Chapter 16 Anti-Inflammatory, Antiarthritis, and Related Agents, Chapter 16, NUR150: Chapter 16- AntiInflammatory, Antiarthritis, and Related Agents, Chapter 16: Anti-Inflammatory, Antiarthritis, and Related Agents, Pharmacology Prep U Chapter 16 Ant...

A client prescribed allopurinol denies any current symptoms of gout. What response should the nurse provide when the client asks why the medication has been prescribed? "Allopurinol promotes formation of uric acid. It is used in combination with another drug to prevent reoccurrences of the symptoms of gout." "Allopurinol is used to prevent or treat hyperuricemia, which commonly occurs with gout." "Allopurinol is used to cure hyperuricemia, which commonly occurs with gout." "Allopurinol is not a first-line drug but can be used to cure gout."

"Allopurinol is used to prevent or treat hyperuricemia, which commonly occurs with gout." Rationale: Allopurinol is used to prevent or treat (but not cure) hyperuricemia, which occurs with gout and with antineoplastic drug therapy. Allopurinol prevents formation of uric acid. The drug promotes resorption of urate deposits and prevents their further development. Allopurinol is among the first-line drugs used in the treatment of gout but does not cure the condition.

Which instruction would be most important to include when teaching parents about over-the-counter (OTC) anti-inflammatory agents? "Be sure to read the label for the ingredients and dosage." "Aspirin is best for treating your child's flulike symptoms." "Make sure to give the drug on an empty stomach or before meals." "Refrain from using acetaminophen for the child's symptoms."

"Be sure to read the label for the ingredients and dosage." Rationale: Care must be taken to make sure that the child receives the correct dose of any anti-inflammatory agent. This can be a problem because many of these drugs are available in OTC pain, cold, flu, and combination products. Parents need to be taught to read the label to find out the ingredients and the dosage they are giving the child. Aspirin for flulike symptoms in children is to be avoided due to the increased risk for Reye's syndrome. Children are more susceptible to the GI and central nervous system effects of these drugs, so the drugs should be given with food or meals. Acetaminophen is the most used anti-inflammatory drug for children. However, parents need to be cautioned to avoid overdosage, which can lead to severe hepatotoxicity.

The client states that he knows many people who take acetaminophen, and asks the nurse what it is used for. What is the best response by the nurse? "It is used to treat severe arthritis." "It is an aspirin substitute for pain and fever." "It is used to treat chronic pain." "It is an anti-inflammatory medication."

"It is an aspirin substitute for pain and fever." Rationale: Acetaminophen is used to treat mild to moderate pain, and fever. It has no anti-inflammatory effect and will not address pain related to severe arthritis.

A patient with acute joint inflammation asks the nurse why she shouldn't use acetaminophen for her condition. The nurse would incorporate knowledge of what as the primary reason acetaminophen would be inappropriate when responding to this patient?

"The drug has no effect on inflammation"

A female client with acute joint inflammation asks the nurse why she shouldn't use acetaminophen for her condition. What would be the nurse's best response to this client? "The drug has no effect on inflammation." "The drug has quite a few adverse effects." "This drug is reserved for long-term therapy." "The drug can increase your risk for bleeding."

"The drug has no effect on inflammation." Rationale: The drug has antipyretic and analgesic properties, but no anti-inflammatory properties. Acetaminophen does have adverse effects including hepatotoxicity secondary to chronic use or overdose. Long-term therapy or overdosage can lead to hepatotoxicity. The drug does not increase a person's risk for bleeding.

After teaching the parents of a child who is taking over-the-counter anti-inflammatory agents, which statement by the parents indicates effective teaching?

"We need to read the labels carefully for the ingredients and dosages"

An older adult client has presented to the emergency department reporting frank blood in his stool over the past 24 hours. What assessment question should the nurse prioritize?

"What medications do you take for main or inflammation?"

A male client is taking aspirin 81 mg by mouth each day for prevention of recurrent myocardial infarction. He makes a dentist appointment for a tooth extraction. He calls the health care provider's office and asks the nurse if he is at risk for bleeding. Which response is correct? "Yes, low doses of aspirin may increase your risk of bleeding; I will call you with your new prescriber's orders." "No, the dose of aspirin is too low to increase your risk of bleeding." "Yes, you need to stop the aspirin immediately." "Your dentist must extract the tooth in a hospital setting to reduce the risk of hemorrhage."

