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231 Cards in this Set
- Front
- Back
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Treatment of rheumatoid arthritis is directed at ____, _____, _____, and _____
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Relieving symptoms, maintaining joint function & ROM, minimizing systemic involvement, & delaying progression
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The three major categories of antiarthritic drugs are ___, ____, and ________.
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NSAIDs, DMARDs, and glucocorticoids
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The most commonly employed oral glucocorticoids are ___ and ____
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Prednisone and Prednisolone
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The most rapidly acting disease-modifying antiarthritic drug is _______
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Methotrexate
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_______ is the first member of a new class of drugs, the tumor necrosis factor blockers.
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Etanercept
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The five principal drugs used to treat gout are _______, _______, _______, _______, and _____
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Colchicine, indomethacin, allopurinol, probenecid, sulfinpyrazone
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The most characteristic signs of cholchicine toxicity are _____, ______, ______, and _______
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N/V/D, abd pain
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_______ lacks anti-inflammatory and analgesic actions and is of no benefit during an acute gouty attack.
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Sulfinpyrazone
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The enzyme for synthesis of prostaglandins is _______
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Cyclooxygenase
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Inhibition of cyclooxygenase-s (COX2) results in ______, ______, and _____
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Suppression of inflammation, alleviation of pain, and reduction of fever
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ASA should not be used in the treatment of fever in children because of the risk of the development of ________
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Reye's syndrome
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Name 6 therapeutic uses of ASA
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Suppress inflammation, alleviate pain, reduce fever, dysmenorrhea, suppress platelet aggregation, cancer prevention
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Antiulcer drugs can be used to prevent and treat ASA-induced ulcers. For prevention, pts @ high risk can take a ____ or ______
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PPI or misoprostol
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The principal indications for use of the nonaspirin NSAIDs are the tx of _____ and _____
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Rheumatoid arthritis and osteoarthritis
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_____ is a powerful analgesic w/ minimum anti-inflammatory actions. Pain relief = to that produced by morphine & other opioids
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Ketorolac
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The first COX2 inhibitor approved by the US FDA was ______
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Celecoxib
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______ is a specific antidote to acetaminophen
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Acetylcysteine
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______ can antagonize the antiplatelet actions of ASA and thereby decrease protection against thrombotic events
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Ibuprofen
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What 3 lab tests are done to check thyroid function?
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TSH, T3 & T4
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What does the thyroid do?
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Metabolism, cardiac function
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What are the 2 iodine containing active hormones found in the thyroid?
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T3 & T4
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If you have an increased TSH is your thyroid hypo or hyperactive?
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Hypoactive - hypothyroidism - pituitary is pumping out more TSH to stimulate the thyroid
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If you have a decreased TSH is you thyroid hypo or hyperactive?
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Hyperactive
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*TEST* What are the S/S of hypothyroidism?
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Dry skin, cold intolerance, lethargy, depression, weight gain, related to decreased levels of T3 & T4
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*TEST* What are the S/S of hyperthyroidism?
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Exopthalmos, thin hair, intolerance to heat, nervousness, tachy, or tachy dysrhythmias
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What is a severe thyroid deficiency called?
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Myxedema
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What are 3 causes of hypothyroidism?
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Iodine deficiency, surgical removal of thyroid, destruction from radioactive iodine
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What's another name for hyperthyroidism?
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Graves' disease
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What is the tx for Graves disease?
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Surgical removal, suppression w/ radioactive iodine, suppression w/ drugs
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Name 4 thyroid medications
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Levothyroxine, levoxyl, synthroid, unithroid
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What labs would you ck before giving thyroid meds?
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TSH, T3, T4, Heart Rate (over 100 DON'T GIVE!)
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What is the cause of most cases of PUD?
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Helicobacterpylori
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What could potentially interfere w/ prostaglandin synthesis in the stomach?
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NSAIDs
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What do prostaglandins do in the stomach?
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Protect the lining from gastric acid
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What is the absolute requirement of ulcer formation?
