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78 Cards in this Set

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  • Back

a protective process of the tissues in response to irritation, infection or injury

It is possible to have inflammation without infection or injury
What 3 processes make up the inflammatory response?
1. vasodilation
2. increased vascular permeability
3. migration of WBCs to the inflamed area
What are the 5 cardinal signs of inflammation?
1. redness
2. increased warmth
3. swelling
4. pain
5. varying degrees of loss of function in that area
The cardinal signs of inflammation are initiated by what type of cells? What do these cells specifically release in the body to produce such an effect?
Mast cells- these cells release biochemical mediators such as histamines, leukotrienes and prostaglandins
What are the 3 types of drugs used to treat inflammation?
1. anti-inflammatories
2. immunosuppressants
3. immunomodulators
What are 3 common drug categories that are frequently used to treat inflammation caused by osteoarthritis, rheumatoid arthritis, musculoskeletal disorder, minor surgeries, dental procedures, and GYN disorders (dysmenorrhea / endometriosis)?
1. anti-inflammatories
2. immunosuppressants
3. immunomodulators

Certain drugs that treat inflammatory conditions have antipyretic effects.

Acetaminophen is considered an anti-inflammatory drug.
False- it is a prostaglandin synthesis inhibitor (thus decreases pain) but it's anti-inflammatory response is so weak that it is not considered an anti-inflammatory drug.
What are the 2 primary uses for acetaminophen?
Salicylates and NSAIDS are classifications of ___________ drugs.
How do salicylates and NSAIDS exert their action?
they inhibit prostaglandin
Prostaglandins are converted from arachidonic acid by the enzyme __________.
cyclooxygenase (COX)
What are the 2 forms of COX.
COX-1 and COX-2
Which enzyme, COX-1 or COX-2, is most actively involved in prostaglandin formation at the site of inflammation?
What is the goal of the pharmacological therapy with agents such as salicylates and NSAIDS (anti-inflammatory)?
to inhibit COX
Salicylates and most NSAIDS inhibit COX-1, COX-2, or both?

There is one NSAID that selectively inhibis COX-2.
What is the problem with the inhibition of COX-1?
can leads to bleeding disorders through anti-platelet aggregation
_______ (COX-1 or COX-2) is protective of the stomach lining.
Drugs that inhibit _________ are more likely to cause gastric irritation with bleeding; especially in the elderly.
What is the advantage of selective COX-2 inhibitors?
they decrease the incidence of bleeding disorders
COX-2 selective inhibitors have been implicated in what negative disorders?
increased incidence of cardiac disorders and strokes due to edema and hypertension
Why were rofecoxib and valdecoxib, COX-2 selective inhibitors, taken off the market by the FDA?
because there was an increase in cardiac disorders and strokes associated with these drugs
What is the primary use for aspirin?
used for anti-platelet aggregation in heart disease
What specific consideration should be known about ketorolac, a potent NSAID?
- it is extremely potent, can only be used short term (5 days or less) due to a high potential for nephrotoxicity

- only NSAID that can be given parenterally
What can be caused by both NSAIDS and salicylates due to the inhibition of COX-1?
Peptic Ulcers
What should be done to avoid stomach irritation with NSAIDS and salicylates?
give with food
Many clients must take what with NSAIDS and salicylates to counter the stomach irritation?
antacids and/or histamine blockers

You still should take antacids or histamine blockers to avoid stomach irritation even with the IV form of an NSAID.
Both NSAIDS and salicylates can cause what due to their anti-platelet aggregation abilities?
bleeding disorders
What effect can NSAIDS and salicylates have on the kidneys?
- both can cause vasoconstriction of the kidneys which can lead to renal damage
What can occur when a client takes salicylates in high doses?
tinnitus (ringing in the ears)
What is a nursing consideration for a client with asthma and on salicylates?
- they can cause bronchospasm with wheezing, especially in clients with asthma
Why should children who have viral infections avoid the use of salicylates?
it can lead to the potentially fatal Reye Syndrome
Edema may be caused by the use of NSAIDS. What might this lead to?

