Anti-Inflammatory

Preventing Myocardial Infarctions

aspirin

Cyclooxygenase-2 Inhibitors

celecoxib

Which properties of prednisone make it a useful medication to treat chronic respiratory illnesses such as asthma?​

Duration of action is longer than other glucocorticoids

The nurse documents that client teaching has been effective when a client being discharged with a prescription for prednisolone includes which reasons for contacting their healthcare provider during the teach-back session? Select all that apply.

Fever Mood swings Dyspnea Non-healing sores Severe abdominal pain

Acetylsalicylic Acid and Clotting

1) 1 2) thromboxane A2 3) platelet

Reye's Syndrome

1) acute 2) neurologic

Treatment for Addison's Disease​

1) fludrocortisone 2) prednisone

Use the drop-down menus to select the correct words to complete these sentences.

1) increase 2) hypo

Use the drop-down menus to select the correct words to complete these sentences.

1) increase 2) immunosuppressant 3) perforation 4) fluid retention and alterations in elimination

Aspirin

1) irreversible 2) reduction 3) promotes

Aspirin Absorption and Distribution

1) small intestine 2) does 3) liver 4) kidneys

Choose the correct words to complete these sentences regarding prednisone.

1) synthetic 2) glucocorticoid 3) orally 4) intermediate-acting

Use the drop-down menus to select the words to complete the sentence.

1) under 2) loss

Corticosteroids

1) unlike 2) synthesized as needed

What is the half-life of prednisone?

18-36 hours

Antiplatelet Properties

Acetylsalicylic acid

Which nonsteroidal anti-inflammatory drug (NSAID) is administered to clients with a known risk for cardiovascular disease?

Acetylsalicylic acid

The clinic nurse is reviewing the health records of four clients who walked into the clinic after starting steroidal anti-inflammatory medications. Which client should the nurse assess first?

An older adult with diabetes mellitus type 2 and cardiovascular disease whose adult child noticed confusion

For which client should the nurse withhold a new order for prednisone, 60 mg by mouth once daily, and contact the prescribing healthcare provider?

An older adult with osteoporosis and a fractured hip

The adrenal cortex (outer layer) secretes steroids, which are responsible for which biological function?

Anti-inflammatory actions

Salicylates are used as which of the following? Select all that apply.

Antiplatelet Antipyretic Anti-inflammatory Analgesic

Which three properties do all nonsteroidal anti-inflammatory drugs (NSAIDs) share? Select that all apply.

Antipyretic Anti-inflammatory Analgesic

Which statements are true about administering aspirin to a client experiencing a myocardial infarction (MI)? Select all that apply.

Aspirin is shown to reduce cardiac death following MI. Administer aspirin at the first sign of MI.

Clients with which conditions should use aspirin with caution?

Bleeding disorders

For each effect of nonsteroidal anti-inflammatory drugs (NSAIDs) within the body, indicate if the response results from blocking the COX-1 and/or COX-2 enzyme. Each effect may be caused by both enzymes.

COX-1 Antipyretic Anti-inflammatory Protects gastric mucosa Analgesic Antiplatelet COX-2 Antipyretic Anti-inflammatory Analgesic Antiplatelet

What is the primary indication for administering low-dose acetylsalicylic acid daily?

Cardiovascular protection

The nurse is reviewing the health record of a client receiving prednisone for adrenal insufficiency and furosemide for edema. Which documented findings should the nurse report to the healthcare provider immediately? Select that all apply.

Dark, tarry stools Serum potassium 2.7 mEq/L (reference: 3.5-5.0 mEq/L) Weight increased 2.3 lb (1.04 kg) in one day

Addison's disease can result in which outcomes? Select all that apply.

Dehydration ​ Hyponatremia hyperkalemia

The nurse working in the trauma intensive care unit (ICU) is reviewing the admission orders of an older adult admitted with a left leg immobilizer and wounds to the torso, arms, legs, and feet after a motorcycle crash. Nurses in the emergency department reported that the wounds were flushed with sterile saline prior to the dressings being applied. The client's home medications include long-term use of dexamethasone tablets for an autoimmune disorder and topical cream for eczema.​ Which admission order should the nurse question?

