Ch 71 Cyclooxygenase Inhibitors: Nonsteroidal Anti-Inflammatory Drugs and Acetaminophen

A client has received instructions to take 650 mg aspirin every 6 hr as needed for arthritic pain. What should the nurse include in the client's medication teaching? Select all that apply. A. Take the aspirin with meals or a snack B. Make an appointment with a dentist if bleeding gums develop C. Do not chew enteric-coated tablets D. Switch to acetaminophen if tinnitus occurs E. Report persistent abdominal pain

A, C, E. Aspirin is irritating to the stomach lining and can cause ulceration; the presence of food, fluid, or antacids decreases this response. Enteric-coated tablets must not be crushed or chewed. Aspirin therapy may lead to GI bleeding, which may be manifested by abdominal pain; if present, the prescriber must be notified immediately. Bleeding gums should be reported to the practitioner, not the dentist. Acetaminophen does not contain the anti-inflammatory properties present in aspirin; tinnitus should be reported to the practitioner.

A HCP prescribes aspirin to be continued at home for a client with severe arthritis. What should the nurse teach the client about taking aspirin? A. Take the medication with meals B. See a dentist if bleeding gums develop C. Switch to acetaminophen if tinnitus occurs D. Avoid spicy foods while taking the medication

A. Acetylsalicylic acid is irritating to the stomach lining and can cause ulceration; the presence of food, fluid, or antacids decreases this response. Bleeding gums should be reported to the HCP, not the dentist. Acetaminophen does not contain the anti-inflammatory properties present in aspirin; tinnitus should be reported to the HCP. Avoiding spicy foods is unnecessary as long as aspirin is taken with food.

Which drug increases the risk of Reye's syndrome in children? A. Aspirin B. Naloxone C. Ibuprofen D. Acetaminophen

A. Aspirin increases the risk of Reye's syndrome in children. Naloxone, ibuprofen, and acetaminophen can be used, but the child should be assessed for renal and liver functioning before prescribing.

Which medication should the nurse anticipate the HCP will prescribe to relieve the pain experienced by a client with rheumatoid arthritis? A. Aspirin B. Hydromorphone C. Meperidine D. Alprazolam

A. Because of its anti-inflammatory effect, acetylsalicylic acid is useful in treating arthritis symptoms. Opioids such as hydromorphone and meperidine should be avoided because they promote drug dependency and do not affect the inflammatory process. Alprazolam is an antianxiety, not an anti-inflammatory, agent.

A client who takes four 325 mg tablets of buffered aspirin 4x a day for severe arthritis complains of dizziness and ringing in the ears. Which complication does the nurse conclude that the client probably is experiencing? A. Salicylate toxicity B. Anaphylactic reaction C. Withdrawal symptoms D. Acetaminophen overdose

A. Excessive aspirin ingestion can influence the vestibulocochlear nerve (cranial nerve VIII), causing tinnitus and dizziness. The client is experiencing symptoms of toxicity, not an anaphylactic response. Withdrawal symptoms occur when a medication is no longer being administered. The chemical name of aspirin is acetylsalicylic acid, not acetaminophen.

A client with rheumatoid arthritis is to begin taking ibuprofen 800 mg by mouth 3x a day. The nurse provides education about the medication's side effects. The nurse concludes that the teaching was effective when the client makes which statement? A. "I need to have my blood work checked periodically" B. "I need to balance exercise with rest" C. "I need to change positions slowly" D. "I need to take the medication between meals"

A. If the client will be taking the medication long term, periodic diagnostic tests are necessary because ibuprofen is nephrotoxic, is hepatotoxic, and prolongs the bleeding time. Balancing exercise with rest is important for all clients with arthritis; it is not related to ibuprofen. Ibuprofen does not cause postural hypotension. Ibuprofen causes epigastric distress and occult bleeding; it should be taken with meals or milk to reduce these adverse reactions.

A nurse is caring for an older adult who is taking acetaminophen for the relief of chronic pain. Which substance is most important for the nurse to determine if the client is taking because it intensifies the most serious adverse effect of acetaminophen? A. Alcohol B. Caffeine C. Saw palmetto D. St. John's wort

A. Too much ingestion of alcohol can cause scarring and fibrosis of the liver. 85%-95% of acetaminophen is metabolized by the liver. Acetaminophen and alcohol are both hepatotoxic substances. Metabolites of acetaminophen, along with alcohol, can cause irreversible liver damage. Caffeine stimulates the cardiovascular system, not the liver. In addition, caffeine does not interact with acetaminophen. Saw palmetto is not associated with increased liver damage when taking this drug. It often is taken for benign prostatic hypertrophy because of its anti-inflammatory and antiproliferative properties in prostate tissue. St. John's wort is classified as an antidepressant and is not associated with increased liver damage when taking acetaminophen. However, it does decrease the effectiveness of acetaminophen.

