Pharmacology Chapter 24

Duloxetine

A nurse is caring for a client who has new diagnosis of fibromyalgia. Which of the following medications should the nurse anticipate being prescribed for this client?

Nausea Rash Increased gout pain

A nurse is providing teaching for a client who has gout and a new prescription for allopurinol. For which of the following adverse effects should the client be taught to monitor? select all that apply

Allopurinol

Drug of choice for patients with chronic tophaceous gout

delayed

Leukocyte infiltration of the inflamed tissue occurs during _________________ phase of inflammation.

Allopurinol

A 65-year-old man has been diagnosed with chronic gout. The nurse anticipates that the patient will be treated with a. Allopurinol b. colchicine c. adalimumab d. infliximab

Aspirin has the potential to cause Reye's Syndrome in children

A father presents to the emergency department with his 4-year-old son. The father explains that his son had a fever, so he gave the child baby spirin to decrease the fever and it has not worked . What should concern the nurse about a 4-year-old receiving aspirin?

The subcutaneous site for redness following injection

A nurse is caring for a client who has a new prescription for adalimumab for rheumatoid arthritis. Based on the route of administration of adalimumab, which of the following should the nurse plan to monitor?

I'll let the doctor know if i develop sores in my mouth while taking this medication

A nurse is evaluating teaching for a client who has rheumatoid arthritis and a new prescription for ethotreate. Which of the following statements by the client indicates understanding of the teaching?

a. Anemia Celecoxib is a COX-2 inhibitor that is contraindicated in patients with anemia. Celecoxib can cause an increased risk of gastrointestinal adverse effects, including bleeding.

A patient has been prescribed celecoxib to treat arthritis. The nurse will contact the health care provider if the patient shows symptoms of which condition? a. Anemia b. Cataracts c. Glaucoma d. Hyperthyroidism

a. Colchicine

A patient is admitted to the hospital with an acute gout attack. The nurse expects that which medication will be ordered to treat acute gout? a. Colchicine b. Allopurinol c. Probenecid d. Sulfinpyrazone

c. Peptic ulcer disease

A patient is taking ibuprofen. The nurse understands that COX-1 and COX-2 inhibitors are different in that ibuprofen is more likely than celecoxib to cause which adverse effect? a. Fever b. Constipation c. Peptic ulcer disease d. Metallic taste when eating

Ketorolac

The first injectable NSAID

swelling pain redness heat loss of function

The five cardinal signs of inflammations are:

24

The half-life of corticosteroids is greater than _________________ hours.

does

The half-life of each NSAID (does/does not) differ greatly.

Crohn disease

The nurse identifies infliximab as useful in the treatment of rhuematoid arthritis as well as a. Crohn disease b. asthma c. peptic ulcer d. multiple sclerosis

b. "You can try enteric-coated aspirin." Gastric distress is a common problem with uncoated aspirin. Enteric-coated tablets can be used. Changing to another medication or taking the medication with milk are extreme measures that may not relieve the gastric distress.

The nurse is caring for a patient who states, "I can't take aspirin. It makes my stomach hurt." What is the nurse's best response to the patient? a. "You should take ibuprofen instead." b. "You can try enteric-coated aspirin." c. "I will see if you can get a prescription for another pain reliever." d. "Try taking the aspirin with milk."

Vasodilation with increased capillary permeability

What occurs during the vascular phase of inflammation?

5-10 days

When discontinuing steroid therapy, how long of period should the dosage should be tapered?

Ibuprofen is inhibits prostaglandins synthesis

When preaparing discharge teaching for a patient who has been prescribed ibuprofen for arthritis, how does the nurse explain the mode of action?

c. Have annual eye examinations

When teaching a patient who is receiving allopurinol, what should the nurse encourage the patient to do? a. Eat more meat b. Increase vitamin C intake c. Have annual eye examinations d. Take medication 2 hours before meals

higher

When using NSAID's for inflammation, the dosage is generally ______________ than that for pain relief.

Immunomodulator

A 35 -year-old woman diagnosed with rheumatoid arthritis has been prescribed infliximab. The nurse identifies infliximab as which type of medication? a. Immunosuppressive b. Immunomodulator c. Antimalarial d. Steroid

Monitor the client for hypersensitivity

A nurse is preparing to administer belimumab for a client who has systemic lupus erythematosus. Which of the following actions should the nurse plan to take?

a. Tinnitus

A patient is taking aspirin for arthritis. Which adverse reaction should the nurse teach the patient to report to the health care provider? a. Tinnitus b. Seizures c. Sinusitis d. Palpitations

Aspirin and warfarin

A patient with a complicate medical history including hypertension, atrial fibrillation, and arthritis calls the health care providers office to speak with a nurse about all of these bruises I have all of a sudden. Which potential drug interaction should concern the nurse with these symptoms?

Oxicams

Indicated for long-term arthritic conditions

injury infection

Inflammation is a response to tissue ________________ and ______________.