"Yes, low doses of aspirin may increase your risk of bleeding; I will call you with your new prescriber's orders." Rationale: If a client has a history of taking aspirin, including the low doses prescribed for antithrombotic effects, there is a risk of bleeding from common therapeutic procedures (e.g., intramuscular injections, venipuncture, insertion of urinary catheters or GI tubes) or diagnostic procedures (e.g., drawing blood, angiography).

Gold Compounds

-Actions: Absorbed by macrophages; results in inhibition of phagocytosis (tissue destruction is decreased) -Absorption varies based on route of administration; widely distributed throughout body -Contradictions: Known allergy, sever diabetes, CHF, renal or hepatic impairment, hypertension, blood dyscrasias, recent radiation, history of toxic heavy metals -Not safe for use during pregnancy/lactation (use barrier contraceptives) -Adverse Effects: stomatitis, glossitis, laryngitis, colitis, diarrhea, gold bronchitis, and intestinal peneumonitis, bone marrow depression, vaginitis, nephrotic syndrome, dermatitis, pruritis, flushing, fainting, dizziness -Drug Interactions: penicillamine, antimalarials, cytotoxic drugs, or immunosuppressive agents

Acetaminophen

-Actions: acts on the thermoregulatory cells of the hypothalamus; mechanism of action has not been identified -Used to treat fever and pain (not inflammation) -Absorbed from GI tract -Peak 0.5-2 hrs -Extensively metabolized in the liver, excreted in the urine -Half life is about 2 hrs -Contradictions: Known allergy, use with caution in pregnancy/lactation -Adverse Reactions: headache, hemolytic anemia, renal dysfunction, skin rash and fever; hepatotoxicity associated with chronic use-potentially fatal. -Antidote is acetylcysteine -Drug Interactions: oral anticoagulants increase bleeding, hapatotoxicity with barbituates, carbamazepine, hydantoins, or rifampin

Salicylates

-Actions: inhibits synthesis of prostaglandin, used to treat mild-moderate pain and fever -Absorbed from stomach; metabolized in liver, excreted in urine -Peak in 5-30 mins -Contradictions: Known allergy, bleeding abnormalities, impaired renal function -Not indicated for pregnancy/lactation -Drug Interactions: Interact with other drugs by interfering with absorption

Other Disease-Modifying Antirheumatics -anakinra (Kineret) -leflunomide (Arava) -tofacitinib (Xeljanz) -penicillamine (Depen)

-Actions: relief of signs/symptoms of rheumatoid arthritis -Slow absorption from GI or subcutanous routes -Metabolized in tissues or liver; excreted in urine -Adverse Effects: local irritation at injection site, pain with injection, increased risk of infection, hepatic toxicity, rashes, bone marrow depression, multiple CNS problems -Drug Interactions: leflunomide cannot be combined with other hepatoxic drugs. Absorption of penicillamine is decreased if taken with iron salts/antacids. Anakinra/Etanercept used together= risk of serious infections

Salicylates (Nursing Considerations)

-Diagnoses: Disturbed sensory perception if toxic effects occur -Administer with food to alleviate GI effects; ensure hydration to prevent toxicity -Monitor for adverse effects of drug: ringing in ears, acidosis, N/V/D, metal confusion and lassitude

Tumor Necrosis Factor Blockers -adalimumab (Humira) -certolizumab (Cimzia) -etanercept (Embrel) -golimumab (Simponi) -infliximab (Remicade)

-First Class of DMAD used -Decreases local effects of TNF, a cytokine that can cause death of tumor cells and stimulate proinflammatory activities; blocks joint damage -Treats: rheumatoid arthritis, polyarticular juvenile arthritis, psoriatic arthritis, plaque psoriasis and ankylosing spondylitis -Given subcutaneously with exception of infliximab (given IV) -Peak 48-72 hrs; Half time 115 hours-2 weeks -Excreted in tissues -Contradictions: acute infection, cancer, sepsis, TB, hepatitis, myelosuppression or demyelinating disorders -Adverse Effects: risk of serious-fatal infections and development of lymphomas/other cancers; dymyelinating disorders (MS); heart failure, MI, and hypotension -Drug Interactions: any other immune suppressant drugs with TNF blockers increase risk of serious infection/cancer

A patient who is taking salicylates comes to the emergency department for evaluation. What signs would lead the nurse to suspect acute salicylate toxicity?

