Pharmacology In Nursing - Module 10

Front 1

(def)

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

Back 1

Inflammation

Front 2

True/False:

It is possible to have inflammation without infection or injury

Back 2

True

Front 3

What 3 processes make up the inflammatory response?

Back 3

1. vasodilation
2. increased vascular permeability
3. migration of WBCs to the inflamed area

Front 4

What are the 5 cardinal signs of inflammation?

Back 4

1. redness
2. increased warmth
3. swelling
4. pain
5. varying degrees of loss of function in that area

Front 5

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?

Back 5

Mast cells- these cells release biochemical mediators such as histamines, leukotrienes and prostaglandins

Front 6

What are the 3 types of drugs used to treat inflammation?

Back 6

1. anti-inflammatories
2. immunosuppressants
3. immunomodulators

Front 7

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)?

Back 7

1. anti-inflammatories
2. immunosuppressants
3. immunomodulators

Front 8

True/False:

Certain drugs that treat inflammatory conditions have antipyretic effects.

Back 8

True

Front 9

True/False:

Acetaminophen is considered an anti-inflammatory drug.

Back 9

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.

Front 10

What are the 2 primary uses for acetaminophen?

Back 10

antipyretic
analgesic

Front 11

Salicylates and NSAIDS are classifications of ___________ drugs.

Back 11

anti-inflammatory

Front 12

How do salicylates and NSAIDS exert their action?

Back 12

they inhibit prostaglandin

Front 13

Prostaglandins are converted from arachidonic acid by the enzyme __________.

Back 13

cyclooxygenase (COX)

Front 14

What are the 2 forms of COX.

Back 14

COX-1 and COX-2

Front 15

Which enzyme, COX-1 or COX-2, is most actively involved in prostaglandin formation at the site of inflammation?

Back 15

COX-2

Front 16

What is the goal of the pharmacological therapy with agents such as salicylates and NSAIDS (anti-inflammatory)?

Back 16

to inhibit COX

Front 17

Salicylates and most NSAIDS inhibit COX-1, COX-2, or both?

Back 17

both

Front 18

True/False:

There is one NSAID that selectively inhibis COX-2.

Back 18

true

Front 19

What is the problem with the inhibition of COX-1?

Back 19

can leads to bleeding disorders through anti-platelet aggregation

Front 20

_______ (COX-1 or COX-2) is protective of the stomach lining.

Back 20

COX-1

Front 21

Drugs that inhibit _________ are more likely to cause gastric irritation with bleeding; especially in the elderly.

Back 21

COX-1

Front 22

What is the advantage of selective COX-2 inhibitors?

Back 22

they decrease the incidence of bleeding disorders

Front 23

COX-2 selective inhibitors have been implicated in what negative disorders?

Back 23

increased incidence of cardiac disorders and strokes due to edema and hypertension

Front 24

Why were rofecoxib and valdecoxib, COX-2 selective inhibitors, taken off the market by the FDA?

Back 24

because there was an increase in cardiac disorders and strokes associated with these drugs

Front 25

What is the primary use for aspirin?

Back 25

used for anti-platelet aggregation in heart disease

Front 26

What specific consideration should be known about ketorolac, a potent NSAID?

Back 26

- 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

Front 27

What can be caused by both NSAIDS and salicylates due to the inhibition of COX-1?

Back 27

Peptic Ulcers

Front 28

What should be done to avoid stomach irritation with NSAIDS and salicylates?

Back 28

give with food

Front 29

Many clients must take what with NSAIDS and salicylates to counter the stomach irritation?

Back 29

antacids and/or histamine blockers

Front 30

True/False:

You still should take antacids or histamine blockers to avoid stomach irritation even with the IV form of an NSAID.

Back 30

True

Front 31

Both NSAIDS and salicylates can cause what due to their anti-platelet aggregation abilities?

Back 31

bleeding disorders

Front 32

What effect can NSAIDS and salicylates have on the kidneys?

Back 32

- both can cause vasoconstriction of the kidneys which can lead to renal damage

Front 33

What can occur when a client takes salicylates in high doses?

Back 33

tinnitus (ringing in the ears)

Front 34

What is a nursing consideration for a client with asthma and on salicylates?

Back 34

- they can cause bronchospasm with wheezing, especially in clients with asthma

Front 35

Why should children who have viral infections avoid the use of salicylates?

Back 35

it can lead to the potentially fatal Reye Syndrome

Front 36

Edema may be caused by the use of NSAIDS. What might this lead to?

Back 36

hypertension

Front 37

True/False:

NSAIDS and Salicylates work on inflammation relatively quickly, decreasing inflammation in a few hours.

Back 37

False- normally it takes days or weeks to reduce inflammation

Front 38

The use of herbs (dong quai, feverfew, garlic, ginger, and ginkgo biloba) along with NSAIDS and Salicylates, can increase the risk for what?

Back 38

bleeding disorders

Front 39

Corticosteriods are examples of what drug class?

Back 39

immunosuppressant drugs

Front 40

Corticosteroids are hormonal substances produced by what?