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Gastric acid - injures cells of mucosa and activates peptin
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Antacids can contain a lot of what electrolyte that could be important for pts w/ HF to be aware of?
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Sodium
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Why should antacids be given 1 hr before other meds?
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Binds w/ other meds
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What is included in a prevpak?
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Prevacid, Amoxicillin, clarithromycin X 2 weeks
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How many drugs are typically used to tx H. Pylori?
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At least 3
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What does an H2 blocker suppress?
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Gastric acid
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What is the 1st line choice for ulcers/
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H2 antagonists
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What is the only IV PPI?
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Protonix
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What is carafate's action?
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Creates a barrier against acid & pepsin - acts like a bandaid for the stomach
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Should carafate be given through a dobhoff?
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NO - clogs it
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Does carafate neutralize gastric acids?
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NO
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What should decadron make you think of?
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Spinal or cerebral edema - also increases effectiveness of anti-nausea meds
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What would be the anti-nausea drug of choice if there is a full stomach? WHY?
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Reglan - enhances acetylcholine
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Name an IV muscle relaxant
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Robaxin
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What is the difference between benzodiazepines & barbiturates?
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BZD's cap GABA - barbiturates - no cap
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Killer cocktail?
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Sodium pentothal (barbiturate), succinyl choline (paralytic - can't breathe), potassium (stops heart)
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What ist he enzyme associated w/ inflammation targeted by NSAIDS?
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Cyclooxygenase
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What does dysmennorhea mean?
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Painful menstrual cramps
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How much is in a baby ASA?
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81mg
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What NSAID can help in the prevention of Alzheimer's?
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Ibuprofen
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Should ASA & Ibuprofen be mixed when ASA's are taken for prevention of MI?
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NO -
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Why is cytotec given w/ toradol?
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Protects the stomach lining
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Should a person w/ severe kidney disease take ibuprofen?
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NO
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*TEST* What is the 1st symptom of ASA toxicity?
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Tinnitis
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Acetominophen decreases fever and pain but not inflammation T or F
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True
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What is the drug that neutralizes acetaminophen?
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Acetylcysteine (mucomyst)
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How is acetylcysteine (Mucomyst) given?
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Liquid on ice (tastes bad!)
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Adrenal cortex releases what?
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Salt, sugar, & Sex
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Glucocorticoids mimic what physical response?
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Stress
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How long does it take for adrenal glands to "wake up" after long term steroid therapy?
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up to 1 year
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How does giving a glucocorticoid before 0900 minimize adrenal insufficiency?
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It mimics natural morning burst of glucocorticoids
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What drug is used for palliative tx for a client w/ tumor induced spinal compression/
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Dexamethasone
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What are some live vaccines?
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Flu, polio
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Why is the great toe the most common place for gout?
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Lowest and coolest place in the body
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*TEST* If you get GI upset when taking colchicines what should you do?
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STOP taking it!
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What is colchicine taken for?
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Gout - decreased information
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What is the only IV anti-inflammatory?
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Ketorolac
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What are the first generation anti-inflammatory drugs?
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ASA, ibuprofen, naproxen, ketorolac, indomethacin
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What happens when Ibuprofen and ASA are taken together?
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Antagonizes anti-platelet actions of ASA & decreases protection against thrombotic events
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Name a 2nd generation anti-inflammatory medication
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Celecoxib (Celebrex)
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What enzyme(s) is/are inhibited by first generation anti-inflammatory drugs?
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COX-1 and COX-2
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What enzyme(s) is/are inhibited by second generation anti-inflammatory drugs?
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COX-2 only
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What is the most common side effect of NSAIDs?
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GI bleeding
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What can be done to minimize the most common side effect of NSAIDS?
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How does Tylenol fit into the NSAID class?
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Antipyretic and analgesic (but NOT anti-inflammatory)
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How does Tylenol OD cause death?
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Liver failure
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How much Tylenol is too much?
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More than 4 gm/ day
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How is Tylenol OD treated?
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With Acetylcystine (mucomyst)
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Why is ASA not given to children
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Risk of Reye's syndrome
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How do you treat ASA OD?