A 6 yo child who has undergone abdominal surgery complains of incisional pain. The nurse administers the prescribed acetaminophen. The mother asks the nurse why her child isn't being given ibuprofen. How will the nurse respond? A. "It could prolong bleeding time" B. "It's contraindicated for young children" C. "It can suppress the healing of the incision" D. "It becomes ineffective when given for long periods"

A. Tylenol is not associated with bleeding complications like ibuprofen but if used long term, can result in liver toxicity. Ibuprofen, an NSAID, prolongs bleeding time; in the postop period, medications that interfere with clotting and prolong bleeding are contraindicated. Ibuprofen is safe for young children when administered in appropriate doses. Ibuprofen exerts an anti-inflammatory action; it does not interfere with the healing process. Tolerance for ibuprofen does not develop.

What are the desired outcomes that the nurse expects when administering ibuprofen? Select all that apply. A. Diuresis B. Pain relief C. Antipyresis D. Bronchodilation E. Anticoagulation F. Reduced inflammation

B, C, F. Prostaglandins accumulate at the site of an injury, causing pain; NSAIDs like ibuprofen inhibit COX-1 and COX-2 (both are isoforms of the enzyme cyclooxygenase), which inhibit the production of prostaglandins, thereby contributing to analgesia. NSAIDs inhibit COX-2, which is associated with fever, thereby causing antipyresis. NSAIDs inhibit COX-2, which is associated with inflammation, thereby reducing inflammation.

A client with rheumatoid arthritis takes aspirin routinely to reduce pain. The client asks whether it is the arthritis, the aspirin, or some other ear problem that causes the bilateral ear buzzing the client is now experiencing. What is an appropriate nursing response? A. "The ringing in your ears is a sign of an ear infection" B. "Aspirin may have caused some nerve damage in your ear" C. "Accumulation of ear wax causes ringing in the ears" D. "Your symptoms are an expected response to the aging process"

B. Aspirin may damage the eighth cranial (acoustic) nerve, causing ringing in the ears and impaired hearing. Pain, not ringing in the ears, is a sign of otitis media. Diminished hearing, not ringing, occurs because of mechanical obstruction of the outer ear. Aging may cause decreasing acuity in the extremes of pitch, but it does not cause ringing in the ears.

A client who has been taking ibuprofen for rheumatoid arthritis asks the nurse if acetaminophen can be substituted instead. What is the appropriate nursing response? A. "Acetaminophen is the preferred treatment for RA" B. "Acetaminophen irritates the stomach more than ibuprofen does" C. "Ibuprofen has anti-inflammatory properties and acetaminophen does not" D. "Yes, both are antipyretics and have the same effect"

C. Ibuprofen has an anti-inflammatory action that relieves the inflammation and pain associated with arthritis. Acetaminophen is not an NSAID. NSAIDs are preferred for the treatment of RA. Acetaminophen does not cause gastritis; this is an effect of aspirin. Ibuprofen is not an antipyretic.

Aspirin is prescribed on a regular schedule for a client with rheumatoid arthritis. The nurse understands that the drug is being used primarily for which of its properties? A. Analgesic B. Antipyretic C. Anti-inflammatory D. Antiplatelet

C. The anti-inflammatory action of aspirin reduces joint inflammation. Aspirin reduces fever, but this is not the rationale for prescribing it for clients with RA. Aspirin does not preserve bone integrity. Flexion contractures are prevented by exercise, not aspirin.

A nurse is teaching an older adult client about managing chronic pain with acetaminophen. Which client statement indicated that the teaching is effective? A. "I can drink beer with this, but not wine" B. "I need to limit my intake of acetaminophen to 650 mg a day" C. "I should take an emetic if I accidentally overdose on the acetaminophen" D. "I have to be careful about which OTC cold preparations I take when I have a cold"

D. Many OTC cold preparations contain acetaminophen; the amount of acetaminophen in cold preparations must be taken into consideration when the total amount of acetaminophen taken daily is calculated. A typical single dose is 650 mg a day for adults. Acetaminophen should not exceed 3 to 4 g a day, with a lower dose preferred in older adults. An emetic is contraindicated because it may reduce the client's ability to tolerate oral acetylcysteine, the antidote for acetaminophen toxicity. Alcohol of any type, when taken with acetaminophen, increases the risk of liver injury.

Acetaminophen

First-generation NSAID

Aspirin

First-generation NSAID

Ibuprofen

First-generation NSAID

Adverse effects

Gastric ulceration, bleeding, and renal impairment

Cyclooxygenase Inhibitors

Suppress inflammation, relieve pain, and reduce fever