NSAIDS and Salicylates work on inflammation relatively quickly, decreasing inflammation in a few hours.
False- normally it takes days or weeks to reduce inflammation
The use of herbs (dong quai, feverfew, garlic, ginger, and ginkgo biloba) along with NSAIDS and Salicylates, can increase the risk for what?
bleeding disorders
Corticosteriods are examples of what drug class?
immunosuppressant drugs
Corticosteroids are hormonal substances produced by what?
the adrenal cortex
The levels of corticosteroids naturally in the body will rise in response to what?
physical or psychological stress
What 3 things can exogenous corticosteroids decrease?
1. decrease inflammation
2. decrease the allergic response
3. decrease the symptoms caused by an auto-immune disease
How do corticosteroids decrease inflammation?
they suppress the immune system
Corticosteroids penetrate cell membranes and bind to what?
intracellular corticosteroid receptors
The # of what is reduced in the blood when there is a higher # of corticosteroids?
The number of circulating lymphocytes, basophils, and monocytes

Phagocytosis is enhanced with the use of corticosteroids.
False- it is inhibited
What is the largest concern with the use of corticosteroids?
- the suppression of the immune system
What drug class has a mechanism of action that can predispose the body to infection, decrease the ability to fight infection, and mask the signs and symptoms of infection?
In addition to inhibiting phagocytosis, corticosteroids also inhibit the release of what 3 things?
- histamines
- leukotrienes
- prostaglandins

Corticosteroids work quickly and are very effective.
Why are corticosteroids generally only for short term use?
because they have many potentially serious adverse effects
Corticosteroids can cause what due to the inhibition of COX-1?
peptic ulcers
What are some negative effects of long-term corticosteroid treatments?
- impaired immune response
- hypernatremia
- edema
- hypertension
- hyperglycemia
- hypokalemia
- hypocalcemia
- osteoporosis
- mood swings
- weight gain
- changes in fat distribution
Why must corticosteroids be discontinued in tapering doses (5-10 days)?
to prevent adrenal insufficiency (unless they were used for a very short time or a very low does)
DMARDs (disease-modifying antirheumatic drugs) are used to treat what?
rheumatoid arthritis

DMARDs are prescription only
At what point would you use a DMARD in the treatment of rheumatoid arthritis?
when less toxic remedies have not reduced the inflammatory response adequately
What 4 classifications of drugs fall under the DMARD category?
- anti-inflammatories
- immunosuppressants
- immunomodulators
- anti-malarial drugs
Which category of DMARD are gold compounds that decrease rheumatoid factor by inhibiting phagocytosis and lysosomal activity?
Which category of DMARD is reserved for the most extreme cases of rheumatoid arthritis due to extreme adverse reactions (ex. damage to normal cells while stopping the division of abnormal cells)?
Which category of DMARD are tumor necrosis factor antagonists and typically safer for long term use?
Which category of DMARD is primarily used for malaria but used off label in the treatment of rheumatoid arthritis?
anti-malarial drugs
What are some of the side effects of the anti-inflammatory class of DMARDs?
- GI disturbances
- allergic reactions
- respiratory distress
- blood dyscrasia
Which category of DMARD is considered gold therapy?
anti-inflammatory class (these are gold compounds)
What 2 categories of DMARDs should not be used during an active infection and why?
- immunosuppressants and immunomodulators because they decrease the immune system response
_______ and _______ damage can occur with the long-term use of hydroxychloroquine, an anti-malarial drug.
retinal and corneal damage
What are 2 recommended exams for someone on long-term anti-malarial drug therapy?
baseline eye exam
periodic exams thereafter
Glucosamine and Chondroitin are OTC herbs used for the treatment of what? How do they work?
treatment of osteoarthritis, they inhibit cartilage degeneration
What does SAM-e, an OTC herb, claim to do?
improve mood and flexibility of joints
What should be monitored for clients with diabetes and taking glucosamine/chondroitin (OTC herbs)?
- blood glucose levels
It is not advisable to take SAM-e along with what?
St. John's wort or antidepressants
Gout is a condition caused by increased levels of what?
serum uric acid
What are the 2 causes of increased serum uric acid?
- increased production of uric acid
- decreased renal excretion of uric acid
How does gout develop from hyperuricemia?
deposits of crystal are made in the joints and surrounding tissue
What part of the anatomy is most greatly affected by gout?
the large toe
What is the goal of the pharmacological therapy in the treatment of gout? (4)
- decrease uric acid synthesis
- decrease inflammation
- decrease crystal deposit
- eliminate uric acid in urine
What is recommended with the use of all anti-gout drugs?
increased fluid intake
Colchicine, an anti-gout drug, can cause what negative side effect?
diarrhea (GI disturbances)