EDAPT: Anti-Inflammatory

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

Acetylsalicylic acid directly affects cyclooxygenase- (COX-) _____ decreasing the formation of __________ leading to a decrease in __________ aggregation.

1 Thromboxane A2 Platelet

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 client taking a newly ordered glucocorticoid medication asks the nurse why it must be taken at a specific time each day. The nurse explains that this type of medication is best taken __________ since this is the time when the body produces the greatest amount of these hormones.

Early in the morning

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 Dyspnea Non-healing sores Mood swings Severe abdominal pain

What is the half-life of prednisone?

18-36 hours

A client at high risk for an embolic stroke tells the nurse that they are starting a new medication to decrease blood clotting but cannot recall the name. When asked to name the drug, which answer provided by the nurse is best?

Acetylsalicylic acid

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

Acetylsalicylic acid

__________ may also be used for its antiplatelet properties.

Acetylsalicylic acid

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

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

Reye's syndrome is a(n) __________ and potentially life-threatening condition that can cause progressive and possibly permanent __________ damage.

Acute Neurologic

Unlike other glucocorticoids, prednisone has minimal impact on __________.

Adrenal insufficiencies

A client on long-term steroidal anti-inflammatory therapy tells the nurse that they hate "moon face" changes, so they have stopped leaving the house. The most appropriate outcome of care is that the client will experience __________.

An improved body image

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.

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

Analgesic Anti-inflammatory Antipyretic

Drug-to-drug interactions of ibuprofen may decrease the effects of which medications? Select all that apply.

Angiotensin-converting enzyme (ACE) inhibitors Diuretics Anti-platelet effect of low-dose aspirin Antihypertensives

The nurse confirms that a client taking a nonsteroidal anti-inflammatory drug (NSAID) for the first time understands its therapeutic uses when they mention which actions of the medication? Select all that apply.

Anti-inflammatory Analgesic Antipyretic

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 Anti-inflammatory Analgesic Antipyretic

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

Antiplatelet agents Warfarin

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

Antipyretic Analgesia Anti-inflammatory

__________ is commonly used to prevent myocardial infarctions and transient ischemic attacks.

Aspirin

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

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

Cardiac disease Peptic ulcer disease Infection Glaucoma

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

Cardiovascular protection

Within the nonsteroidal anti-inflammatory drugs (NSAIDs) class of medications, the only COX-2 specific inhibitor is __________.

Celecoxib

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.

The nurse is caring for a client who has just been diagnosed with Addison's disease. The nurse understands that the mineralocorticoid __________ and a glucocorticoid __________ will likely be prescribed.

Fludrocortisone Prednisone

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.

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

Gastrointestinal (GI) bleeding Hypoglycemia Tinnitus

When taken orally, the __________ absorbs __________ of ibuprofen, as compared to __________ absorption when administered intravenously (IV). Once in the body, ibuprofen is metabolized by the __________ and excreted through the __________.

Gastrointestinal (GI) tract 80% 100% Liver Kidneys

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

Has minimal impacts on fluid-electrolyte balance.

Which are generic glucocorticoids? Select all that apply.

Hydrocortisone Methylprednisolone Prednisolone Triamcinolone

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

Which are the most common adverse effects of corticosteroid drugs?

Hyperglycemia Fluid retention Hypertension Gastric ulcers Weight gain

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

Hyperkalemia Hyponatremia Dehydration ​

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.

Taking ibuprofen with aspirin, oral potassium, other nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or alcohol will __________ gastrointestinal (GI) effects.

Increase

Systemically administered corticosteroids can interact with many drugs. Based on your knowledge of a corticosteroid's mechanism of action, caution should be used when a client is also taking a non-potassium-sparing loop diuretic, because both drug classes can result in an __________ in the excretion of potassium and other electrolytes in the urine and can lead to severe __________kalemia.

Increase Hypo

Use corticosteroids cautiously in clients with diabetes mellitus as they may __________ blood glucose levels. Use of corticosteroids is often avoided in the presence of serious infection such as septicemia, systemic fungal infections, and varicella because these drugs have __________ properties. Use corticosteroids cautiously when treating clients with gastritis, reflux disease, or ulcer disease, because these drugs can potentially cause gastric __________. Use corticosteroids cautiously in clients with cardiac, renal, and/or liver dysfunction, because these drugs can potentially cause __________.

Increase Immunosuppressant Perforation Fluid retention and alterations in elimination

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

Increase in stress effects Increase in blood pressure

A client taking ibuprofen for osteoarthritis mentions having four (4) alcoholic drinks per day. Based on this information, the nurse should teach the client about which risk of drinking alcohol while taking ibuprofen?

Increased risk of gastrointestinal (GI) bleeding

Ibuprofen works by __________ prostaglandin synthesis, thereby reducing pain, inflammation, and fever.

Inhibiting

What is the main action of ibuprofen?

Inhibiting prostaglandin synthesis

Prednisone is a(n) __________ acting systemic glucocorticoid with a half-life of 18-36 hours.

Intermediate

What are the available routes of administration for ibuprofen? Select all that apply.

Intravenous Oral

Aspirin is a(n) __________ inhibitor of cyclooxygenase 1 (COX-1) receptors within the platelets themselves. It causes a(n) __________ in the formation of thromboxane A2, a substance that normally __________ platelet aggregation.

Irreversible Reduction Promotes

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.

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

Low-dose: 2-3 hours High-dose: 15-30 hours

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the __________ commonly prescribed drugs on the market.

