module 2. pain and inflammatory

ADRs of ALL Salicylates(eg aspirin)

1. GI Irritation 2. HSR 3. Inhibition of platelet aggregation 4. Ototoxicity 5. Electrolyte imbalance 6. Reye's syndrome

When caring for a patient diagnosed with rheumatoid arthritis, the patient tells the nurse that he or she has had insufficient response to nonsteroidal anti-inflammatory drugs (NSAIDs) and his or her condition continues to worsen. What drug does the nurse anticipate will be ordered next for this patient?

A) Auranofin (Ridaura) B) Ibuprofen (Motrin) C) Acetaminophen (Tylenol) D) Ketorolac (Toradol) Ans: A Feedback: Gold compounds such as auranofin are prescribed when more usual anti-inflammatory therapies are ineffective and the patients condition worsens despite weeks or months of standard pharmacological treatment. Ibuprofen and ketorolac are NSAIDs, which have been tried without good results. Acetaminophen is not an anti-inflammatory and would not be appropriate to control this patients condition.

The nurse assesses laboratory results related to blood clotting when the assigned patient takes what drug regularly? (Select all that apply.)

A) Salicylates B) Nonsteroidal anti-inflammatory drugs (NSAIDs) C) Gold compounds D) Acetaminophen E) Disease-modifying antirheumatic drugs (DMARDs) Ans: A, B Feedback: Salicylates and NSAIDs can both inhibit blood clotting resulting in bleeding if not monitored. Gold compounds, acetaminophen, and DMARDs do not have a known impact on blood clotting.

A health care professional should advise a patient who has which of the following to stop taking ibuprofen (Advil) to treat an occasional headache or muscle strain? A) Penicillin allergy B) Peptic ulcer disease C) Dysmenorrhea D) Hyperthyroidism

ANS: B Rationale: Ibuprofen, an NSAID, is inappropriate for patients who have peptic ulcer disease. Health care professionals should monitor patients who are taking OTC analgesics for gastric bleeding, and test or treat patients who have H. pylori prior to long-term or repeated treatment with these drugs.

A patient who takes low-dose aspirin to prevent cardiovascular events asks a health care professional about taking ibuprofen (Advil) to treat rheumatoid arthritis. The health care professional should respond with which of the following statements? A) "Ibuprofen will increase the risk for salicylism." B) "Ibuprofen will reduce the antiplatelet effects of low-dose aspirin." C) "Low-dose aspirin will reduce the anti-inflammatory effects of ibuprofen." D) "Low-dose aspirin will reduce the analgesic effects of ibuprofen."

ANS: B Rationale: Ibuprofen, an NSAID, reduces the antiplatelet effects of low-dose aspirin. Patients taking low-dose aspirin for its antiplatelet effects should not take ibuprofen. ppt: : Aspirin adverse effects AE> clotting system issues(abnormal bleeding)

A health care professional is caring for an older adult patient who is about to begin taking aspirin to treat an ankle sprain. The health care professional should tell the patient to report which of the following adverse reactions? A) Polyuria B) Bone pain C) Weight gain D) Infection

ANS: C Rationale: Aspirin can cause renal dysfunction, especially in older adults and patients who have pre-existing renal or liver dysfunction and heart failure. Patients should report reduced urine output, weight gain, edema, or bloating. Health care professionals should monitor BUN and creatinine values, and stop aspirin therapy for patients who develop signs of renal dysfunction. PPT: Nephrotoxicity/ liver and renal function test

The nursing instructor is discussing COX-2 inhibitors with her nursing students. Where would the instructor tell her students that COX-2 inhibitors work?

At sites of trauma and injury The COX-2 inhibitors are thought to act only at sites of trauma and injury to more specifically block the inflammatory reaction. COX-1 is present in all tissues and seems to be involved in many body functions including blood clotting, protecting the stomach lining, and maintaining sodium and water balance in the kidney.

A patient presents at the emergency department complaining of dizziness, mental confusion, and difficulty hearing. What should the nurse suspect is wrong with the patient?

C) Salicylism Salicylism can occur with high dosage of aspirin. Dizziness, ringing in the ears, difficulty hearing, nausea, vomiting, diarrhea, mental confusion, and lassitude can occur.

A health care professional should question the use of acetaminophen (Tylenol) for patients who have which of the following? A) Asthma B) Diabetes mellitus C) Heart failure D) Alcohol use disorder

D) Alcohol use disorder

When the nurse learns that the patient with rheumatic arthritis is complaining of stomatitis, the nurse should further assess the patient for the adverse effects of what medication?

Gold-containing compounds Various adverse effects are common with the use of gold salts and are probably related to their deposition in the tissues and effects at that local level: stomatitis, glossitis, gingivitis, pharyngitis, laryngitis, colitis, diarrhea, and other GI inflammation; gold-related bronchitis and interstitial pneumonitis; bone marrow depression; vaginitis and nephrotic syndrome; dermatitis, pruritus, and exfoliative dermatitis; and allergic reactions ranging from flushing, fainting, and dizziness to anaphylactic shock.

A nurse is caring for a patient in the early stage of rheumatoid arthritis. The nurse would expect what medication classification to be used in the treatment of this patient?

Nonsteroidal anti-inflammatory drugs (NSAIDs)

COX-2 inhibitors increase the risk for cardiovascular problems?

Vasodilation is blocked. Platelet clumping is blocked.

A health care professional should advise patients to take acetaminophen (Tylenol) for which of the following? (Select all that apply.) A) To reduce fever B) To decrease inflammation C) To relieve mild pain D) To promote sedation E) To alleviate anxiety

A) To reduce fever C) To relieve mild pain

What produces pain sensations when stimulated by generating nerve impulses?

A-delta fibers C fibers

how acetaminophen works? therapeutic action

Acetaminophen acts directly on the hypothalamus to cause vasodilation and sweating.

According to the Gate Control Theory, what interventions by the nurse could help to block pain impulses?

Back massage

taking a COX-2 , needs to be assessed for what

Bleeding time Gastrointestinal (GI) effects Water retention

cleint education of overuse of acetaminophen, tell the parents it is important to do?

Check the label of over-the-counter (OTC) medications carefully to watch for inclusions of acetaminophen in the ingredients.

Which of the following drugs can increase the risk of Reye's syndrome in children who have viral infections? A) Butorphanol (Stadol) B) Acetaminophen (Tylenol) C) Tramadol (Ultram) D) Aspirin

D) Aspirin PPT: children-beware of Reyes

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

Tinnitus

The nurse is teaching the patient, who has been newly prescribed etanercept (Enbrel), how to administer the medication. What statement is accurate?

You can use each of the subcutaneous injection sites to avoid tissue damage. Etanercept is given by injecting it into the subcutaneous tissues. The injection sites should be rotated to avoid tissue damage. Because it is not taken orally, there is no requirement related to amount of water to be taken or waiting an hour after taking an antacid. Etanercept is not injected into the muscle but rather into the subcutaneous tissue.

Tinnitus

is associated with salicylate therapy.

The disease-modifying antirheumatic drug (DMARD) category of antimalarials

may cause visual changes, GI upset, rash, headaches, photosensitivity, and bleaching of hair.