Pharm Ch. 16

How should the nurse counsel a client concerning a new prescription for celecoxib and its affect on long-standing low-dose acetylsalicylic acid therapy?

"Continue both therapies as prescribed."

A female client asks why she must consult with the health care provider when she uses cold products for her children. What is the nurse's best response?

"There is a risk of overdose, because acetaminophen is a very common ingredient in OTC cold, flu, fever, and pain remedies."

Ketorolac (Toradol)

*class*: nonsteroidal anti-inflammatory agents, nonopioid analgesics *Indication* pain *Action*: Pain relief due to prostaglandin inhibition *Nursing Considerations*: -may cause GI bleeding, Stevens-Johnson Syndrome, anaphylaxis, drowsiness - should not exceed 5 days of therapy - bleeding risk increased with garlic, ginger, and ginkgo - may decrease effectiveness of hypertensive medications and diuretics

low dose aspirin

81 mg, prevents rick of death and MI with pt with MI history

rheumatoid arthritis

A chronic systemic disease characterized by inflammation of the joints, stiffness, pain, and swelling that results in crippling deformities

Which client is at highest risk for developing hepatotoxicity related to the use of acetaminophen?

A male 30 years of age who drinks four beers per day

A woman who is in the second trimester of her first pregnancy has been experiencing frequent headaches and has sought advice from her nurse practitioner about safe treatment options. What analgesic can the nurse most safely recommend?

Acetaminophen

Which agent would be least appropriate to administer to a client with joint inflammation and pain?

Acetaminophen

A client with acute joint inflammation tells the nurse , "I've been taking acetaminophen as it's ordered on the bottle, but my swelling and inflammation doesn't seem to be getting better." What should the nurse teach the client?

Acetaminophen has no effect on inflammation."

Acetaminophen actions

Acts directly on the hypothalamus to cause vasodilation and sweating, which will reduce fever; mechanism of action as an analgesic is not understood.

An adult client has been admitted to the emergency department after deliberately overdosing on approximately 50 grams of acetaminophen. The nurse should prepare for what intervention?

Administration of acetylcysteine as prescribed

Methotrexate

Antineoplastic- (DMARD)

A male 16 years of age presents to the health care provider's office with nausea, vomiting, and pain in the right upper quadrant. He states he has had flu-like symptoms for four to five days. What is the most appropriate action of the nurse?

Ask for a medication history.

A healthcare provider has recommended the use of acetaminophen to treat the client's pain. What should the nurse teach the client about safe and effective use of acetaminophen?

Avoid taking more than 3000 mg in any 24-hour period

A patient with arthritis is on nonsteroidal anti-inflammatory drug (NSAID) therapy. What should be evaluated by the nurse to determine the effectiveness of NSAID therapy?

Better mobility

A client is receiving anakinra as treatment for arthritis. The nurse understands that this drug acts in which manner?

Blocks interleukin-1

NSAIDs block what?

COX-1 and COX-2 (involved in blood clotting, protecting the stomach lining, & maintaining sodium and water balance in kidney

nonsteroidal anti-inflammatory drugs black box warning

CV and GI risks

A student nurse asks the nurse why acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) help to reduce cancer pain. What is the nurse's best explanation?

Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment. These drugs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation.

A client's history reveals an allergy to sulfonamides. The nurse understands that which drug would be contraindicated?

Celecoxib

Avoid ________________ if have history of chinese hamster ovary products because its made from these products

Etanercept (TNF blocker)

True/False Gold compounds are commonly used as first-line therapy for the treatment of rheumatoid arthritis.

False

African Americans have increased risk of developing ___________ and higher doses need to be used, increasing the risk for ___________

GI adverse effects, adverse effects

NSAIDs are most associated with

GI irritation and bleeding

Auranofin

Gold compound- rheumatoid arthritis actions: taken up by macrophages, which inhibits phagocytosis & release of lysosomal enzymes that cause damage assoc. w/ inflammation adverse effects: bone marrow suppression, renal toxicity, dermatitis, nausea, vomiting, stomatitis

The nurse is administering chrysotherapy to a patient with rheumatoid arthritis. What drug will the nurse be administering?

Gold salts

Anakinra

IL-1 receptor antagonist - SubCu injections. often used in combination with other antiarthritis drugs

What conditions are salicylates are effective in managing?