Most

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

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

Complete the chart with the correct half-life for ibuprofen in neonates, children, and adults.

Neonates: 26-43 hours Children: 1-2 hours Adults: 2-4 hours

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

Neuralgia Headaches Rheumatoid arthritis

In which class of medications do propionic acid derivatives belong?

Nonsteroidal anti-inflammatory (NSAIDs)

To which class of medications do salicylates belong?

Nonsteroidal anti-inflammatory (NSAIDs)

Prednisone is the most commonly prescribed __________ corticosteroid.

Oral

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

Physiologic stress Emotional stress Surgery Trauma

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.

Nonsteroidal anti-inflammatory drug (NSAID) side effects (e.g., protecting gastric mucosa, decreasing platelet aggregation, and vasoconstriction) are due to the inactivation of cyclooxygenase-1 and 2 resulting in the loss of the protective properties of __________.

Prostaglandins

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

Rectal Oral

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

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

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

Relieve pain Block inflammation Reduce fevers

The nurse is reviewing the health record of a healthy older adult scheduled to visit the clinic the next day. The client's only medication is daily ibuprofen, 2,400 mg in three divided doses for rheumatoid arthritis. Based on this assessment, which laboratory tests should the nurse anticipate being ordered?

Renal function studies

The nurse administering an inhaled glucocorticoid drug should encourage the client to __________ afterwards.

Rinse their mouth

Complete the chart with the onset, peak, and duration for ibuprofen PO and IV routes.

Route: PO Onset: 0.5-2.5 hours Peak: 1-4 hours Duration: 4-8 hours Route: IV Onset: 0-2 hours Peak: 10-12 hours Duration: 4-6 hours

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

Route: PO Onset: 5-30 minutes Peak: 1-3 hours Duration: 3-6 hours

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

Salicylates

An adult who started taking ibuprofen for a sprained ankle notifies the nurse at the doctor's office of the clinical manifestations below. After hearing that the client's symptoms started 12 hours before the call, the nurse determines that which two side effects do not require emergency intervention? Select that all apply.

Slow mental processing Loose, watery stools

Aspirin is absorbed from the upper __________. It is distributed quickly and __________cross the placenta in pregnant women. Aspirin is metabolized by the __________and excreted by the __________.

Small intestine Does Liver Kidney

Prednisone is a __________ corticosteroid. Prednisolone is the __________ form of prednisone, converted by the liver.

Solid Liquid

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

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

A client is prescribed celecoxib. Review the client's health record and select the documented findings that should prevent the client from receiving this medication. Melissa (pronouns: she/her/hers) is a 78-year-old female admitted with pneumonia. She has a history of chronic obstructive pulmonary disease (COPD) and has been a smoker for 25 years. She has allergies to sulfa, codeine, and pollen.

Sulfa

When exogenous glucocorticoids are administered, the body stops producing exogenous hormones. Therefore, if the exogenous hormones are stopped abruptly, adrenal __________ will result.

Suppression

Prednisone is a __________ corticosteroid. Prednisone is a __________, one type of corticosteroid. Prednisone is only administered __________. Prednisone is a(n) __________ medication, which refers to its duration of action.

Synthetic Glucocorticoid Orally Intermediate-acting

Which terms describe prednisone? Select all that apply.

Synthetic glucocorticoid Systemic glucocorticoid Intermediate-acting 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.

The __________ of ibuprofen include analgesia, anti-inflammatory, and antipyretic.

Therapeutic effects

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.

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

Addison's disease is caused by the __________ secretion of adrenocortical hormone, causing symptoms such as weight __________, for which steroidal anti-inflammatory drugs are used for treatment.

Under Loss

__________ other hormones, corticosteroids are __________.

Unlike Synthesized as needed

Select whether each item is either an indication for use or a contraindication for ibuprofen by dragging it to the correct column.

*Indications:* Antipyretic action Osteoarthritis Musculoskeletal disorders Dysmenorrhea *Contraindications:* Severe heart failure Congenital heart disease Phenylketonuria

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

*Interaction:* Warfarin Insulin Aspirin​ *Safe to Use:* Ampicillin​

Which clients should not receive ibuprofen? Select all that apply.

A middle-aged adult who smokes and has bleeding gastric ulcers A teen living with phenylketonuria A 2-month-old with a temperature of 102.9 °F (39.4 °C)

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 Effect of NSAID:* Indigestion Headache Blurred vision

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."

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

*Blood thinners/anticoagulants* - Used in combination with glucocorticoids, they can result in excessive anticoagulation. *Oral contraceptives* - Increase the half-life of adrenal drugs. *Nonsteroidal anti-inflammatory and other ulcerogenic drugs* - Additive gastrointestinal effects and an increased chance for gastric ulcer development. *Antidiabetic drugs* - Reduction in hypoglycemic effects, elevated blood glucose levels, thyroid hormones, and antifungal drugs; can decrease renal clearance of the adrenal drug. *Immunosuppressants* - 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.

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

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

*Indication for Use:* • Adrenocortical deficiency • Gastrointestinal (GI) diseases (such as ulcerative colitis) • Decreased immune response following organ transplantation *Not an Indication for Use:* • Type II diabetes • Parkinson's disease

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

The nurse should contact the prescribing healthcare provider before administering naproxen to a client who is already taking which medication?

Warfarin

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.

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

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. Clients on chronic prednisone therapy who undergo surgery may need additional steroids. A client is at increased risk of developing hypoadrenal crisis if long-term prednisone use is stopped abruptly.

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.