-Hyperpnea -Tetany -Excitement

Nonsteroidal Anti-Inflammatory and Related Agents (4)

-Propionic Acids (Fenoprofen, Ibuprofen) -Acetic Acids (Declofenac, Etofolac) -Fenamates (Mefamic acid) -Cyclooxygenase-2 Inhibitors (Celecoxib)

The nurse should monitor laboratory results related to blood clotting when the client takes what drugs regularly?

-Salicylates -Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs

-Strong anti-inflammatory and analgesic effects -OTC (may lead to abuse) -Inhibits prostaglandin secretion -Readily absorbed in the GI tract -Contradictions: allergy to any NSAID or salicylate -Adverse Effects: GI, blood clotting, Na/H2O balance -Drug Interactions: decreased diuretic effect when used with loop diuretics; beat blockers-decreased antihypertensive effect; lithium toxicity, esp when combined with ibuprofen

Which condition would contraindicate the use of gold salts?

-Uncontrolled diabetes -Hypertension -Blood dyscrasias

Chrysotherapy treats: (3)

-rheumatoid arthritis -juvenile rheumatoid arthritis -in patients whose disease has been unresponsive to standard therapy

Disease Modifying Anti-Rheumatic Drugs

-treatment of arthritis that aggressively affect the process of inflammation -alter's bodys ability to initiate inflammatory reaction -used early in diagnosis before joint damage occurs -used when patients do not respond to conventional therapy (Tumor Necrosis Factor Blockers,

A patient takes ibuprofen at approximately 10 A.M. The patient would most likely feel peak effects of the drug at which time?

12 P.M.

A patient is prescribed penicillamine. The nurse instructs the patient that they will not experience the full effect of the drug for how long?

2 to 3 months

A patient who is taking aspirin daily is scheduled to undergo a colonoscopy. The patient stops taking the aspirin as ordered before the procedure. The nurse would instruct the patient that she could resume taking the aspirin after what length of time?

7 days

What is the most frequently used agent for managing pain and fever in children?

Acetaminophen

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? Aspirin Diflunisal (Dolobid) Acetaminophen Ibuprofen

Acetaminophen Rationale: Acetaminophen is the analgesic of choice during pregnancy.

A child has symptoms of influenza, including a fever. Which medication should not be administered to the child because of the risk of Reye's syndrome? Acetaminophen Acetylsalicylic acid Ibuprofen Ascorbic acid

Acetylsalicylic acid Rationale: In children and adolescents, aspirin is contraindicated in the presence of viral infections, such as influenza or chickenpox, because of its association with Reye's syndrome. Acetaminophen and ibuprofen are safe to administer for fever reduction and pain relief in children and adolescents since no connection with Reye's syndrome has been established. Ascorbic acid is safe to administer to children but is not used to reduce fever or pain.

A patient is allergic to tartrazine. Which agent would be contraindicated?

Aspirin

The client reports to the nurse that the client is having ringing in the ears. The nurse questions the client on use of what medication? Aspirin Acetaminophen Steroids Antibiotics

Aspirin Rationale: Tinnitus (ringing of the ears) is a symptom of salicylism. It is not seen with the use of acetaminophen, steroids, or antibiotics.

A client with a history of chronic pain related to rheumatoid arthritis presents at the emergency department reporting dizziness, mental confusion, and difficulty hearing. What assessment is most appropriate?

Assess the client's use of salicylates

What agent would a nurse identify as a gold salt?

