Pharm - Chapter 44 - Antiinflammatory and Antigout Drugs

A patient is prescribed celecoxib for the treatment of rheumatoid arthritis. Which instruction does the nurse give to the patient for safe administration of the drug? 1 "Take the drug after a meal." 2 "Take the drug with caffeine." 3 "Avoid taking the drug with fluid." 4 "Take the drug on an empty stomach."

1 "Take the drug after a meal." Taking celecoxib after a meal decreases gastrointestinal upset, so the nurse would advise the patient to take the drug after meals. Administration of the drug with caffeine should be avoided because it may interfere with absorption of the drug. When the drug is taken with fluid, the risk of gastrointestinal upset is decreased. Administration of the drug on an empty stomach may cause gastrointestinal upset; therefore it should be avoided.

Which conditions are the most common indications for celecoxib? Select all that apply. 1 Arthritis 2 Tendonitis 3 Acute pain 4 Dysmenorrhea 5 Thromboprevention

1 Arthritis 3 Acute pain 4 Dysmenorrhea Celecoxib was the first cyclooxygenase-2 (COX-2) inhibitor and is currently still in use. It is available in oral form. This drug is commonly used for acute painful and inflammatory conditions. These conditions include arthritis, ankylosing spondylitis, and primary dysmenorrhea. Indomethacin is the most commonly used drug for the treatment of tendonitis. Aspirin is the primary nonsteroidal antiinflammatory drug. It is most commonly used for thromboprevention.

Which nonsteroidal antiinflammatory drug (NSAID) may cause Reye's syndrome in children with viral illnesses or fever? 1 Aspirin 2 Piroxicam 3 Meloxicam 4 Nabumetone

1 Aspirin Administration of aspirin or medications that contain aspirin in children with viral illnesses or fever may cause Reye's syndrome. To reduce the risk of Reye's syndrome, aspirin or medications that contain aspirin must not be given to children or teenagers with flu-like symptoms. Other drugs can be administered to children to treat fever or inflammation. Piroxicam, meloxicam, and nabumetone are enolic acid derivatives. These drugs do not cause Reye's syndrome in children.

Which nonsteroidal antiinflammatory drug (NSAID) is prescribed for the patient with myocardial infarction? 1 Aspirin 2 Celecoxib 3 Prednisone 4 Dexamethasone

1 Aspirin Aspirin is a nonsteroidal antiinflammatory drug that is prescribed for the patient with myocardial infarction. Aspirin inhibits the formation of thromboxane A2. It reduces platelet aggregation, which prevents blood clotting. Due to its protective action, it is prescribed for patients with myocardial infarction and stroke. Celecoxib is a cyclooxygenase-2 inhibitor that increases the risk of myocardial infarction by reducing the prostaglandin levels. Thus it should not be prescribed to a patient with myocardial infarction. Prednisone and dexamethasone are corticosteroid antiinflammatory medications. They can be prescribed to patients with myocardial infarction, but they are not NSAIDs.

Which conditions are major adverse effects that limit the long-term administration of aspirin? Select all that apply. 1 Bleeding 2 Dim vision 3 Hyperglycemia 4 Renal impairment 5 Gastrointestinal intolerance

1 Bleeding 4 Renal impairment 5 Gastrointestinal intolerance Aspirin, or acetylsalicylic acid, is a widely used analgesic, antipyretic, and antiinflammatory drug. Major adverse effects such as bleeding (often gastrointestinal), renal impairment, and gastrointestinal intolerance limit the long-term administration of aspirin. Dim vision is a central nervous system effect that occurs due to acute or chronic salicylate intoxication. Hyperglycemia is a metabolic disturbance that occurs due to acute or chronic salicylate intoxication.

Which medication used for the treatment of gout inhibits the metabolism, mobility, and chemotaxis of polymorphonuclear leukocytes? 1 Colchicine 2 Febuxostat 3 Probenecid 4 Allopurinol

1 Colchicine Colchicine is the oldest available drug for the treatment of acute gout. It inhibits the metabolism, mobility, and chemotaxis of polymorphonuclear leukocytes. Febuxostat is a nonpurine selective drug that inhibits the enzyme xanthine oxidase. Probenecid inhibits the reabsorption of uric acid in the kidney, which thereby increases the excretion of uric acid. Allopurinol inhibits the enzyme xanthine oxidase, which subsequently prevents uric acid production.

