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101 Cards in this Set
- Front
- Back
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Pathophysiology of Inflammation |
Rx to tissue injury> Release chemical mediators> trigger vascular response> migration of leukocytes/WBCs> Release of chemical mediators (histamine, kinins, and prostoglandin) |
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Histamines |
Chemical Mediator in Inflammation First mediatorininflammatory process Cause dilation of arterioles (redness/erythema) Increase capillary permeability (swelling/edema) |
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Kinins (Bradykinin) |
Chemical Mediator in Inflammation Increase capillary permeability (swelling/edema) Increase pain (nerve endings/swelling) |
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Prostaglandins
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Chemical Mediator in Inflammation
Increase capillary permeability (swelling/edema)Increase vasodilation (Heat) Increase pain and fever |
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Five (5) Cardinal signs of inflammation
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Redness (erythema)
Swelling (edema) Heat Pain Loss of function |
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Causes of Inflammation other than infection (4 items) |
trauma, surgical interventions, extreme heat or cold, and caustic chemical agents
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Cyclooxygenase (COX) enzyme
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Converts arachidonic acid into prostaglandins(synthesis of prostaglandins cause inflam/pain
2 Types: COX-1: protects stomach lining and regulates blood platelets COX-2: triggers inflammation and pain |
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COX-1
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protects stomach lining and regulates blood platelets
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COX-2
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triggers inflammation and pain
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Four (4) Anti-inflammatory drug groups
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Nonsteroidal anti-inflammatory drugs (NSAIDs)Corticosteroids
Disease-modifying anti-rheumatic drugs Anti-gout drugs |
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how do anti-inflammatories reduce inflammation? (3 items) |
reduce fluid migration and pain, lessening loss of function, and increasing the patient’s mobility and comfort.
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NSAIDs (5 important items)
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Inhibit biosynthesis of prostaglandins
Analgesic effect (relieves pain) Antipyretic effect (reduces body temp) Inhibit platelet aggregation (slower to clot) Mimic effects of corticosteroids |
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NSAID Action (2 items) NSAID Uses (2 items) |
Inhibit COX enzyme
Inhibit prostaglandin synthesis Reduce inflammation and pain Typically not recommended for fever or headaches (Except aspirin, ibuprofen) |
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Only NSAIDs available OTC are:
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ibuprofen (Motrin, Advil) and naproxen (Aleve).
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Seven (7) Groups of NSAIDs
1st GEN (6 items) 2nd GEN (1 item) |
1st GEN:
1) Salicylates (aspirin) 2) Parachlorobenzoic acid (indomethacin) 3) Phenylacetic acids (ketorolac tromethamine) 4) Propionic acid derivatives (ibuprofen, naproxen) 5) Fenamates (meclofenamate) 6) Oxicams (meloxicam) 2nd GEN: 1) Selective COX-2 inhibitors (celecoxib) |
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Aspirin (salicylate) Action |
Anti-inflammatory, anti-platelet, anti-pyretic effects
Therapeutic serum salicylate level15 to 30 mg/dLToxic serum salicylate level Greater than 30 mg/dL – mild Greater than 50 mg/dL – severe Overdose – acute or chronic |
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Aspirin (salicylate) Drug Interactions (3 items) |
Increased bleeding with anticoagulantsHypoglycemia with oral anti-diabetics