Inflammation, fever, pain

What would be appropriate to use in combination with gold salts?

Low-dose corticosteroids

A nurse suspects that a client is experiencing 274. What would the nurse assess for?

Mental confusion

Ibuprofen indications

NSAID- treatment of pain, arthritis, dysmenorrhea, juvenile arthritis

block inflammation before all signs and symptoms can develop.

NSAIDS

An 8-year-old child is experiencing pain following tonsillectomy. Which drug would be an appropriate pain reliever for this client?

Nonsalicylates

Naproxen indications

Pain, joint conditions, fever, dysmenorrhea

In which children or teenagers is the use of salicylates, particularly aspirin, contraindicated because their use appears to be associated with Reye syndrome?

Patients with chickenpox

Antiarthritis Agents

Prevent and suppress arthritis in selected patients with rheumatoid arthritis

Acetaminophen adverse effects

Rash, fever, chest pain, liver toxicity and failure, bone marrow suppression.

A 15-year-old client is brought to the emergency department by his friends. He reports visual changes, drowsiness, and tinnitus. He is confused and hyperventilating. These symptoms may be attributable to which condition?

Salicylate intoxication

(aspirin) -- extracted from willow bark

Salicylates

After teaching a group of students about disease-modifying antirheumatic drugs, the instructor determines that the students need additional teaching when they identify which as an example?

Sulindac

The nurse would question the health care provider who prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) for which client?

The client diagnosed with peptic ulcers

The client has been prescribed one aspirin a day. The nurse understands that is prescribed for which of the following?

To inhibit platelet aggregation

T/F Because many anti-inflammatory drugs are available OTC, the potential for abuse and overdosing is increased.

True

T/F If one NSAID doesnt work, another might; depends on the pt.

True

The nurse is checking the orders for pain management for a client that had coronary surgery 24 hours ago. The nurse identifies that the client has been receiving Celebrex and a narcotic postoperatively for pain management. What is the most appropriate response of the nurse?

Withhold the Celebrex and notify the health care provider.

A group of nursing students are reviewing information about nonopioid analgesics. The students demonstrate understanding of the information when they identify which drug as a nonsalicylate analgesic?

acetaminophen

Causes vasodilation and heat release, lowering fever and working to relieve pain.

acetaminophen

Salicylates can cause

acidosis and 8th cranial nerve damage

A nurse is assigned to care for a patient with arthritis in a health care facility. The patient has been prescribed celecoxib. Celecoxib is contraindicated in clients with:

allergy to sulfonamides.

While providing client teaching relative to inflammatory disorders, the nurse would explain the presence of inflammation as:

an attempt by the body to remove the damaging agent and repair the damaged tissue.

The nursing student demonstrates understanding when choosing what as the effect of a salicylate?

analgesic effect, antipyretic effect, anti-inflammatory effect

Corticosteroids

anti-inflammatory agents that treat skin inflammation

African Americans have a documented decreased sensitivity to the pain-relieving effects of ...

anti-inflammatory drugs

A nurse is aware that a client prescribed meloxicam is most likely being treated for what health problem?

arthritis

A nurse is reviewing the medical record of a client who is prescribed nonsteroidal anti-inflammatory drug (NSAID) therapy. The nurse determines that the drug would be contraindicated for the client if a hypersensitivity to which drug was found?

aspirin

Prior to administering NSAIDs, the nurse asks the client about an allergy to:

aspirin.

antipyretic

blocking fever, often by direct effects on the thermoregulatory center in the hypothalamus or by blockade of prostaglandin mediators

Antihistamines

blocks the action of histamine and helps prevent symptoms of allergy

TNF contraindications

cannot be used in anyone with an acute infection, cancer, sepsis, tb, hepatitis, myelosuppression or demyelinating disorders becaue they block the immune/inflammatory response and serious reactions could occur.

A nurse is reviewing a journal article about a nonsteroidal anti-inflammatory drug (NSAID) that is associated with an increased risk of cardiovascular thrombosis, myocardial infarction, and stroke. The nurse is most likely reading about which drug?

celecoxib

pharmacokinetics of antiarthritis agents

cencentrated in the hypothalamic-pituitary-adrenocortical system. teratogenic, 2nd BC needed if using.

