Pharmacology Ch 16: Anti-Inflammatory, Antiarthritis, and Related Agents

A client with chronic pain has been prescribed a salicylate. The Nurse should expect what medication on this client's medication administration record? 1-Indomethacin 2-Piroxicam 3-Celecoxib 4-Diflunisal

4-Diflunisal Indomethacin, piroxicam, and celecoxib are NSAIDs

A child with juvenile arthritis has been prescribed auranofin 0.125 mg/kg/day PO. The client weighs 88 lb. How many milligrams of auranofin should the nurse administer each day?

5 mg The client's weight must be converted to kilograms: 88 lb ÷ 2.2 = 40 kg. To calculate the daily dose, multiply the child's weight by the prescribed dose: 0.125 mg × 40 kg = 5 mg.

A client with acute joint inflammation tell the nurse, "I've been taking acetaminophen as it's ordered on the bottle, but my swelling and inflammation don't seem to be getting better." What should the nurse teach the client? A) "It takes some people a few weeks to feel a difference." B) "Acetaminophen has no effect no inflammation." C) "Acetaminophen's only clinical use is for pain treatment." D) "Keep taking it as ordered, and watch for any signs of bleeding."

B) "Acetaminophen has no effect no inflammation." Acetaminophen has antipyretic and analgesic properties, but no antiinflammatory properties. Acetaminophen does not increase a person's risk for bleeding. Relief of pain and fever occurs quickly.

What salicylate would be appropriate for treating inflammation in a client with ulcerative colitis? Select all that apply A) Salsalate B) Balsalazide C) Mesalamine D) Aspirin E) Olsalazine

B) Balsalazide C) Mesalamine E) Olsalazine Salsalate is used to treat pain, fever, and inflammation in adults but is not indicated for use in ulcerative colitis treatment. Balsalazide can be used to treat mild-to-moderate acute ulcerative colitis in adults. Olsalazine and mesalamine are used to treat ulcerative colitis and other inflammatory bowel diseases in adults. Aspirin would be inappropriate because of the risk for GI bleeding.

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

False Blockage of COX-1 receptors leads to sodium retention and increased blood pressure. COX-2 is active at sites of trauma or injury when more prostaglandin is needed. Recent studies suggest that they may block some protective responses in the body, such as vasodilation and inhibited platelet clumping, which is protective if vessel narrowing or blockage occurs; blocking this effect could lead to cardiovascular problems.

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

True Clients with rheumatoid arthritis have high levels of rheumatoid factor (RF), an antibody to immunoglobulin G (IgG). RF interacts with circulating IgG to form immune complexes, which tend to deposit in the synovial fluid of joints, as well as in the eye and other small vessels.

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

True NSAIDs are used to reduce inflammation and lower fever and also have analgesic properties. They can also be used to treat dysmenorrhea.

A client with a history of chronic pain is scheduled to undergo a colonoscopy. What health education should the nurse provide the client? a) "Confirm with your provider, but you'll likely have to stop taking aspirin 1 week before the procedure." b) "Some clients have some discomfort during a colonoscopy, but the provider will likely give you an anti-inflammatory before it." c) "It's very important that you write down every drug that you're allergic to and bring it to your appointment." d) "Make sure not to take any Tylenol for at least 3 days before the day of the procedure."

a) "Confirm with your provider, but you'll likely have to stop taking aspirin 1 week before the procedure." Salicylates are contraindicated for clients who have had surgery or invasive procedures within 1 week because of the risk for increased bleeding. Thus, the nurse would inform that client that he or she can resume taking the aspirin after 1 week. There is no need to avoid Tylenol and the client's allergies do not necessarily need to be written down by him or her. Anti-inflammatories may or may not be given before the procedure.

A client is alarmed celecoxib is prescribed, stating, "I heard on TV that celecoxib causes heart attacks." How should the nurse best respond? a) "This drug hasn't been definitively proven to be unsafe, so it's still available." b) "As long as you take your heart medications, you'll be fine." c) "That was a scare that was entirely created by the media." d) "A final decision from the FDA on whether celecoxib is safe will be released in 2018."

a) "This drug hasn't been definitively proven to be unsafe, so it's still available." Celecoxib remains on the market despite a two to three times increase in CV events because further research called into question these findings and the drug continues to be monitored. There is no promise of a decision in 2018. The media played a role in the public response, but did not wholly create the controversy.

A neonate born at 28 weeks' gestation has been diagnosed with patent ductus arteriosis. The nurse should anticipate what action? a) Administration of indomethacin IV b) Meloxicam administration c) IV administration of naproxen d) Intramuscular injection of ketorolac

a) Administration of indomethacin IV. Patent ductus arteriosis can be treated with IV indomethacin in premature neonates. Ketorolac and meloxicam are not used for this purpose. Naproxen does not treat this health problem and is only administered orally.