Increased gastric ulcer risk with glucocorticoids |
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Aspirin (salicylate) Lab Considerations (2 items) |
Increase PT, bleeding time, INR, uric acidDecrease potassium, cholesterol, T3 and T4 levels
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Aspirin (salicylate) Cautions (3 items) |
Do not take with other NSAIDs
Avoid during third trimester of pregnancy Do not give to children with flu or virus symptoms (Reye’s syndrome) |
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Aspirin (salicylate) Side Effects/Adverse Reactions (5 items) |
Tinnitus, hearing loss
Dizziness, confusion, drowsiness GI distress, peptic ulcer Thrombocytopenia, leukopenia, agranulocytosisHepatotoxicity |
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Salicylate Hypersensitivity (3 items) |
Tinnitus, dizziness, bronchospasm
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Salicylism (mild) (10 symptoms)
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Tinnitus, dizziness, headache, confusion, sweating, drowsiness, thirst, nausea, vomiting, diarrhea
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Severe salicylate poisoning (3 items)
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Convulsions, cardiovascular collapse, coma
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Aspirin (salicylate) Nursing Assessment (2 items) |
Assess medical history for gastric upset, gastric bleeding or liver disease
Obtain drug/food/herbal history |
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Aspirin (salicylate) Nursing Diagnosis (2 items) |
Risk for injury r/t vertigo
Chronic pain r/t tissue welling of rheumatoid arthritis |
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Aspirin (salicylate) Planning (2 items) |
Pain will be reduced within 12-24 hoursInflammation will be reduced within 1 week
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Aspirin (salicylate) Interventions (6 items) |
Monitor labs
Observe for bleeding (i.e.) dark stools, bleeding gums, petechiae, ecchymosis, purpura Do not take w/ Coumadin Discontinue 3-7 days prior to surgery Do not use w/ children for flu/virus s/s Causes GI upset – take with food |
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Aspiring (salicylate) Evaluations (2 items) |
Evaluate effectiveness in relieving painDetermine if pt is having any side effects
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Para-Chlorobenzoic Acid
Example: indomethacin (Indocin) (4 important notes) |
May cause sodium and water retention and increased blood pressure
Used for rheumatoid arthritis, gouty arthritis and osteoarthritis Potent prostaglandin inhibitor; highly protein bound (90%) Very irritating to the stomach and should be taken with food |
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Phenylacetic Acid Derivatives
Example: ketorolac (Toradol) (5 considerations) |
Inhibits prostaglandin synthesis, recommended for short-term management of pain
First injectable NSAID Used with post-surgical pain management (analgesic efficacy equal or superior to that of opioid analgesics) Administered IM in doses of 30-60 mg q6h Also available in PO and intranasal preparations |
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Propionic Acid Derivatives (2 examples)
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ibuprofen (Motrin, Advil)
naproxen (Naprosyn) |
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Ibuprofen Drug Interactions (4 items) |
Increased bleeding with warfarin, increased effects with phenytoin, sulfonamides, warfarinDecreased effect with aspirin
Hypoglycemia when taken with insulin Increased risk of toxicity if taken with Calcium channel blockers |
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Ibuprofen Side Effects (8 Items) |
Gastric distress (to be taken with food)
Tinnitus, dizziness, confusion, edema Blood dyscrasias, dysrhythmias, nephrotoxicity |
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Ibuprofen Nursing Planning (1 item) |
Inflammatory process will subside in 1 to 3 weeks
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Ibuprofen Nursing Interventions (5 items) |
Observe for bleeding gums, petechiae, ecchymosis, black stools.