Analgesic

compounds with pain-blocking properties, capable of producing analgesia

adverse effects of salicylates

direct stomach effects, bleeding abnormalities, salicylism--ear ringing, mental confusion, hyperpnea, tachypnea, hemmorrhage, convulsions, tetany, coma, eighth cranial nerve stimulation.

DMARD

disease-modifying antirheumatic drug

nonsteroidal anti-inflammatory drugs (NSAIDs)

drugs that block prostaglandin synthesis and act as anti-inflammatory, antipyretic, and analgesic agents

Anti-inflammatory agents

drugs that block the effects of the inflammatory response

The nurse administering ibuprofen should assess an adult client for which potential symptoms?

fever, pain, moderate pain

A client is admitted to the emergency department with suspect salicylism. The client's plasma salicylate level is 300 mcg/mL. Which sign/symptom would the nurse expect to assess?

flushing, headache, thirst

anti-inflammatory, analgesic, & antipyretic effects of NSAIDS are related to

inhibition of prostaglandin synthesis.

tumor necrosis factor

involved in the inflammation of autoimmune diseases

Adverse effects of DMARDs

irritation at injection site, pain with injection, potential fatal hepatic toxicity and rashes, bone marrow suppression, hypersensitivity, lymphomas and cancer

contraindications with salicylates

known allergies, bleeding abnormalities, impaired renal function, chickenpox, surgery (within 1 wk), preg/lactation

Contraindications of gold compounds

known allergies, severe diabetes, CHF, severe debilitation, renal/hepatic impairment, hypertension, blood dyscrasias, recent radiation treatment, history of toxic level of heavy metals, preggo

A client with mild low back pain has been advised to take acetaminophen. The nurse teaching the client about this medication would include that excessive intake of acetaminophen may result in which?

liver damage.

Acetaminophen causes

liver failure

Gold salts prevent

macrophage phagocytosis, lysosomal release, and tissue damage

therapeutic effects of salicylates

mild to moderate pain, fever, inflammatory conditions (rheumatoid arthritis/osteoarthritis

The client has been prescribed celecoxib. Which are adverse reactions related to the use of celecoxib?

oliguria, neutropenia, rhinitis, stomatitis

Acetaminophen (Tylenol)

pain, fever

Reye's syndrome

potentially serious or deadly disorder in children that is characterized by vomiting and confusion

chrysotherapy does not repair damage, but they....

prevent further damage and most effective if used early in the disease

Salicylates block

prostaglandin activity while NSAIDS block prostaglandin synthesis

COX-1

protects stomach lining and regulates blood platelets

TNF black box warning

risk of serious infections and development of lymphoma and other cancers

A patient enters the emergency room with reports of visual changes, drowsiness, and tinnitus. The patient is confused and hyperventilating. These symptoms may be attributable to:

salicylate intoxication.

Salicylates

salicylic acid compounds, used as anti-inflammatory, antipyretic, and analgesic agents; they block the prostaglandin system

A nurse is preparing to teach a client about the adverse effects of prescribed nonsteroidal anti-inflammatory drug (NSAID) therapy. The nurse plans to focus on the most common adverse reactions caused by this group of drugs. Which effects would the nurse include as being involved?

stomach

adverse effects of gold compounds

stomatitis, glossitis, gingivitis, pharyngitis, laryngitis, colitis, diarrhea, GI inflammation, gold bronchitis & interstitial pneumonitis, bone marrow depression, vaginitis & nephrotic syndrome

Salicylism

syndrome associated with high levels of salicylates—dizziness, ringing in the ears, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude

inflammatory response

the body's nonspecific response to cell injury, resulting in pain, swelling, heat, and redness in the affected area

DMARDs affect

the immune response to slow inflammation and joint damage. they are assoc. w/ potentially fatal injections and the development os cancers

DMARDs alter the course of..

the inflammatory process and treat arthritis by aggressively affecting the process of inflammation

chrysotherapy

treatment with gold salts; gold is taken up by macrophages, which then inhibit phagocytosis; it is reserved for use in patients who are unresponsive to conventional therapy, and can be very toxic

disease-modifying antirheumatic drugs (DMARDs)

treats arthritis and aggressively affect the process of inflammation

COX-2

triggers inflammation and pain

Anti-inflammatory agents block

various chemicals assoc. with inflammatory reaction

A client asks the nurse about herbal products that might provide the same effects as aspirin. Which product would the nurse identify?

willow bark