA disease and therefore reduces the amount of damage done
|
|
(SAARD's): Gold compounds, AKA (chrysotherapy)
|
-many contraindications
-only 30% to 35% of pts benefit from use -puritis around eyes, palms, and dorsa of the hands -stomatitis (inflammation of the mouth) -painful ulcers of the buccal mucosa, tongue, palate or pharynx -metallic taste |
|
(SAARD's): Gold compounds, AKA (chrysotherapy)
|
Three phases for dosage regimen:
1). a 2- or 3- week period of injections that increase gradually to test for severe reactions or unusual problems 2). a "loading period"of weekly injections, until a total dose of 1 g of injected gold is reached 3). a gradual decrease in dose until a maintenance dosage is found Painful injections and should be given in gluteus maximus muscle |
|
(SAARD's): hydroxychloroquine sulfate
|
used in confirmed cases of RA and systemic or discoid lupus erythematosus
|
|
SAARD's: Hydroxychloroquine sulfate
|
-requires 4 to 12 wks of therapy before improvement is seen. if there is no improvement after 6 months, the drug should be stopped
-corticosteroids and NSAID's may be used until the effects of the SAARD's work |
|
SAARD's: Hydroxychloroquine sulfate
|
-Retinopathy is a serious adverse effect
-not to be used with other SAARD's |
|
SAARD's: Infliximab
|
used in combination with methotrexate to reduce the s/s of RA and limit the worsening of damage to joints. this leads to improved physical function in pts with moderate to severe active RA who have had an inadequate response to methotrexate alone.
used in Crohn's disease (inflammatory bowel disease) |
|
SAARD's: Infliximab
|
-FDA requires a label that this med may activate TB, invasive fungal infections, and other oppotunistic infections
-high rate of mortality in pts who have preexisting CHF -watch for: dyspnea, flushing, headache, and rash that may occur within 1 to 2 hours of infusion |
|
SAARD's: leflunomide
|
-this product is a pyrimidine synthesis inhibitor that has an antiinflammatory effect
-reduces s/s of RA and slows structural damage to joints |
|
SAARD's: Leflunomide
|
-FDA warning label that pregnancy must be ruled out and avoided in all women who are of child bearing age
-this is a category "X" drug that is contraindicated during pregnancy |
|
SAARD's: Leflunomide
|
may produce hepatotoxicity, and there is some evidence of increased risk of cancer of the lymph system
|
|
SAARD's:Methotrexate (Amethopterin)
|
-used to treat various cancerous and psoriatic conditions
-mechanism for RA is unknown -may affect immune function -reduces joint swelling in 3 to 6 wks, but no evidence that is causes remission of the disease or limits bone erosion |
|
SAARD's:Methotrexate (Amethopterin)
|
-used in cases of severe RA that are unresponsive to other treatment
-adverse reaction includes DEATH -it is most toxic to - bone marrow - liver - kidney - lungs |
|
SAARD's: Pencillamine
|
-chemical breakdown of penecillin
-mode of action is unknown -known to be effective in relieving the symptoms of arthritis and in some way stops the disease progression - only 30% of pts get any benefit from use |
|
SAARD's: Pencillamine
|
-requires excellent pt compliance because it is an oral preparation that pt must administer themselves
-when maintenance dosage is reached, urine and blood follow up should continue every 2 wks for 6 months -if worsening of disease occurs during treatment, NSAID's are indicated rather than increase of the dosage of Pencillamine -no therapeutic effect may be seen for 3 to 6 months |
|
SAARD's: Pencillamine - Adverse Reaction
|
-many toxic side effects
-pt with renal impairment or active renal disease should not receive this treatment -blood dyscrasias and skin reactions are dangerous |
|
SAARD's: Pencillamine - Adverse Reaction
|
-do not use with gold compounds or cytotoxic drugs
-50% of pt taking Pencillamine have adverse reactions, some of which are fatal |
|
SAARD's: Pencillamine - Assessment
|
-history: RA treatment
-liver, kidney, cardiovascular,hematopoietic disease |
|
SAARD's: Pencillamine - pt teaching
|
-gold compounds injections are painful and should be given in gluteus maximus
-pt receiving Myochrysine injections hould remain lying down for 15 minutes after the injections -shake vial -check for med color, if it iis darker than pale yellow it should not be used |
|
SAARD's: Pt and Family Teaching
|
-very slow acting, 12 - 20 wks
-serious toxic effects can occur -notify dr for problems with kidneys, lungs, liver, skin or blood -monitor dosage -pain will increase 1 to 2 days post injection but will subside -most common adverse reaction: skin rash, itching, ulcers or sores in the mouth, easy bruising or bleeding |
|
Uric acid
|
-a metobolite of protein, is present in the blood within a very specific range
-high uric acid levels cause the excess uric acid to form crystals, usually in the kidneys and in joint spaces -crystals are sharp, long, and jagged edges that tear tissue they come in contact with |
|
Gout
|
-a form of arthritis caused when the body makes to much or does not get rid of uric acid
-S/S = swelling, heat, inflammation and severe pain |
|
Uricosuric agents
|
-increase the excretion of urate salts in the urine by blocking tubular reabsorption of these salts in the kidney
|
|
Uricosuric agents
|
-do not have significant antiinflmmatory or analgesic properties and therefore are of little help during an acute episode of gout
|
|
AntiGout: Colchicine
|
-used to treat acute gouty attacks
-NOT an antiinflammatory, analgesic, or uricosuric agent -decreases uric acid deposits in the tissues |
|
AntiGout: Probenecid
|
inhibits tubular reabsorption of urate, increasing uric acid excretion
|
|
AntiGout: Allopurinol
|
-inhibits the production of uric acid by decreasing the production of xanthine oxidase, an enzyme that metabolized purine hypoxanthine to xanthine and xanthine to uric acid
-NOT an antiinflammatory, analgesic -USED in prophylactic therapy |
|
AntiGout: Adverse Reactions
|
URICOSURIC AGENTS
-fever, dizziness, pruritus, rashes, anorexia, constipation, diarrhea, nausea, vomiting, and exacerbation of acute attacks of gout COLCHICINE -may cause ab pain, severe diarrhea, nausea, and vomiting. Prolonged use may cause bone marrow depression, myopathy, alopecia (hair loss) ALLOPURINOL drowsiness, alopecia, rash, diarrhea, ab pain, nausea, vomiting |
|
AntiGout: Drug Interactions
|
-Salicylates antagonize (interfere) the uricosuric action of these drugs
-increase the effects of the following drugs by decreasing renal tubular excretion: sulfonamides, sulfonylureas, naproxen, indomethacin, rifampin, dapsone, pantothenic acid, aminosalicylic acid, and methotrexate -increased sensibility to CNS depressants |
|
Anti Gout: Pt Teaching
|
-at least 50% of initial attacks occur int the great toe
-usually develops in the lower extremities -URICOSURIC agents are to be started only after the acute attack has resolved -initiation of therapy with uricosuric agents may cause an acute attack of gout |
|
Anti Gout
|
-colchicine are not to be given IM or subcutaneously but must be given IV
-with acute attack, colchicine should be given immediately, and then a dose should be given every hour until either symptoms go away or the pt develops signs of toxicity |
|
Anti Gout: Uricosuric drugs
|
-do not have an effect on acute gouty attacks, but they help prevent attacks if they are taken regularly
-Take with meals to prevent GI issues |