Observe for GI upset, peripheral edema Do not take at the same time w/ aspirin or acetaminophen Avoid during pregnancy Avoid taking 1-2 days before and during menstruation |
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Fenamates EXAMPLE: meclofenamate (Meclomen) (5 Notes) |
Potent NSAID
Used for acute and chronic arthritic conditionsGastric irritation is a common side effect Patients with a history of peptic ulcer should avoid taking this group of drugs Other side effects include edema, dizziness, tinnitus, and pruritus |
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Oxicams
EXAMPLE: meloxicam (Mobic) (5 Notes) |
Indicated for osteoarthritis
Can cause gastric problems like ulceration and epigastric distress Some COX-2 selectivity Highly protein bound Should not be taken with aspirin or other NSAIDs |
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Ibuprofen Nursing Assessment (2 Items) |
Check history of allergy to NSAIDs; obtain drug and herbal history
Check medical history for severe renal or liver disease, peptic ulcer or bleeding disorder, GI upset or peripheral edema |
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Ibuprofen Nursing Diagnoses (2 Items) |
Risk for injury r/t dizziness
Risk for activity intolerance r/t fatigue |
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Selective COX-2 Inhibitors
Example: Celecoxib (Celebrex) Action and Use |
Action: Selectively inhibits COX-2 enzyme without inhibition of COX-1
Use: Decrease inflammation and pain with protection of the stomach lining and decreased clotting time |
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Selective COX-2 Inhibitors
Example: Celecoxib (Celebrex) Caution (1 item) & Side Effects (5 items) |
Caution: Avoid during third trimester of pregnancy
Side effects: Headache, dizziness, sinusitisGI distressPeripheral edema |
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NSAIDs in Older Adults (4 Important Notes) |
Greater incidence (4X) of GI distress, ulcerationReduced dose decreases risk of side effectsEdema is likely to occur
Watch renal function |
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Corticosteroids
EXAMPLES: prednisone, prednisolone, dexamethasone 4 Important Notes |
Control inflammation by suppressing or preventing many of the components of the inflammatory process at the injured site
Not the drug of choice for arthritis because of their numerous side effects Frequently used to control arthritic flare-upsTaper off (over 5-10 days) |
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Disease-ModifyingAnti-Rheumatic Drugs (DMARDs)
EXAMPLE: methotrexate (Mexate) USE (2 items) |
Treat moderate to severe rheumatoid arthritis by disrupting the inflammatory process and delaying disease progression
Also used with other NSAIDs as a drug of last resort when other anti-malarials fail, slow to work... 4-12 weeks to see result. |
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Gout (4 Notes) |
Inflammatory disease of joints, tendons, and other tissues
Usually occurs in joint of the great toe Defect in purine metabolism leads to uric acid accumulation Purine-containing foods: organ meats, sardines, salmon, gravy, herring, liver, meat soups, and alcohol (especially beer) |
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Anti-Gout Drugs
EXAMPLE: Colchicine Action (2 items), Side Effects (1 item), and Contraindications (2 items) |
Action:
Inhibit migration of leukocytes to inflamed site Used for the treatment of acute gout Side Effects: GI distress (take with food) Contraindications Severe renal, cardiac, or GI problem Avoid alcohol and caffeine |
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Anti-Gout Uric Acid Inhibitor EXAMPLE: allopurinol (Zyloprim) Action (3 items) Uses (2 items) Side Effects (3 items) |
Action:
Decreases production of uric acid Used in the treatment of chronic gout Prophylactic to prevent gout attacks Uses : Patients with renal impairment/obstructionsPatients that don’t respond to Uricosurics (probenecid) Side Effects: Do not take w/ large doses of vitamin C Do not eat purine containing foodsReport any gastric upset |
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Allopurinol Nursing Assessment (3 items) |
Obtain medical history esp w/ any gastric, renal, cardiac or liver disorders
Assess BUN, Creatinine, ALP, AST, ALT, LDH, uric acid values Record urine output |
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Allopurinol Nursing Diagnoses (2 items) |
Impaired tissue integrity r/t inflammation of great toe
Acute pain r/t tissue swelling |
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Alopurinol Nursing Interventions (4 items) |
Monitor CBC, liver enzymes, renal function
Tell patient to get yearly eye examinations for visual changes Advise patient to avoid alcohol, caffeine, and thiazide diuretics that increase uric acid levelAdvise patient to increase fluid intake to increase uric acid excretion |
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Anti Gout Drugs Uricosurics EXAMPLE: Probenecid (Benemid) Action (4 Notes) Side Effects (2 Notes) |
Action:
Increase uric acid excretion by blocking reabsorption of uric acid Do not use during acute attacks Can be taken w/ colchicine Avoid aspirin Side effects Gastric irritation; patient should take with food Flushed skin, sore gums, headache |