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No treatment - Supportive - mechanical vent., external cooling, IV fluids, HCO3- to control acidosis, hemodialysis, gastric lavage, charcoal
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What are the s/s of ASA toxicity?
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Initial - resp alkalosis. Later - resp excitation becomes resp depression, acidosis, hyperthermia, sweating, dehydration, electrolyte imbalance, stupor/coma, death (resp failure)
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What are some of the uses for NSAIDs?
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Pain relief, antipyretic, R/A, gout, dysmennorhea, cancer and alzheimer's prevention
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Is there a cure for Rheumatoid arthritis?
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NO
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What are some non-drug measures that can be taken to help with RA pain?
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Heat/cold, balanced exercise, surgery
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What are the 3 main drug classes used to treat RA?
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NSAIDs, Glucocorticoids, DMARDs (Non-biologic and Biologic)
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What is the benefit of NSAIDs in the tx of RA?
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Rapid relief, relatively safe, less monitoring required than glucocorticoids & DMARDS
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What is the drawback of NSAIDs in the tx of RA?
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Do not prevent joint damage or slow disease progression
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What are the benefits of Glucocorticoids in the tx of RA?
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Rapid relief, slows disease progression
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What is the drawback of glucocorticoids in the tx of RA?
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Short term use only - serious adverse effects if used long-term
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Name 6 disease modifying antirheumatic drugs (DMARDs)
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Methotrexate, hydroxychloroquine (Plaquenil), Sulfasalazine (azulfidine), Etanercept (Enbrel), Infliximab (Remicade), and Gold Salts
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Name the 3 DMARD I drugs
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Methotrexate, hydroxycholorquine (plaquenil), and sulfasalazine (azulfidine),
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Name the 2 biologic DMARD II's
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Entanercept (Enbrel) and Infliximab (Remicade)
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Name the DMARD III drug
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Gold Salts
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What is the first choice DMARD drug for pts w/ RA?
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Methotrexate
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Why is Methotrexate the DMARD drug of choice for RA?
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Cheap, 89% of pts improve, and fast acting (3-6 weeks)
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What are some side effects of methotrexate?
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Teratogen, hard on the liver, kidneys, bone marrow and GI tract
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What is the DMARD drug often combined w/ methotrexate but can be rx'ed alone?
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Sulfasalazien (azulfidine)
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What is different about the DMARD II drugs (Biologic DMARDs)?
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They are immmunosuppressant drugs that are tumor necrosis factor antagonists
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What are the drawbacks to using DMARD II drugs? (Biologic DMARDS)
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Expensive, many side effects (infection most common)
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How are entanercept (Enbrel) and Infliximab (Remicade) given?
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IV
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How are gold salts given?
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Oral or IM
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Are gold salts commonly prescribed?
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NO
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When are gold salts used?
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In conjunction with or when other therapies for RA fail
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What is the difference between Gouty Arthritis and Hyperuricemia?
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Hyperuricemia - high serum uric acid levels. Gouty arthritis - deposits of uric acid crystals
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What is the drug used to inhibit uric acid formation and tophi formation?
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Allopurinol
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What are the side effects of allopurinol?
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Hard to take!! N/V/D, abd pain in 80% of pts
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What are the 2 drugs that act on renal tubules to reabsorb uric acid?
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Probenicid and sulfinpyrazone
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What 3 drugs are used to treat hyperuricemia?
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Allopurinol, probenicid and sulfinpyrazone
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What drugs are used to treat gouty arthritis?
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NSAIDS, Colchicine, Glucocorticoids
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What is the drug class of choice for treating gouty arthritis?
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NSAIDs
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What is the drug colchicine used for?
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Anti-inflammatory specific for gout
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Should you get a tattoo if you are on ASA therapy?
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NO - stop 7-10 days prior to tattoo
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What is good about Tylenol?
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No stomach upset, GI bleeds, Kids - no Reye's syndrome
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Why are glucocorticoids good?
