Pharmacology Chapter 70

Front 1

The nurse is administering celecoxib (Celebrex) 100 mg to an 82 year old patient with osteoarthritis (degenerative joint disease). Which of the following adverse effects, if present, would be of most concern to the nurse?
A. Edema
B. Flatulence
C. Headache
D. Nausea

Back 1

A. Edema

Front 2

How many regular strength aspirin (325mg) tablets are equivalent to the lowest dose of aspirin that is known to be potentially fatal?

Back 2

12

Front 3

The nurse should instruct patients to dispose of aspirin tablets if they develop an odor that smells like what?

Back 3

vinegar

Front 4

A patient is scheduled for a total knee replacement. Preoperative teaching by the nurse should include that the patient should discontinue high-dose aspirin therapy prescribed for joint pain for what period of time before surgery?

Back 4

one week

Front 5

Cyclooxygenase has what two forms?

Back 5

1. COX-1
2. COX-2

Front 6

What are the two major groups of cyclooxygenase?

Back 6

1. NSAIDS (nonsteroidal anti-inflammatory drugs)
2. acetaminophen

Front 7

Inhibition of COX-1 (good) can cause what?

Back 7

1. gastric ulceration
2. renal impairment
3. bleeding tendencies

Front 8

Inhibition of COX-2 (bad) can suppress what?

Back 8

1. inflammation
2. pain
3. fever
4. protection against colon cancer

Front 9

What is the first prototype of first-generation NSAIDS?

Back 9

Aspirin

Front 10

Name the four major beneficial actions of Aspirin.

Back 10

1. suppress inflammation
2. mild/moderate pain relief
3. reduce fever
4. prevention of stroke/MI

Front 11

Name two ways to reduce the risk of aspirin-induced gastic ulcers.

Back 11

1. testing for and eliminating H.pylori prior to therapy
2. giving a proton pump inhibitor

Front 12

How do NSAIDS work?

Back 12

They reduce pain by inhibiting prostaglandins by interacting and interfering with cyclooxygenase (COX 1)

Front 13

Where can cyclooxygenase be loacted in the body?

Back 13

in all body tissues

Front 14

At site of injury in the tissues what does cyclooxygenase do?

Back 14

COX catalyzes the synthesis of prostaglandins to promote inflammation and receptors to painful stimuli.

Front 15

Name three important functions of the cyclooxygenase (COX-1).

Back 15

1. protecting the gastric mucosa
2. supporting renal function
3. promoting platelet aggregation

Front 16

Which COX has been dubbed the "good COX" and which is the "bad COX"?

Back 16

Good: COX-1
Bad: COX-2

Front 17

What is the one MOST beneficial effect of inhibiting COX-1 (good)?

Back 17

Protection against MI and stroke

Front 18

What are the two adverse effects of inhibiting COX-2 (bad)?

Back 18

-renal impairment
-promotion of MI or stroke

Front 19

True or False:
Acetaminophen can suppress inflammation

Back 19

False
Acetaminophen falls into the category of cyclooxygenase inhibitors that has a lack of effect on inflammation. NSAIDS would suppress inflammation.

Front 20

What are the two groups of NSAIDS?

Back 20

1. first generations NSAIDS
2. second generation NSAIDS

Front 21

The first generation NSAIDS inhibit what?

Back 21

COX-1 and COX-2

Front 22

The second generation NSAIDS inhibit what?

Back 22

Only COX-2

Front 23

What is the chemical family that Aspirin belongs to?

Back 23

salicylates

Front 24

What is acetylsalicylic acid?

Back 24

Aspirin (ASA)

Front 25

Is Aspirin a reversible inhibitor of cyclooxygenase?

Back 25

No aspirin is different than NSAIDS. Aspirin is irreversible.

Front 26

What is the half-life of Aspirin?

Back 26

15-20 minutes

Front 27

How is Aspirin distributed?

Back 27

bound to plasma albumin

Front 28

How can we increase the excretion rate of Aspirin?

Back 28

By increasing the pH of the urine from 6 to 8.

Front 29

Should healthy women younger than 65 take daily Aspirin?

Back 29

No.

Front 30

What are the most common gastrointestinal side effects of Aspirin?

How can they be prevented?

Back 30

1. gastric distress
2. heartburn
3. nausea

Prevented by taking Aspirin with food or full glass of water.

Front 31

What can we use to prevent ulcers?

Back 31

proton pump inhibitors

Front 32

Salicylism

Back 32

syndrome that begins to develop when aspirin levels climb slightly above therapeutic levels.

Front 33

Where is Aspirin fall on the Pregnancy Risk Category?

Back 33

Category D: there is evidence of human fetal risk, but the potential benefits from us of the drug during pregnancy may outweigh the potential for harm.

Front 34

Name some patients where Aspirin is contraindicated?

Back 34

- peptic ulcer disease
- bleeding disorders
- hypersensitivity to aspirin or NSAIDS
-pregnant women

Front 35

How is Aspirin always administered?

Back 35

PO (orally)

Front 36

True or False
Non Aspirin NSAIDS can promote thrombotic events?

Back 36

True. Aspirin is the only one that prevents thrombotic events.

Front 37

Why does celecoxin (Celebrex) not provide the same cardiac protection as Aspirin?

Back 37

celecoxin (Celebrex) does not inhibit COX-1 in platelets therefore does not suppress platelet aggregation.

Front 38

Celecoxib contains sulfur molecule and should be avoided in what patients?

Back 38

Patients with sulfa allergies.

Front 39

What are the properties of Acetaminophen?

Back 39

analgesic
antipyretic

Front 40

Acetaminophen overdose can cause severe damage to what organ?

Back 40

Liver

Front 41

What is the half-life of Acetaminophen?

Back 41

2 hours

Front 42

What is the major pathway acetaminophen is metabolized?

Back 42

Acetaminophen undergoes conjugation with glucuronic acid to form nontoxic metabolites.

Front 43

What is the minor pathway acetaminophen is metabolized?

Back 43

Acetaminophen is oxidized by cytochrome P450 into a highly reactive and toxic compound.

Front 44

What is the principle feature of acetaminophen overdose?

Back 44

hepatic necrosis

Front 45

What is an antidote to give a patient within 8-10 hours of an acetaminophen overdose that is 100$ effective?

Back 45

acetylcysteine (PO or IV)