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Types of Skin Lesions Macules (freckle) (2 identifying items) |
flat with varying colors, < 1 cm
Patch if > 1 cm |
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Types of Skin Lesions Papules (wart,nevi) (1 identifying factor) |
raised, solid, not fluid, < 1 cm
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Types of Skin Lesions Vesicles |
raised, filled with serous fluid, <1 cm
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Types of Skin Lesions Plaques |
hard, rough, raised, and flat on top
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Acne Vulgaris Characteristics (2 items) |
Papules, nodules and cysts on the face, neck , shoulders, and back resulting in keratin plugs at the base of the pilosebaceous oil glands near the hair follicle
Increase in androgen production that occurs during adolescence, increase in the production of sebum. Sebum + keratin = plug, then acne |
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Nonpharmacological approach to Acne Vulgaris
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Prescribed or OTC cleansing agent, several times a day, avoid vigorous scrubbing, well balanced diet, decrease stress
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Mild anti acne drugs |
Keratolytics (keratin dissolvers)
benzoyl peroxide resorcinol salicylic acid |
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Moderate Anti-acne Drugs (6 items) |
tretinoin (Retin-A, Renova)
adapalene (Differin) azelaic acid (Azelex) tazarotene (Tazorac) clindamycin erythromycin |
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Severe Anti-acne Drugs 3 Types |
Oral antibiotics (4 examples)
doxycycline minocycline tetracycline erythromycin Topical glucocorticoids Systemic: isotretinoin (Amnesteem) Side effects: Pruritis, nosebleeds, inflammation of eyes/lips, teratogenic effects Monitoring of blood work |
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benzoyl peroxide information
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Applied several times a day as a cream, lotion or gel. It loosens the outer horny layer of the epidermis. (>10% solution is used for moderate acne). Can be used in combination with a topical antibiotic.
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Erythromycin and clindamycin information
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Erythromycin and clindamycin are the most frequently prescribed topical antibiotics and have the fewest side effects.
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tretinoin information
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Derivative of Vitamin A. Alters keratinization. May be used with benzoyl peroxide or topical antibiotics. Do not apply to open wounds. Cleanse are first. Pregnancy category B. (no possible adverse effect on fetus on Laboratory Testing)
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Doxycycline Information |
pregnancy category D (There is positive evidence of human fetal risk)
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minocycline
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Once-daily treatment. Take with food to decrease esophageal irritation. Do not cur/crush/chew. Pregnancy category D
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Isotretinoin information |
Only use when oral antibiotics have failed. Avoid sunlight, contact lenses, and use with tetracycline and vitamin A to reduce toxic effects. Monitor CBC, glucose, and lipid levels. Swallow whole tablet. Pregnancy category X (Contraindicated in pregnancy)
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I PLEDGE |
FDA Risk management program for isotretinoin (2005)
Internet based registry system / central database Includes implications for Patient (registration, pregnancy testing, contraception use, abstenance) Health care provider (registration, plan of care – birth control, labs) Pharmacist (registration, only buy from registered wholesaler, 7 day Rx) Wholesaler (registration) |
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Psoriasis characteristics (4 items)
Nonpharmalogical Approach (1 item) |
Erythematous papules and plaques covered with silvery scales
Appears on scalp, elbows, palms of hands, knees, and soles of feet Epidermal cell growth and turnover are accelerated @ 5 X normal rate Periods of remission and exacerbation Ultraviolet light (UVA) & (UVB) |
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Psoriasis Mild to Moderate Treatment 3 Types |
Keratolytics (keratin dissolvers)
salicylic acid sulfur Topical glucocorticoids, Other Topicals anthralin (Psoriatec), calcipotriene (Dovonex) tazarotene (Tazorac) coal tar (Scytera) |
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Psoriasis Severe Treatments |
Systemic: methotrexate
Biologic agents alefacept (Amevive) etanercept (Enbrel) infliximab (Remicade) adalimumab (Humira) ustekinumab (Stelara) |
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Psoriasis Biologic Agents General Information |
Tumor necrosis factor (TNF) inhibitors. All TNF inhibitors have a risk of severe opportunistic infections. Very expensive, but have fewer side effects that other systemic treatments.