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Decrease inflammation, relieve discomfort, RA, asthma
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Why are glucocorticoids bad?
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Mask infections such as TB, cuase hyperglycemia, moon face, pot belly
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How do you stop taking glucocorticoids?
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TAPER
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If you are depressed & on steroid therapy will you need more or less steroids?
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MORE
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RA is an autoimmune disease. What types of meds will be used for tx?
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NSAIDS, DMARDS, methotrexate
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Why is methotrexate good for RA pts?
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It works in 80% of pts
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What is important advice to give to a pt taking Enbrel?
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NO LIVE VACCINES!
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Why should glucocorticoids be avoided in pregnancy?
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Cause problems w/ baby's adrenal glands.
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What is a medication just for gout (an antiinflammatory)?
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Colchicine
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How muc Ca++ can your body absorb at once?
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500mg - the rest is excreted
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*TEST* What do female pts on birth control need know prior to major abdominal sx?
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Stop birth control 1 month before due to risk of blood clots!
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*TEST* What is the most common side effect of hormone replacement therapy?
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Nausea
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*TEST* What should you advise pts regarding abdominal pain while taking colchicine?
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STOP TAKING IMMEDIATELY IF ABDOMINAL PAIN OCCURS
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*TEST*If you have a uterus can you take estrogen on it's own?
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No - needs progesterone too!
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What does progestin do in a birth control pill?
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Suppresses LH, thickens cervical mucus, thins endometrium preventing ovum implantation, interferes w/ function inside fallopian tubes
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What are the side effects of oral contraceptives?
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Venous thrombosis, MI, migraine, decreased estrogen exposure = decreased bone health, gall bladder disease, breast cancer.
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What does estrogen do in a birth control pill?
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Inhibits ovulation by suppressing FSH & LH, alters endometrium
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What do you do if you miss a dose of progestin only birth control?
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Take it ASAP
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What do you do if you miss 2 doses progestin only birth control?
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Take 1 pill ASAP, discard 2nd pill, take 3rd pill next day
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What do you do if you miss 3 doses progestin only birth control?
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Terminate dosing cycle, restart with next menses, use barrier method
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What do you do if you miss 1 dose combined birth control?
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Take ASAP
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What do you do if you miss 2 doses combined birth control?
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Take 2 pills per day for 2 days
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What do you do if you miss 3 doses combined birth control?
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Initiate new cycle. Start 7 days after last pill. Use barrier method for first 2 wks
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When do you start a cycle of combined birth control pills?
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On the 5th day of the cycle
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When do you start a cycle of progestin only birth control pills?
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On the 1st day of the cycle
|
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How do you use a transdermal contraceptive patch?
|
One patch weekly for 3 wks then 1 patch free week
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How long is the mirena device effective?
|
5 yrs
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How long is the paragard (copper T) device effective?
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10 yrs
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What happens if a pt is taking Oral contraceptives as well as warfarin?
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Warfarin effectiveness is reduced
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How long can a vaginal ring be used?
|
3 weeks
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Will the Plan B pill terminate a pregnancy?
|
NO
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What are 3 methods used for the "day after"
|
Combined oral contraceptives, progestin only pill, IUD
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What is a side effect of Depo Provera that prevents women from using the drug for more than 2 yrs?
|
Decreased bone density
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What is the most common form of birth control?
|
Sterilization
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What is the most effective form of birth control?
|
Sterilization
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What is the principal source of estrogen in premenopausal women?
|
Ovaries
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What are the side effects of estrogen?
|
GI - nausea, endrometrial cancer (when used alone), breast cancer (when used w/progestin),
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Where is progesterone secreted?
|
Ovaries and placenta
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What is the job of progesterone?
|
Maintains uterus during pregnancy, decline causes onset of menstruation.