Discontinue dexamethasone.

About Prednisone

intermediate

Complete the chart with the correct half-life for low-dose and high-dose aspirin.

low: 2-3 high: 15-30

Nonsteroidal Anti-Inflammatory Drugs

most

Place the correct response in each blank cell to complete the table.

onset: 5-30 minutes peak: 1-3 hours duration: 3-6 hours

Type of Corticosteroid

oral

Nonsteroidal Anti-Inflammatory Drugs: Adverse Effects

prostaglandins

Client Teaching

rinse their mouth

Prednisone Versus Prednisolone

solid liquid

Aldosterone is a type of corticosteroid called a mineralocorticoid mainly used for which intended outcome?

Fluid-electrolyte balance

Which instruction should the nurse include when teaching a client taking a newly prescribed steroidal anti-inflammatory drug?

Follow administration instructions carefully.

Nonsteroidal anti-inflammatory drugs (NSAIDs) should not be administered to clients with which health alterations or conditions? Select all that apply.

Gastrointestinal (GI) bleeding Acetylsalicylic acid sensitivity Second half of pregnancy

Which clinical manifestations are adverse effects of salicylates? Select all that apply.

Gastrointestinal (GI) bleeding Tinnitus Hypoglycemia

How does prednisone differ from the other three intermediate-acting glucocorticoids?

Has minimal impacts on fluid-electrolyte balance

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is indicated for which alterations in health? Select all that apply.

Headaches Rheumatoid arthritis Neuralgia

Adverse effects associated with corticosteroid administration are widespread and can occur in every body system. The most commonly seen adverse effect in hospitalized clients is what?

Hyperglycemia

The nurse preparing to admit a client brought to the emergency department with a salicylate overdose plans to assess for which clinical manifestation?

Hyperglycemia

Why is it important to taper the daily dosage of prednisone with long-term use? Select all that apply.

If stopped abruptly, adrenal suppression can result. This allows the hypothalamus, pituitary, adrenal (HPA) axis time to resume stimulation of endogenous hormone production.

The hypersecretion of cortisol will lead to which outcomes? Select all that apply.

Increase in stress effects Increase in blood pressure

For each client symptom or health alteration, indicate if it is an indication for use and/or a side effect of nonsteroidal anti-inflammatory drug (NSAID) therapy. Note: Items may be both an indication for use and a side effect.​

Indication for Use of NSAID Osteoarthritis Headache Postoperative pain Muscle pain Side effects Indigestion Headache Blurred vision

Indicate whether each of the following are or are not indications for corticosteroid use.

Indication: Adrenocortical deficiency Gastrointestinal (GI) diseases (such as ulcerative colitis) Decreased immune response following organ transplantation

What are the therapeutic effects of salicylates? Select all that apply.

Inhibits prostaglandin production Reduces thromboxane A2 formation Irreversible inhibitor of cyclooxygenase 1 (COX-1) receptors within platelets

For each drug listed, indicate if prednisone has an interaction with the drug or if it is safe to use.

Interaction: Warfarin Insulin Aspirin

Prednisone, as with all corticosteroids, is classified as a pregnancy category C drug. What does this mean?

It can be secreted in breast milk and should be used cautiously.

To which class of medications do salicylates belong?

NSAIDS

By which routes can salicylates be administered? Select all that apply.

Oral Rectal

The nurse caring for a client taking prednisone knows that it can exacerbate, worsen, or precipitate which conditions? Select all that apply.

Peptic ulcer disease Infection Glaucoma Cardiac disease

Which medication is the most commonly used oral systemic synthetic corticosteroid?

Prednisone

Why should prednisone be used cautiously with immunocompromised individuals?

Prednisone is an immunosuppressant.

For each medication class listed, indicate the drug-to-drug indication that can occur when given with a nonsteroidal anti-inflammatory drug (NSAID). Note: Some medication classes may be associated with more than one drug-to-drug interaction.

Prolonged Bleeding Time Anticoagulants Cephalosporins Thrombolytic agents Salicylates Increased Gastrointestinal Side Effects Salicylates Decreased Medication Effectiveness Salicylates Diuretics Antihypertensives

Which indications for use are common for all nonsteroidal anti-inflammatory drugs (NSAIDs)? Select all that apply.