Auranofin

A patient is receiving anakinra as treatment for arthritis. The nurse understands that this drugs acts in which manner? -interferes with free-floating tumor necrosis factor -inhibits the DHODH enxyme -Blocks interleukin-1 -Lowers immunoglobulin M factor levels

Blocks interleukin-1

A client is receiving anakinra as treatment for arthritis. The nurse understands that this drug acts in which manner? Interferes with free-floating tumor necrosis factor Inhibits the DHODH enzyme Blocks interleukin-1 Lowers immunoglobulin M factor levels

Blocks interleukin-1 Rationale: Anakinra blocks the increased interleukin-1 responsible for the degradation of cartilage in rheumatoid arthritis. Etanercept reacts with free-floating tumor necrosis factor released by active leukocytes in autoimmune inflammatory disease to prevent damage caused by tumor necrosis factor. Leflunomide directly inhibits an enzyme, dihydroorotate dehydrogenase (DHODH), that is active in the autoimmune process. Penicillamine lowers immunoglobulin M rheumatoid factor levels.

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

Celecoxib

What drug, currently on the market, has been shown to have a two-to-threefold increase in cardiovascular events in patients using this drug?

Celecoxib (Celebrex)

The nurse is caring for a client who reports taking 800 mg of ibuprofen three times a day for relief of menstrual cramps. What laboratory results should the nurse prioritize when assessing the client?

Complete blood count

NSAIDs (Nursing Considerations)

Contradictions: -known allergies to salicylates, NSAIDs, tartazine -pregnancy/lactation -hepatic/renal disease, CV dysfunction, hypertension, GI bleed/peptic ulcer *Get baseline status before beginning therapy and for any potential adverse effects

olsalazine (Dipentum)

Converted to mesalamine in the colon; has the same direct anti-inflammatory effects -Treatment of ulcerative colitis and other IB disease in adults

After reviewing information about anti-inflammatory agents, the students demonstrate a need for additional review when they identify what as an example of an NSAID?

Diflunisal

African Americans are at a lower risk for developing GI adverse effects with NSAIDs.

False

Blockage of COX-2 receptors results in sodium retention and increased blood pressure.

False

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

False

Antipyretic

Fever blocker

Temperature regulation occurs in the hypothalamus. Normally, when the body temperature increases the body will respond by causing vasodilation in the periphery. What physiologic change is occurring with fever that allows the body's temperature to increase? Fever occurs because of the activation of lymphocytes. Fever occurs as a result of increased synthesis of prostaglandin in the hypothalamus. Fever occurs because the body allows the set point to be changed. Fever occurs as a result of basophile release.

Fever occurs as a result of increased synthesis of prostaglandin in the hypothalamus. Rationale: Fever is the result of fever-inducing substances called pyrogens, which activate certain monocytes/macrophages, which in turn secrete cytokines. Cytokines increase the synthesis and secretion of prostaglandin E2 (PGE2) in the hypothalamus, and PGE2 stimulates the hypothalamus to reset the regulating mechanism to tolerate a higher body temperature.

When describing various anti-inflammatory and antiarthritis agents, the nurse explains that which group of drugs inhibit phagocytosis?

Gold salts

The nurse is administering chrysotherapy to a patient with rheumatoid arthritis. What drug will the nurse be administering? Hydroxychloroquine Humira Gold salts Azathioprine

Gold salts Rationale: The administration of gold salts is called chrysotherapy. Gold is an anti-inflammatory agent that interferes with cells and substances in the immune system. There are two forms of intramuscular gold salts: gold sodium thiomalate and aurothioglucose.

What derivative is injected directly into the affected knee for relief of pain due to arthritis?

Hyaluronidase

A nurse is caring for a client who has just been diagnosed with rheumatoid arthritis. What first-line treatment should the nurse anticipate?

Ibuprofen

What principle should guide the possible use of indomethacin in an older adult client? This client should be prescribed intravenous (IV), rather than oral, administration of indomethacin. Indomethacin should be avoided in a client of this age. The client must be cautioned against taking the drug on an empty stomach. Indomethacin is among the preferred nonsteroidal anti-inflammatory drugs (NSAIDs) for this client.

Indomethacin should be avoided in a client of this age. Rationale: The Beers Criteria indicate that indomethacin is inappropriate in the geriatric population and is associated with a high risk of severity. This information makes all the other options incorrect.