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Psoriasis etanercept information |
Drug worsens infections, especially TB. May also worsen heart failure. Drug is given twice weekly for 12 weeks, then weekly. Injection site reaction (erythema, itching, pain, swelling)
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Psoriasis adalimumab information |
Drug administered every other weekas subcutaneous injection. Injection istereaction (erythema, ithching,pain , swelling) and infections, including reactivation of TB.
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Verruca Vulgaris (Warts) Characteristics (3 items) |
Hard, horny nodule that may appear anywhere on the body, particularly on the hands and feetMay be benign lesions, or they may be precursors to cancerous lesions, especially those in the genital region.
May be removed by freezing, electrodessication, or surgical excision |
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Verruca Vulgaris (Warts)
Treatment Drugs (4 items) |
salicylic acid (common warts)
podophyllum resin (venereal warts) imiquimod (Aldara, Zyclara) (external genital and perianal warts) podofilox (Condylox) (external genital and perianal warts) |
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Acne Vulgaris and Psoriasis Nursing Assessment
(6 items) |
Obtain history of onset of lesions
Assess skin eruptions. Describe lesions, location, and drainage if present Assess type of psoriatic lesions Obtain VS, esp. temp Obtain baseline labs |
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Acne Vulgaris and Psoriasis Nursing Diagnoses (4 items) |
Knowledge deficit r/t management of skin lesions and adverse effect of medicaitons
Risk for impaired skin integrity r/t side effects of medications Risk for infection r/t selected medications Risk for disturbed body image r/t skin lesions |
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Acne Vulgaris and Psoriasis Planning
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Pt will have increased knowledge of management of skin condition.
Pt lesions will be decreased in size or will be absent after therapy and skin care. Pt will report improve body image. |
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Acne Vulgaris and Psoriasis Interventions
(4 items) |
Establish rapport, because pt. may be embarrassed
Apply topical medications to skin lesions using aseptic technique. Monitor vital signs and report abnormal findings Check lesion sites during drug therapy for improvement or adverse reactions to drug therapy |
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Drug Induced Dermatitis Characteristics (2 items) |
Rash, urticaria, papules, and vesicles
Life-threatening skin eruptions erythema multiforme (red blisters over a large portion of the body) Stevens-Johnson syndrome (large blisters in the oral and anogenital mucosa, pharynx, eyes, and viscera) toxic epidermal necrolysis (widespread detachment of the epidermis from underlying skin layers) |
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Contact Dermatitis Characteristics and Causes |
Characteristics
Skin rash with itching, swelling, blistering, oozing, or scaling at the affected skin sites Causes Chemical: cosmetics, perfume, soap, dyes Plants: poison ivy, oak and sumac |
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Contact Dermatitis Nonpharmacological and Pharmacological Measures |
Nonpharmacological measures
Avoid direct contact, protective gloves/clothingOatmeal Baths, oil stripping soaps Pharmacologic measures Wet dressings of Burow’s solution (aluminum acetate) Calamine lotion Glucocorticoid ointments, creams, or gels Dexamethasone Hydrocortisone Triamcinolone |
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Impetigo Etiology and Treatment |
Etiology: Common Staphylococcus aureus infection
Population affected: children 2-5 yrs. old Treatment Topical (mild to moderate) Systemic (severe) mupirocin (Bactroban) retapamulin (Altabax) May have to add an oral antibiotic if multiple lesions and topical therapy is ineffective |
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Hair Loss and Baldness Treatment |
minoxidil (Rogaine)
causes vasodilation, increasing cutaneous blood flow. When d/c – hair loss occurs within 3-4 months. finasteride (Propecia, Proscar) in higher doses (5 mg tablets) – it can be used also for BPH (benign prostatic hyperplasia) |
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Degrees of Burns |
First – superficial epidermal (erythema, painful)
Second – Deep thickness (blistering, very painful) Third – Full thickness (pearly white skin, charred, no pain) |
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Topical Drugs for Burns (2 items) |
mafenide (Sulfamylon Cream)
Side effects/adverse reactions Burning sensations, blistering, superinfection, metabolic acidosis silver sulfadiazine (Silvadene) Side effects Skin discoloration |
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Sliding Scale Insulin |
Sliding-scale insulin coverage