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

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

A client's care provider has recommended the use of acetaminophen to treat the client's pain. What should the nurse teach the client about the safe and effective use of acetaminophen? a) "Take the medication with food to prevent GI upset." b) "Avoid taking more than 3,000 mg in any 24-hour period." c) "Avoid excessive doses because there is no antidote." d) "Avoid drinking grapefruit juice with acetaminophen."

b) "Avoid taking more than 3,000 mg in any 24-hour period." Clients should avoid taking more than 3,000 mg of acetaminophen daily to avoid hepatic damage. Acetylcysteine is an antidote for overdose, and there is no need to avoid grapefruit juice. GI upset is rare, so there is no particular need to take it with food.

A client was given 400 mg ibuprofen PO at approximately 10:00 hours for the treatment of back pain. The client would most likely feel peak effects of the drug at which time? a) 10:30 b) 11:30 c) 12:30 d) 13:30

b) 11:30 Ibuprofen peaks in 1 to 2 hours so the client should be experiencing the peak effect by 12 p.m. Peak effects would not be experienced by 10:30 a.m. Peak effects would have subsided by 4 or 6 p.m.

A parent has sought care from the nurse practitioner to treat a child's fever. The nurse practitioner is most likely to recommend what drug? a) Naproxen b) Acetaminophen c) Indomethacin d) Ibuprofen

b) Acetaminophen Acetaminophen is the most frequently used drug for managing fever and pain in children. Ibuprofen and naproxen are both effective treatments for pain and fever in children, but they are not the most commonly used medications. Indomethacin is not indicated for fever control.

A client has been given acetaminophen to reduce a fever. How will this be achieved? a) Reducing inflammation by inhibiting prostaglandins. b) Acting directly on thermoregulatory cells in the hypothalamus. c) Increasing fluid reabsorption in the kidney to reduce fever. d) Causing vasodilation, allowing heat to be expelled from the body.

b) Acting directly on thermoregulatory cells in the hypothalamus. Acetaminophen functions by acting directly on thermoregulatory cells in the hypothalamus to reduce fever. It does not impact kidney function, has no effect on vasodilation, and is not an anti-inflammatory medication.

A client experiences intense knee pain due to arthritis and the use of a hyaluronidase derivative is being considered. What assessment finding must be considered? a) Allergies to shellfish or diagnostic contrast solution. b) Whether the client is comfortable having an injection into the knee joint. c) The client's adherence to previous medication regimens. d) The client's expectations for future mobility.

b) Whether the client is comfortable having an injection into the knee joint. Hyaluronidase is injected directly into the knee once a week for 3 weeks to relieve arthritis pain in the knee when unresponsive to conventional treatment. Adherence is less of an issue because of the infrequent administration. An allergy to shellfish or contrast dye is not a contraindication. The client's expectations must be assessed, but this would not be as significant an issue as the delivery method.

A client's history reveals an allergy to sulfonamides. The nurse understands that which drug would be contraindicated? a) Diclofenac b) Naproxen c) Celecoxib d) Ibuprofen

c) Celecoxib Celecoxib is contraindicated for use in clients who are allergic to sulfonamides. Ibuprofen, naproxen, and diclofenac are not contraindicated in clients with a sulfonamide allergy.

A client is to receive etanercept. What characteristic of the client may contraindicate the use of this medication? a) Employment involving heavy machinery b) Occasional dysphagia c) Fear of injections d) Lack of social support

c) Fear of injections Etanercept can only be administered subcutaneously. Because it is given subcutaneously, dysphagia is not a problem. CNS effects are unlikely, so operating machinery is not dangerous. A client's lack of social support must be addressed, but does not necessarily preclude treatment.

Which conditions would contraindicate the use of gold salts? Select all that apply. a) Cardiac arrhythmias b) Uncontrolled diabetes c) Hypertension d) Asthma e) Blood dyscrasias

c) Hypertension, b) Uncontrolled diabetes, e) Blood dyscrasias Gold salts are contraindicated in the presence of 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. Gold salts are not contraindicated in the presence of asthma or cardiac arrhythmias.