Anti-Inflammatory Agent

Inflammatory response blocker

Which of the following best described the action of NSAIDs? -Blocks prostaglandin activity -Acts directly on thermoregulatory cells -Inhibits phagocytosis -Inhibits prostaglandin synthesis

Inhibits prostaglandin synthesis

What is acetaminophen's mechanism of action to reduce fever?

It acts directly on the thermoregulatory cells in the hypothalamus

Which of the anti-inflammatory drugs have geriatric warnings been associated with? (Select all that apply.) Indomethacin (Indocin) Sulindac (Clinoril) Ketorolac (Tordal) Ketoprofen (Orudis) Naproxen (Naprosyn)

Ketorolac (Tordal) Naproxen (Naprosyn) Ketoprofen (Orudis) Rationale: Geriatric warnings have been associated with naproxen, ketorolac, and ketoprofen because of reports of increased toxicity when they are used by older patients. These NSAIDs should be avoided if possible. Clinoril and indocin are not associated with toxicity in older patients.

Which of the following would be appropriate to use in combination with gold salts? -Penicillamine -Cytotoxic agents -Immunosuppressants -Low-dose corticosteroids

Low-dose corticosteroids

A client is diagnosed with inflammatory bowel disease. Which agent would the nurse expect to administer? Diflunisal Aspirin Choline magnesium trisalicylate Mesalamine

Mesalamine Rationale: Mesalamine or olsalazine would be appropriate for a client with inflammatory bowel disease. Diflunisal is indicated for the treatment of moderate pain and arthritis in adults; aspirin is used for the treatment of fever, pain, and inflammatory conditions. Choline magnesium trisalicylate is indicated for the relief of mild pain, fever, and arthritis.

balsalazide (Colazal)

New drug that treats ulcerative colitis

A patient is receiving auranofin as treatment for rheumatoid arthritis. The nurse would expect this drug to be given by which route?

Oral

Analgesic

Pain blocker

When acetylsalicylic acid is administered in low doses, it blocks the synthesis of thromboxane A2. What physiologic effect results from this action? Inflammation is relieved. Core body temperature is reduced. Pain is relieved. Platelet aggregation is inhibited.

Platelet aggregation is inhibited. Rationale: At low doses, acetylsalicylic acid blocks the synthesis of thromboxane A2 to inhibit platelet aggregation; this lasts for the life of the platelet. None of the remaining options accurately describes the physiologic action results of this medication since neither inflammation, core body temperature, nor pain is affected by the synthesis of thromboxane A2.

Nonsteroidal Anti-Inflammatory Drug (NSAID)

Protaglandin synthesis blocker

The nurse should teach a client with rheumatic disease who is being prescribed salicylate therapy to monitor himself or herself for what?

Ringing in the ears

An agent would be least appropriate to use as treatment for ulcerative colitis?

Salsalate

A patient is to receive etanercept. The nurse would expect to administer this drug by which route?

Subcutaneous

A client diagnosed with osteoarthritis has been prescribed meloxicam. Which instruction should the client be given to assure the medication's safe administration? Take the medication with orange juice. Crush enteric-coated tablets to aid swallowing. Take the medication with food. Take the medication at bedtime.

Take the medication with food. Rationale: Meloxicam should be taken with food to decrease the risk of gastric irritation. Meloxicam is not an enteric-coated tablet and is never crushed. It is not always necessary to take this medication at bedtime. Orange juice is not of particular risk to the absorption of meloxicam.

The nurse is educating an African American client about the safe and effective use of anti-inflammatories. In order to address the known ethnic factors relating to this client's drug therapy, the nurse should do what?

Teach the client about the heightened risk for GI adverse effects.

A parent states that he generally gives his children "half an aspirin" in the event that any of them has a fever. What is the nurse's best response to the client's statement?

Teach the client to avoid giving aspirin due to the risk for Reye's syndrome

A 65-year-old man who just had a heart attack is placed on aspirin, 81 mg daily. The nurse is explaining the purpose of this medication to the client and his wife. What would be the nurses best explanation? The aspirin is being prescribed because it reduces the prostaglandins in your body. The aspirin is being prescribed because it will protect your heart. The aspirin is being prescribed because it reduces your risk of a second heart attack. The aspirin is being prescribed to relieve the pain from the heart attack.