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What are the side effects of progesterone?
|
Breakthrough bleeding, sore breasts, breast cancer (increases estrogen's effects), teratogenic effects in high doses 1st 4 mos
|
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Where is testosterone produced?
|
Interstitial cells of the testes
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What does testosterone do?
|
Development & maintenance of primary & 2ndary characteristics in males
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Do you need progesterone if you don't have a uterus?
|
NO
|
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What are SERMS?
|
Selective Estrogen Modulators
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Name one SERM?
|
Tamoxifen
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What is a side effect of tamoxifen?
|
Breast and uterine cancer, thromboembolism,
|
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What is tamoxifen used for?
|
To prevent and treat breast cancer
|
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What is Raloxifine used for?
|
Osteoporosis and breast cancer prevention
|
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What is the difference between Tamoxifen and Raloxifine?
|
Raloxifine doesn't activate endometrial estrogen receptors
|
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When does menopause occur?
|
When the ovaries stop producing estrogen and progesterone
|
|
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What are the symptoms of menopause?
|
Hot flashes, mood swings, tiredness, loss of libido, vaginal dryness & irregular bleeding
|
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Why did the women's health initialtive regarding prevention of heart disease w/ HRT terminate early?
|
Increased breast cancer and cardiovascular events (stroke)
|
|
|
|
|
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What are the advantages to HRT?
|
Decreased colon cancer and hip fracture risk
|
|
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What type of drug is Prempro?
|
Combined estrogen/progesterone HRT (conjugated estrogens)
|
|
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What type of drug is Premarin?
|
Estrogen only HRT
|
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Why would vaginal estrogen cream be prescribed?
|
Relieves dryness, helps relieve bladder symptoms.
|
|
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Where would you place a transdermal HRT patch?
|
On the abdomen but not at the waist - it will get rubbed off
|
|
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Name a vasomotor symptom of menopause?
|
Hot flashes
|
|
|
Who should use the "mini pill"?
|
Older women, smokers, & breast feeding moms
|
|
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What is a side effect of IUD's?
|
Pelvic Inflammatory Disease
|
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What is important information to teach a woman who is taking birth control & penicillin?
|
Use barrier method - PCN decreases effectiveness of birth control
|
|
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What are some contra-indications to using combination birth control pills?
|
Smoking, hx of DVT, 35+, breastfeeding
|
|
|
What is progesterone indicated for?
|
Contraception, HRT, DUB, Amenhorrhea, endometrial carcinoma & hyperplasia (not cure! Palliative)
|
|
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What is estrogen indicated for?
|
HRT, contraception
|
|
|
What is the net result of glucocorticoids on the ater and electrolyte status in the body?
|
Hypernatremia, hypokalemis, & edema
|
|
|
The major clinical application of glucocorticoids stems from their ability to ____.
|
Suppress immune responses & inflammation
|
|
|
Glucocorticoids interrupt the inflammatory process by _____, _______, and _____/
|
Inhibit synthesis of prostaglandins, leukotrienes, & histamine, suppress lymphocytes & phagocytes
|
|
|
Because of tehir mineralcorticoid activity, glucocorticoids can cause:
|
Sodium & H2O retention & potassium loss
|
|
|
Prominent symptoms of cushing's syndrome include:
|
Hyperglycemia, glucosuria, fluid & electrolyte disturbances, osteoporosis, muscle weakness, cutaneous striations, lowered resistance to infection
|
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|
Glucocorticoids are contraindicated for pts w/ ___ & ____.
|
Systemic fungal infections, those receiving live-virus vaccines
|
|
|
Glucocorticoid use may produce a withdrawal syndrome. Symptoms include:
|
Hypotension, hypoglycemia, myalgia, arthralgia, fatigue
|
|
|
Where are glucocorticoids secreted?
|
Adrenal glands
|
|
|
If glucocorticoid levels are insufficient what symptoms would be manifested?
|
Hypotension, hypoglycemia
|
|
|
Glucocorticoids suppress/increase inflammatory response
|
Suppress
|
|
|
Glucocorticoids suppress/increase immune response
|
Suppress
|
|
|
What are the adverse effects of glucocorticoids?