The nurse has conducted a health education session for new parents. After learning about the safe and effective use of anti-inflammatories, which statement by the parents indicates effective teaching? a) "We need to give the drug on an empty stomach or 2 hours after meals." b) "We can temporarily give our child extra doses of acetaminophen if we need to do so." c) "We should use aspirin if our child develops symptoms of the flu." d) "We need to read the labels carefully for the ingredients and dosages."

d) "We need to read the labels carefully for the ingredients and dosages." Anti-inflammatory agents can be found in a number of combination products to treat pain, cold, flu, and nasal congestion. It is important for parents to read the label of each medication carefully to avoid overdosing the child with multiple products containing the same antiinflammatory agent. Children are more susceptible to the GI and CNS effects of these drugs, so the drugs should be given with food or meals. Aspirin for flu-like symptoms in children is to be avoided due to the increased risk for Reye's syndrome. Acetaminophen is the most commonly used anti-inflammatory drug for children. However, parents need to be cautioned to avoid overdosage, which can lead to severe hepatotoxicity.

An adult client has been admitted to the emergency department after deliberately overdosing on approximately 50 g of Tylenol. The nurse should prepare for what intervention? a) Watchful waiting b) Administration of naloxone as prescribed c) Intravenous administration of Lactated Ringer's d) Administration of acetylcysteine as prescribed

d) Administration of acetylcysteine as prescribed. Acetylcysteine is the antidote to acetaminophen overdose. Naloxone treats opioid overdoses. Given the high dose of acetaminophen, watchful waiting would be inadequate. Lactated Ringer's would not be therapeutically beneficial.

A client with intractable rheumatoid arthritis has been prescribed a gold salt. What medication should the nurse look for on the client's medication administration record? a) Anakinra b) Celecoxib c) Mesalamine d) Auranofin

d) Auranofin Auranofin is a gold salt. Celecoxib is a COX-2 inhibitor. Mesalamine is a salicylate. Anakinra is an interleukin-1 receptor antagonist.

A client with rheumatoid arthritis is relieved to have less pain and inflammation since a change in medications. The nurse is aware that the new medication inhibits phagocytosis and prevents the release of lysosomal enzymes. What medication classification is this client receiving? a) Salicylates b) NSAIDs c) DMARDs d) Gold salts

d) Gold salts Gold salts inhibit phagocytosis. NSAIDs inhibit prostaglandin synthesis. Salicylates block prostaglandin activity. DMARDs act by a variety of mechanisms to address inflammation but do not inhibit phagocytosis.

A client with rheumatoid arthritis is prescribed penicillamine. What should the nurse teach the client about this medication? a) Weekly injections are necessary. b) Monthly injections are necessary. c) The client should avoid acetaminophen during treatment. d) Improvement in symptoms may take 2 to 3 months.

d) Improvement in symptoms may take 2 to 3 months. It may take 2 to 3 months before a response to penicillamine is noted. It is given orally, and there is no contraindication with Tylenol.

A client is receiving auranofin as treatment for rheumatoid arthritis. The nurse should expect this drug to be given by which route? a) Intramuscular b) Intravenous c) Subcutaneous d) Oral

d) Oral Auranofin is administered orally. Aurothioglucose and gold sodium thiomalate are given IM. Auranofin is not given via the subcutaneous, intramuscular, or intravenous routes.

A client with dysmenorrhea has been prescribed naproxen 1,250 mg PO b.i.d. What is the nurse's best action? a) Assess the client's baseline renal and hepatic status. b) Question the prescriber about the route. c) Question the prescriber about the frequency. d) Question the prescriber about the dose.

d) Question the prescriber about the dose. For adults, naproxen is given 250 to 500 mg PO b.i.d. As a result, the nurse should question the prescriber about the dose before proceeding.

The nurse would question the physician who prescribed NSAIDs for which client? a) The client diagnosed with psoriasis b) The client diagnosed with diabetes c) The postpartum client who had a vaginal birth d) The client diagnosed with peptic ulcers

d) The client diagnosed with peptic ulcers. The client diagnosed with peptic ulcer disease is at risk for further GI irritation and bleeding if given NSAIDs, so the nurse would question the physician who ordered this drug. Clients with diabetes and psoriasis may take NSAIDs safely, and the nurse would not question the order. NSAIDs are often ordered for pain control for clients after vaginal birth and this order need not to be questioned.

A client who is taking salicylates presents to the emergency department for evaluation. What assessment findings should lead the nurse to suspect acute salicylate toxicity? Select all that apply. a) Diarrhea b) Tinnitus c) Agitation d) Muscle spasms e) Respiratory rate of 38 breaths per minute

e) Respiratory rate of 38 breaths per minute, d) Muscle spasms, c) Agitation Signs of acute salicylate toxicity include tachypnea, excitement, and tetany (muscle spasms). Diarrhea and tinnitus are not expected.

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

false African Americans have an increased risk of developing GI adverse effects with any anti-inflammatory agent.

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

false Gold compounds are used for a client with rheumatoid arthritis who does not respond to the usual anti-inflammatory agents and if the conditions worsen despite weeks or months of standard pharmacologic treatment.