A patient is prescribed allopurinol to treat gout. The nurse is educating the patient about administration of the drug. Which intervention does the nurse suggest to the patient to ensure safe administration of the drug? 1 Take the drug with a meal. 2 Take the drug with caffeine. 3 Reduce the amount of fluid intake. 4 Take the drug on an empty stomach.

1 Take the drug with a meal. The nurse would advise the patient to take the drug after meals to minimize gastrointestinal symptoms. Caffeine increases uric acid levels and decreases the level of allopurinol, so the nurse would advise the patient to avoid taking the drug with caffeine. The fluid intake should be increased to 3 L a day. If the drug is administered on an empty stomach, it produces gastrointestinal symptoms. Therefore the nurse would advise the patient to avoid taking the drug on an empty stomach.

Which dose of salicylate can cause severe toxicity in a patient? 1 100 to 250 mg/kg 2 300 to 500 mg/kg 3 150 to 300 mg/kg 4 Lower than 100 mg/kg

2 300 to 500 mg/kg A salicylate dose of about 300 to 500 mg/kg can cause severe toxicity in a patient. Salicylate doses from 100 to 250 mg/kg and doses lower than 100 mg/kg cause little or no toxicity in a patient. A 150 to 300 mg/kg dose of salicylate can cause mild to moderate toxicity in a patient.

The nurse is assessing a 3-year-old child who has a fever. After checking the laboratory reports, the nurse finds that the child has influenza B. Which medication(s) would the nurse expect to be included in the care plan? 1 Aspirin 2 Acetaminophen 3 Aspirin and ibuprofen 4 Aspirin combination drug

2 Acetaminophen Acetaminophen should be prescribed to reduce fever because it is safe for the patient. Administration of aspirin to the child may cause Reye's syndrome. It may also result in encephalopathy and damage the child's liver. Therefore the primary health care provider should avoid prescribing aspirin, aspirin and ibuprofen in combination, and aspirin combination medications. Ibuprofen alone can be prescribed to the patient, but not with aspirin.

The nurse is administering aspirin to a patient. The nurse understands that aspirin is an nonsteroidal antiinflammatory drug (NSAID) drug. Which property of aspirin makes it different from the other NSAID drugs? 1 Analgesic property 2 Antiplatelet activity 3 Antipyretic property 4 Antiinflammatory property

2 Antiplatelet activity Aspirin is a nonsteroidal antiinflammatory drug. Unlike other NSAID drugs such as indomethacin and ibuprofen, aspirin has the additional property of inhibiting platelet aggregation. This antiplatelet activity is not shared by any other NSAID. All NSAIDs have analgesic, antipyretic, and antiinflammatory properties.

The nurse is caring for a patient who is taking aspirin to treat rheumatoid arthritis. The nurse learns that the patient uses a gingko supplement. Which adverse effect will the nurse expect in the patient? 1 Leukopenia 2 Increased risk of bleeding 3 Nephrotoxicity 4 Decreased uric acid excretion

2 Increased risk of bleeding Aspirin and gingko may interact with each other and interfere with platelet function, thus increasing the risk of bleeding. Leukopenia is an adverse effect of colchicines. Administration of cyclosporine with aspirin causes nephrotoxicity. Administration of uricosurics with aspirin decreases uric acid excretion.

Which instruction is appropriate for a patient who is on nonsteroidal antiinflammatory drug (NSAID) therapy? 1 Increase fluid intake to 1 to 2 L per day. 2 Take the NSAID with food, milk, or an antacid. 3 Stop the medication if you have any gastrointestinal disturbance. 4 Slowly increase the dosage of medication based on pain intensity.