|
Hyperglycemia, fragile skin, delayed healing, cataracts, decrease protein matrix of bone, reduce muscle mass, immunosuppression, cushingoid symptoms
|
|
|
What type of medication causes redistribution of body fat to trunk/abdomen, buffalo hump and moon face
|
Glucocorticoids
|
|
|
What are 3 common glucocorticoids
|
Prednisone, betamethasone, dexamethasone
|
|
|
How do you administer glucocorticoids?
|
Give in the am to mimic nature, give w/ food
|
|
|
What would glucocorticoids be prescribed for?
|
Allograft rejection, asthma/COPD, RA,
|
|
|
Thyroid hormones affect what 4 things?
|
Metabolism, growth and development, and cardiac function
|
|
|
Deficiency of thyroid hormones in childhood can cause:
|
Short stature & permanent mental impairment
|
|
|
Where is TSH produced?
|
The pituitary
|
|
|
Where is thyrotropin releasing hormone produced?
|
The hypothalamus
|
|
|
S/S of hypothyroidims:
|
Dry skin, cold intolerance, lethargy, depression, weight gain - decreased levels of T3 & T4
|
|
|
S/S of hyperthyroidism:
|
Intolerance to heat, exopthalmos, thin hair, nervousness, tachycardia or tachydysrhythmias
|
|
|
What is a severe deficiency of the thyroid called?
|
Myxedema
|
|
|
What are some causes of hypothyroidism
|
Iodine deficiency, surgical removal, destruction from radioactive iodine
|
|
|
How is hypothyroidism treated?
|
Levothyroxine (T4) and levothyroxine & liothyronine (T3)
|
|
|
What are 2 names for hyperthyroidism?
|
Grave's disease and toxic nodular goiter
|
|
|
Who is most often effected by hyperthyroidism?
|
Women 20-40
|
|
|
Men/women are affected 6 x's more frequently by hyperthyroidism
|
Women
|
|
|
What is exopthalmos?
|
Bulging of the eye out of the socket
|
|
|
What causes exopthalmos?
|
Hyperthyroidism - infiltration of extraocular muscles & orbital fat by lymphocytes, macrophages, plasma cells, mast cells etc..
|
|
|
How is Graves disease treated?
|
Surgical removal of thyroid tissue, radioactive iodine to destroy tissue, or suppression of thyroid hormone synthesis with antithyroid drugs
|
|
|
Name 2 antithyroid drugs
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Propylthiouracil, methimazole
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What is the half life of T4 (levothyroxine)? Why?
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7 days protein bound
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How do NSAIDs cause PUD?
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They inhibit the biosynthesis of prostaglandins
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What is the #1 absolute requirement for the creation of an ulcer?
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Gastric acid!
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Name 4 H2 receptor antagonists
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Tagamet, axid, zantac, pepcid
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Name 4 PPI's
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Prilosec, Prevacid, Protonix, Nexium
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What do H2 receptor antagonists do?
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Block histamine from stimulating acid secreting parietal cells of the stomach
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What are the most effective drugs for suppressing secretion of gastric acid?
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ppiS
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How do PPI's work?
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Cause irreversible inhibition of H+, K+ ATPase (enzyme that generates gastric acid) to block final pathway of gastric acid production
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What are the SE of PPI's?
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HA, N/V/D, long term risk of CA, carcinoid tumors in rats.
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What is a SE of Carafate (in 2%)
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Constipation
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What type of drug is cytotec?
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Antisecretory agent - prevents NSADI induced ulcers by replacing endogenous prostaglandin
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What are the SE of cytotec?
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Diarrhea, abdominal pain, spotting, dysmennorhea
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What type of drug is most effective against N/V used for cancer pts initially?
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Serotonin receptor antagonists
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Name 3 serotonin receptor antagonists
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Ondansetron (Zofran) Granistron (Kytril),Doasetron (Anzamet)
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What are dopamine antagonists used to treat?
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N/V
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What are3 drugs that are dopamine antagonists?
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Prochlorperazine (Compazine), Metoclopramide (Reglan), Droperidol (Inapsine)
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What are the dangerous SE of dopamine antagonists?
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EPS
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