Adjusted doses dependent on individual blood glucose Usually done before eating and at bedtime Usually uses rapid or short-acting insulin |
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Insulin Storage |
Storage of insulin
Keep in refrigerator. Remove from refrigerator 30 minutes before injection. Avoid storing insulin in direct sunlight or at high temperatures. |
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Oral Anti-Diabetic Drugs |
First- and second-generation sulfonylureas
Used to treat type 2 diabetes Stimulate pancreatic beta cells to secrete more insulin |
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First-generation sulfonylureas
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Short-acting: tolbutamide (Orinase)
Intermediate-acting: tolazamide (Tolinase) Long-acting: chlorpropamide (Diabinese) |
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Second-generation sulfonylureas
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Glimepiride (Amaryl)
Glipizide (Glucotrol, Glucotrol XL) |
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Oral Anti-diabetic drugs Nonsulfonylureas |
Biguanide: Metformin (Glucophage)
Action Decreases hepatic production of glucose from stored glycogen Diminishes the increase in serum glucose following a meal Blunts the degree of postprandial hyperglycemia Decreases the absorption of glucose from the small intestine Increases insulin receptor sensitivity as well as peripheral glucose uptake at the cellular level |
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Alpha-Glucosidase Inhibitors
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Acarbose (Precose)
Action: Inhibits the digestive enzyme in the small intestine responsible for the release of glucose from complex carbohydrates (CHO) in the diet Miglitol (Glyset) Action: Inhibits alpha glucosides |
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Thiazolidinediones
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Pioglitazone (Actos)
Antidiabetic Rosiglitazone (Avandia) Avandia users may be at greater risk for heart attack and possibly death. Both drugs are contraindicated in symptomatic heart disease and Class III and IV CHF. |
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Meglitinides
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Repaglinide (Prandin) and nateglinide (Starlix)
Action: They stimulate the beta cells to release insulin. The action of repaglinide and nateglinide is similar to that of sulfonylureas. Short-acting anti-diabetic drugs |
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Incretin Modifiers
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Sitagliptin phosphate (Januvia) and saxagliptin (Onglyza)
Action is to increase the level of incretin hormones, increase insulin secretion, and decrease glucagon secretion to reduce glucose production. Used as adjunct treatment with exercise and diet to reduce both fasting and postprandial plasma glucose |
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Guidelines for Oral Anti-diabetic Therapy for Type 2 Diabetes
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Criteria for use of oral anti-diabetic drugs:
Onset of diabetes mellitus at age 40 years or older Diagnosis of diabetes for less than 5 years Not underweight Fasting blood glucose equal to or less than 200 mg/dL Less than 40 units of insulin required per dayNormal renal and hepatic function |
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Other Antidiabetic Agents
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Exenatide (Byetta) and liraglutide (Victoza)
Actions of exenatide and liraglutide are to enhance insulin secretion, increase beta-cell responsiveness, suppress glucagon secretion, slow gastric emptying, and reduce food intake. |
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Other Antidiabetic Agents
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Pramlintide acetate (Symlin)
Approved for type 1 and type 2 diabetes Improves postprandial glucose control in patients who are using insulin but are unable to achieve and maintain glucose control Suppresses glucagon secretion, slows gastric emptying, and modulates appetite by inducing satiety |
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Hyperglycemic Drugs
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Glucagon
Hyperglycemic hormone secreted by the alpha cells of the islets of Langerhans Increases blood sugar by stimulating glycogenolysis Use: Used to treat insulin-induced hypoglycemia when other methods of providing glucose are not available Route of administration: Parenteral use (subQ, IM, and IV) |
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Hyperglycemic Drugs
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Diazoxide (Proglycem)
Increases blood sugar by inhibiting insulin release from the beta cells and stimulating release of epinephrine (Adrenalin) from the adrenal medulla Not indicated for hypoglycemic reaction Used to treat chronic hypoglycemia caused by hyperinsulinism due to islet cell cancer or hyperplasia |