Back 40

the adrenal cortex

Front 41

The levels of corticosteroids naturally in the body will rise in response to what?

Back 41

physical or psychological stress

Front 42

What 3 things can exogenous corticosteroids decrease?

Back 42

1. decrease inflammation
2. decrease the allergic response
3. decrease the symptoms caused by an auto-immune disease

Front 43

How do corticosteroids decrease inflammation?

Back 43

they suppress the immune system

Front 44

Corticosteroids penetrate cell membranes and bind to what?

Back 44

intracellular corticosteroid receptors

Front 45

The # of what is reduced in the blood when there is a higher # of corticosteroids?

Back 45

The number of circulating lymphocytes, basophils, and monocytes

Front 46

True/False:

Phagocytosis is enhanced with the use of corticosteroids.

Back 46

False- it is inhibited

Front 47

What is the largest concern with the use of corticosteroids?

Back 47

- the suppression of the immune system

Front 48

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?

Back 48

corticosteroids

Front 49

In addition to inhibiting phagocytosis, corticosteroids also inhibit the release of what 3 things?

Back 49

- histamines
- leukotrienes
- prostaglandins

Front 50

True/False:

Corticosteroids work quickly and are very effective.

Back 50

True

Front 51

Why are corticosteroids generally only for short term use?

Back 51

because they have many potentially serious adverse effects

Front 52

Corticosteroids can cause what due to the inhibition of COX-1?

Back 52

peptic ulcers

Front 53

What are some negative effects of long-term corticosteroid treatments?

Back 53

- impaired immune response
- hypernatremia
- edema
- hypertension
- hyperglycemia
- hypokalemia
- hypocalcemia
- osteoporosis
- mood swings
- weight gain
- changes in fat distribution

Front 54

Why must corticosteroids be discontinued in tapering doses (5-10 days)?

Back 54

to prevent adrenal insufficiency (unless they were used for a very short time or a very low does)

Front 55

DMARDs (disease-modifying antirheumatic drugs) are used to treat what?

Back 55

rheumatoid arthritis

Front 56

True/False:

DMARDs are prescription only

Back 56

True

Front 57

At what point would you use a DMARD in the treatment of rheumatoid arthritis?

Back 57

when less toxic remedies have not reduced the inflammatory response adequately

Front 58

What 4 classifications of drugs fall under the DMARD category?

Back 58

- anti-inflammatories
- immunosuppressants
- immunomodulators
- anti-malarial drugs

Front 59

Which category of DMARD are gold compounds that decrease rheumatoid factor by inhibiting phagocytosis and lysosomal activity?

Back 59

anti-inflammatories

Front 60

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)?

Back 60

immunosuppressants

Front 61

Which category of DMARD are tumor necrosis factor antagonists and typically safer for long term use?

Back 61

immunomodulators

Front 62

Which category of DMARD is primarily used for malaria but used off label in the treatment of rheumatoid arthritis?

Back 62

anti-malarial drugs

Front 63

What are some of the side effects of the anti-inflammatory class of DMARDs?

Back 63

- GI disturbances
- allergic reactions
- respiratory distress
- blood dyscrasia

Front 64

Which category of DMARD is considered gold therapy?

Back 64

anti-inflammatory class (these are gold compounds)

Front 65

What 2 categories of DMARDs should not be used during an active infection and why?

Back 65

- immunosuppressants and immunomodulators because they decrease the immune system response

Front 66

_______ and _______ damage can occur with the long-term use of hydroxychloroquine, an anti-malarial drug.

Back 66

retinal and corneal damage

Front 67

What are 2 recommended exams for someone on long-term anti-malarial drug therapy?

Back 67

baseline eye exam
periodic exams thereafter

Front 68

Glucosamine and Chondroitin are OTC herbs used for the treatment of what? How do they work?

Back 68

treatment of osteoarthritis, they inhibit cartilage degeneration

Front 69

What does SAM-e, an OTC herb, claim to do?

Back 69

improve mood and flexibility of joints

Front 70

What should be monitored for clients with diabetes and taking glucosamine/chondroitin (OTC herbs)?

Back 70

- blood glucose levels

Front 71

It is not advisable to take SAM-e along with what?

Back 71

St. John's wort or antidepressants

Front 72

Gout is a condition caused by increased levels of what?

Back 72

serum uric acid

Front 73

What are the 2 causes of increased serum uric acid?

Back 73

- increased production of uric acid
- decreased renal excretion of uric acid

Front 74

How does gout develop from hyperuricemia?

Back 74

deposits of crystal are made in the joints and surrounding tissue

Front 75

What part of the anatomy is most greatly affected by gout?

Back 75

the large toe

Front 76

What is the goal of the pharmacological therapy in the treatment of gout? (4)

Back 76

- decrease uric acid synthesis
- decrease inflammation
- decrease crystal deposit
- eliminate uric acid in urine

Front 77

What is recommended with the use of all anti-gout drugs?

Back 77

increased fluid intake

Front 78

Colchicine, an anti-gout drug, can cause what negative side effect?

Back 78

diarrhea (GI disturbances)