Reduce fevers Relieve pain Block inflammation

A client allergic to which class of medications is highly likely to have a cross-sensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs)?

Salicylates

The nurse caring for a client taking prescribed steroidal anti-inflammatory medications for 2 days should monitor for changes in which serum laboratory values? Select all that apply.

Sodium Potassium Thyroxine (T4) Calcium White blood cells (WBC)

Cortisol may inhibit or control the inflammatory response by which actions? Select all that apply.

Stabilizing inflammatory cell membranes Decreasing white blood cell migration to the inflamed areas Decreasing capillary permeability to the inflammatory cells

When teaching a client about cortisol, the nurse should include information on which factors that increase cortisol levels? Select all that apply.

Surgery Physiologic stress Trauma Emotional stress

Which terms describe prednisone? Select all that apply.

Systemic glucocorticoid Intermediate-acting glucocorticoid Synthetic glucocorticoid

What information should the nurse include when teaching a client with asthma being discharged with a prescription for prednisone? Select that all apply.

The medicine may interfere with sleep, so take the dose at the same time each morning.

Aspirin is commonly used to prevent which conditions? Select all that apply.

Transient ischemic attacks (TIA) Cerebral vascular accident (CVA or stroke) Myocardial infarction (MI)

Which are generic glucocorticoids? Select all that apply.

Triamcinolone Hydrocortisone Methylprednisolone Prednisolone

Expected Outcomes

an improved body image

Production of Exogenous Hormones

suppression

The nurse is providing education to a client who has been prescribed prednisone. Which statement by the client indicates a need for further teaching?

"I can stop taking prednisone as soon as I feel better."

Which client should not receive aspirin?

8-year-old with influenza

Which client is the most at risk for developing adrenal suppression and subsequent hypoadrenal crisis if this dose is stopped abruptly?

A client taking prednisone 50 mg/day for the last 3 months

Which statements are true about prednisone? Select all that apply.

A glucocorticoid (a type of corticosteroid) with mainly anti-inflammatory and immunosuppressant effects​ Has systemic effects Has minimal fluid and electrolyte balance effects (mineralocorticoid activity)​ Is administered orally ​ A corticosteroid, similar to the type of hormone also produced by the adrenal cortex (outer layer of the adrenal gland)

Choose the types of medications that should be used cautiously with prednisone and match them to the associated reason for this caution.

Used in combination with glucocorticoids, they can result in excessive anticoagulation. Blood thinners/anticoagulants Increase the half-life of adrenal drugs. Oral contraceptives Additive gastrointestinal effects and an increased chance for gastric ulcer development. Nonsteroidal anti-inflammatory and other ulcerogenic drugs Reduction in hypoglycemic effects, elevated blood glucose levels, thyroid hormones, and antifungal drugs; can decrease renal clearance of the adrenal drug. Antidiabetic drugs Prednisone, as with all corticosteroids, has immunosuppressant effects. This makes it easier to get an infection or for a current infection to worsen, so prednisone should be used cautiously in clients who are already immunosuppressed. Immunosuppressants

Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided with which medications? Select all that apply.

Warfarin Antiplatelet agents

Which statements are true regarding long-term use of prednisone? Select all that apply.

When discontinuing prednisone therapy, the dosage should be tapered slowly to allow the body time to resume secretion of endogenous hormone. A client is at increased risk of developing hypoadrenal crisis if long-term prednisone use is stopped abruptly. Clients on chronic prednisone therapy who undergo surgery may need additional steroids.

While teaching a client about a newly prescribed steroidal anti-inflammatory medication, the nurse should include which reasons to not stop taking the medication abruptly? Select all that apply.

While taking the medication, the body produces fewer glucocorticoids. Gastrointestinal (GI) upset may occur. The body needs time to begin producing the hormones again. Life-threatening adrenal suppression may occur.

Glucocorticoids

adrenal insufficiencies

Glucocorticoid Medications

early in the morning

Which are the most common adverse effects of corticosteroid drugs?

hyperglycemia fluid retention hypertension gastric ulcers weight gain