2 Take the NSAID with food, milk, or an antacid. Gastrointestinal distress is the most common complication associated with NSAID therapy. Taking the medication along with food, milk, or an antacid minimizes gastrointestinal distress. Therefore the nurse advises the patient to take the NSAID with food, milk, or an antacid. The nurse would tell the patient who is on antigout therapy to increase fluid intake to at least 3 L per day. The patient should immediately report to the health care team if he or she feels any gastrointestinal disturbance during NSAID therapy, but the patient should not stop the medication abruptly because this may lead to complications. The nurse would not encourage the patient to increase the dosage of the medication based on pain intensity; this may lead to serious complications such as gastrointestinal bleeding due to toxicity.

A patient with gout asks the nurse about the mechanism of action of the antigout drugs. Which statement would the nurse make to the patient? 1 "It increases the red blood cells." 2 "It decreases the fatty acid level." 3 "It increases the blood oxygen level." 4 "It decreases the serum uric acid level."

4 "It decreases the serum uric acid level." In gout, the patient's uric acid level increases, and crystal formation takes place in the joints. Antigout drugs decrease serum uric acid levels and prevent the formation of crystals in the joints. Antigout drugs do not act on red blood cells, fatty acids, or blood oxygen. Therefore antigout drugs do not increase red blood cells or the blood oxygen level or decrease the fatty acid level.

The nurse is caring for a patient who has symptoms of acute toxicity due to an overdose of immediate-release ibuprofen, which was administered 1 hour earlier. Which is the appropriate action in this situation? 1 Administer aspirin to the patient. 2 Conduct hemodialysis on the patient. 3 Administer mercaptopurine to the patient. 4 Administer activated charcoal to the patient.

4 Administer activated charcoal to the patient. Ibuprofen is a nonsalicylate nonsteroidal antiinflammatory drug. If the patient shows signs of overdose, activated charcoal should be administered to avoid further absorption of the medication and to reduce further toxic effects. Aspirin should not be administered to the patient in this situation because it causes gastrointestinal irritation and can cause ulcers. Hemodialysis is an effective treatment option during salicylate intoxication. Administering mercaptopurine to the patient is not an effective treatment option because it does not reduce the symptoms of toxicity.

Which intervention is most appropriate for a patient who needs treatment for acute postoperative pain? 1 Administer celecoxib PO every 6 hours. 2 Administer allopurinol PO every 4 hours. 3 Administer indomethacin PO every 4 hours. 4 Administer ketorolac IV every 4 hours PRN.

4 Administer ketorolac IV every 4 hours PRN. Ketorolac is indicated for short-term use for severe-to-moderate pain. Its analgesic effects are similar to those of opioids. The other medications are not used for short-term severe-to-moderate postoperative pain.

Which drug is indicated for the treatment of gout because of its ability to inhibit the enzyme xanthine oxidase? 1 Celecoxib 2 Colchicine 3 Probenecid 4 Allopurinol

4 Allopurinol Allopurinol is indicated for the treatment of gout because of its ability to inhibit the enzyme xanthine oxidase, thereby preventing uric acid production. Celecoxib is used for the treatment of osteoarthritis, rheumatoid arthritis, acute pain symptoms, ankylosing spondylitis, and primary dysmenorrhea. Colchicine helps treat gout by reducing the inflammatory response to urate crystal deposits in joint tissue. Probenecid inhibits the reabsorption of uric acid in the kidney, thereby increasing the excretion of uric acid.

Which assessment finding indicates that the nonsteroidal antiinflammatory drug has been effective? 1 PTT is 100 seconds. 2 Patient's bleeding time is prolonged. 3 Patient has increased circulation to his legs. 4 Pain has decreased from a "6" to "1" on a scale of 10.

4 Pain has decreased from a "6" to "1" on a scale of 10. Prostaglandins are produced in response to activation of the arachidonic acid pathway. Nonsteroidal antiinflammatory drugs (NSAIDs) work by blocking cyclooxygenase, the enzyme responsible for conversion of arachidonic acid into prostaglandins. Decreasing the synthesis of prostaglandins results in decreased pain and inflammation. The length of the partial thromboplastin time (PTT), the bleeding time, and the increased extremity circulation will not necessarily be correlated with the effectiveness of the NSAID medication.