The aspirin is being prescribed because it reduces your risk of a second heart attack. Rationale: Because of its antiplatelet and anti-inflammatory effects, low-dose aspirin (81 mg daily) is useful in preventing or reducing the risk of transient ischemic attacks (TIAs), MI, and ischemic cerebral vascular accident (stroke). It is also indicated for clients with a previous MI, chronic or unstable angina, and those undergoing angioplasty or other revascularization procedures.

A client has developed a fever. What aspect of the client's health history would contraindicate the safe and effective use of acetaminophen? The client has hepatitis C and abuses alcohol The client had an allergic reaction to penicillin during a previous admission The client's most recent hospital admission was because seizures which were treated with benzodiazepines The client was prescribed diclofenac for back pain and did not experience pain relie

The client has hepatitis C and abuses alcohol Rationale: Liver disease and alcoholism contraindicate the use of acetaminophen. An allergy to penicillin would not pose a problem. Similarly, a history of seizures, benzodiazepine use and diclofenac would not rule out the use of acetaminophen.

The nurse would question the physician who prescribed NSAIDs for which patient?

The patient diagnosed with peptic ulcers

Aspirin has been prescribed for a 69-year-old client with a diagnosis of arthritis. The nurse monitors the client for which assessment finding that would indicate the presence of toxicity from this medication? (Select all that apply.) Tinnitus Impaired hearing Tachycardia Diarrhea Photophobia

Tinnitus Impaired hearing Tachycardia Rationale: Symptoms of salicylism include tinnitus, impaired hearing, dizziness, nausea, vomiting, flushing, tachycardia, and mental confusion. Diarrhea and photophobia are not associated with salicylism.

Chrysotherapy

Treatment with gold salts

mesalamine (Pentasa)

Treats inflammation of the large intestine

Aspirin (Bayer)

Treats inflammatory conditions, MI

chlorine magnesium trisalicylate (Tricosal)

Treats mild pain and fevers; arthritis

diflunisal (generic)

Treats modern pain, arthritis in adults

NSAIDs have anti-inflammatory, antipyretic, and analgesic properties.

True

Rheumatoid factor (RF) interacts with circulating IgG to form immune complexes that deposit in the joints precipitating an inflammatory reaction.

True

Inflammatory Response

Uses chemical mediators to produce a reaction that helps destroy pathogens and promotes healing.

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? Administer the Celebrex and narcotic because it is his pain management regimen. Administer the Celebrex. Discontinue the Celebrex. Withhold the Celebrex and notify the health care provider.

Withhold the Celebrex and notify the health care provider. Rationale: Celebrex should not be used for pain management after coronary surgery due to the risk of cardiovascular thrombosis, myocardial infarction, and stroke. The nurse should not administer the medication and should notify the provider. The nurse cannot discontinue the Celebrex without prescriptive authority.

Which agent would be least appropriate to administer to a patient with join inflammation and pain? -ibuprofen -naproxen -acetaminophen -diclofenac

acetaminophen

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 aspirin diflunisal magnesium salicylate

acetaminophen Rationale: Acetaminophen is classified as a nonsalicylate analgesic. Aspirin, diflunisal, and magnesium salicylate are salicylates.

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. diabetic retinopathy. cataract. acute gout.

allergy to sulfonamides. Rationale: Celecoxib is contraindicated among patients with allergy to sulfonamides. Ethambutol is contraindicated in patients with diabetic retinopathy and patients with cataract. Pyrazinamide is contraindicated among patients with acute gout.

Which instruction would be most important to include when teaching parents about OTC anti-inflammatory agents? -be sure to read the label for the ingredients and dosage -aspirin is the best for treating your child flu-like symptoms -make sure to give the drug on an empty stomach or before meals -refrain from using acetaminophen for the child's symptoms

be sure to read the label for the ingredients and dosage

A salicylate is contradicted in patients who have had surgery within the past week for which increased risk? -allergic reaction -toxicity -bleeding -fluid imbalance

bleeding

A group of students are reviewing information about cyclooxygenase receptors. The students demonstrate understanding of the information when they identify which of the following as an effect of COX-2 receptors? -maintenance of renal function -blockage of platelet clumping -provision of gastric mucosal integrity -promotion of vascular hemostasis

blockage of platelet clumping

The nurse administers ibuprofen to adult clients experiencing a variety of health disorders. Following administration, the nurse should assess for therapeutic effects related to what symptoms? Select all that apply. fever pruritus inflammation moderate pain hyperuricemia

fever inflammation moderate pain Rationale: Ibuprofen is used to relieve mild to moderate pain or inflammation related to rheumatoid arthritis or osteoarthritis. In addition, it is effective in reducing fever. During initial attacks of acute gout, ibuprofen may be administered, but it does not directly reduce uric acid levels. Pruritus (itching) management is not a primary indication for ibuprofen use.

What drugs used to treat rheumatoid arthritis are contraindicated in a client who has a history of toxic levels of heavy metals? gold salts cox 2 inhibitors propionic Acids fenamates

gold salts Rationale:Gold salts can be quite toxic and are contraindicated in the presence of any known allergy to gold, severe diabetes, congestive heart failure, severe debilitation, renal or hepatic impairment, hypertension, blood dyscrasias, recent radiation treatment, history of toxic levels of heavy metals, and pregnancy or lactation.

A client has been diagnosed with severe rheumatoid arthritis, and hylan G-F 20 has been ordered. How is this drug given? injected into joint orally IM sub Q

injected into joint Rationale: Hyaluronidase derivatives, such as hylan G-F 20 and sodium hyaluronate, have elastic and viscous properties. These drugs are injected directly into the joints of clients with severe rheumatoid arthritis of the knee. They seem to cushion and lubricate the joint and relieve the pain associated with degenerative arthritis. They are given weekly for 3 to 5 weeks.

A patient is to receive aurothioglucose. The nurse would administer this drug by which route? -oral -subcutaneous -intramuscular -intravenous

intramuscular

A patient is diagnosed with inflammatory bowel disease. Which agent would the nurse expect to administer? -diflunisal -asprin -choline magnesium trisalicylate -masalamine

masalamine

A nurse suspects that a patient is experiencing salicylism. Which of the following would the nurse assess? -excitement -ringing in the ears -tachypnea -convulsions

ringing in the ears

A black patient is receiving a high dose of NSAID for pain relief. Which of the following would be the most important for the nurse to include in the teaching plan? the need to combine the drug with an OTC salicylate signs and symptoms of GI bleeding avoidance of warm soaks for additional pain relief importance of adequate hydration

signs and symptoms of GI bleeding

A patient with severe rheumatoid arthritis of the knees has arrives at the facility for an injection of a drug into the joint. Which agent would the nurse most likely expect to be used? -auranofin -penicillamine -etanercept -sodium hyaluronate

sodium hyaluronate

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 lungs liver peripheral nerves

stomach Rationale: The most common adverse reactions caused by the NSAIDs involve the GI tract, including the stomach, leading to GI bleed and/or possible ulceration. The lungs are not specifically affected by NSAIDs; however, pain associated with respiratory insults such as pneumonia can be relieved. Peripheral nerve pain can also be treated with NSAIDs. There is no injury noted to the liver while taking NSAIDs.

After teaching a group of students about disease-modifying anti-rheumatic drugs, the instructor determines that the students need additional teaching when they identify which of the following as an example? -sulindac -etanercept -adalimumab -methotrexate

sulindac

Corticosteroids

systemically block the inflammatory and immune systems

After teaching a local community group about the use of OTC anti-inflammatory agents, the nurse determines that the group needs additional teaching when they state which of the following? -these drugs are relatively safe since they don't have adverse effects -we can easily overdose on them if we don't follow directions -other signs/symptoms of an illness might not appear with these drugs -these drugs might interact with other drugs and cause problems

these drugs are relatively safe since they don't have adverse effects

Which statement by which a patient receiving gold salts indicates understanding of the drug therapy? -these drugs are used first to try to control my severe disease -these drugs will help prevent further damage from my disease -these drugs should help because I've has the disease for so long -these drugs are safer than most of the other drugs for arthritis

these drugs will help prevent further damage from my disease

salsalate (generic)

used to treat pain, fever, and inflammation in adults