Bronchospasm

The patient with a history of asthma has been prescribed sulfasalazine for arthritis. What can salicylic acid and salicylate derivatives cause that should concern the nurse?

a. Black, tarry stools A major side effect of NSAID therapy is gastrointestinal (GI) distress with potential GI bleeding. Black, tarry stools are indicative of a GI bleed. Headaches, cough, and palpitations should not result from the use of NSAID medications.

Which assessment finding in a patient taking NSAIDs requires immediate intervention? a. Black, tarry stools b. Headache c. Nonproductive cough d.Palpitations

a. Pain has decreased from "a 6 to a 1" on a scale of 10. Prostaglandins are produced in response to activation of the arachidonic acid pathway. Nonsteroidal anti-inflammatory 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 PTT, the bleeding time, and the increased extremity circulation will not necessarily be correlated with the effectiveness of the NSAID medication.

Which assessment finding indicates that the nonsteroidal anti-inflammatory drug has been effection? a. Pain has decreased from "a 6 to a 1" on a scale of 10. b. Patient's bleeding time is prolonged. c. Patient has increased circulation to his legs. d. PTT is 100 seconds.

CHAPTER

24

Immunomodulators

Disrupts the inflammatory process and delays disease progrssion

Cochicine

The first drug used to treat gout

It inhibits the migration of leukocytes to the inflamed area

By which action does colchicine relieve the symptoms of gout?

Celecoxib

Cyclooxygenase inhibitor

Long half-life

What advantage dows piroxicam have over othe NSAIDs?

Acetylsalicylic acid (ASA)

Oldest antiinflammatory agent

Indomethacin

One of the first nonsteroidal anitiinflammatory drugs (NSAID's) introduced

Inhibition of the reabsorption of uric acid

Uricosuric agents such as probenecid are used in the treatment of gout. What is the mechanism of action?

Fenamates

Potent class of NDAID use for acute and chronic arthritic

PRACTICE

QUESTIONS #5

Increase fluid intake Avoid alcoholic beverages Avoid foods high in purine Take the drug with food

The nurse is planning teaching regarding antigout drug. What information should be included? select all that apply

Intravenously

The patient asks the nurse how the infliximab will be administered. The nurse should respond that this medication is administered. a. orally b. subcutaneously c. intramuscularly d. intravenously

Now i wont have to drink so much water

A 35-year-old female patient has been prescribed ibuprofen 400 mg tid for arthritis. What statement by the patient would indicate a need for further education?

Avoid taking aspirin with ibuprofen Take with food to reduce GI upset Monitor for bleeding gums, nosebleeds. black tarry stools

A patien has been advised to take ibuprofen. When teaching the patient about ibuprofen, which instruction should the nurse include? select all that apply a. Avoid taking aspirin with ibuprofen b. Take with food to reduce GI upset c. Monitor for bleeding gums, nosebleeds. black tarry stools d. Take herbs, ginkgo and garlic, with ibuprofen e. Take NSAIDs 2 days before menstruation to decrease discomfort

It neutralizes tumor necrosis factor (TNF), thereby altering the inflammatory response.

A patient has been switched to the immonomodulator etanercept for severe rhumatoid arthritis. What is the mechanism of actoin for etanercept?

d. Notify your health care provider that the medication is not effective If pain persists, the best advice is for the patient to switch to another pain reliever, such as ibuprofen. Increasing the dose of aspirin may lead to gastric distress. Changing the medication regimen is outside of the nurse's scope of practice.

A patient has been taking aspirin for chronic pain. The patient states that the pain is not relieved with 650 mg of aspirin every 4 hours. What is the best instruction for the nurse to give the patient? a. Increase your dose to 1000 mg every 4 hours. b.Alternate aspirin and a narcotic analgesic every 4 hours. c. Take aspirin and a COX-1 inhibitor at the same time. d.Notify your health care provider that the medication is not effective.

Corticosteroids are used to control arthritic flare-ups in severe cases. Corticosteroids are usually administered once a day Corticosteroids are tapered over the course of 5-10 days

A patient has started taking corticosteroids for an arthritic condition. What information should the nurse include in a health teaching plan? select all that apply

a. Fatigue b. Headache c. Chest pain e.Severe infections

A patient is taking infliximab and asks the nurse what side effects /adverse reactions to expect from this drug. The nurse list which side effects? a. Fatigue b. Headache c. Chest pain d. Renal damage e.Severe infections

Do your take your drug with food? Have you notices a change in the color of your bowel movement? What dosage of the NSAID are taking? Where is the heartburn located?

A patient who is taking NSAIDs for arthritis complains of persidtent heartburn. What further question(s) should the nurse ask the patient about the heartburn? select all that apply

b. My stomach aches and burns

An older adult patient takes tometin for arthritis pain. Which statement made by the patient is of most concern to the nurse? a. I feel like I am coming down with a cold b. My stomach aches and burns c. I have a bad headache d. I fell dizzy when i get up fast

It tends to cause less GI irritation

Ibuprofen is a frequently prescribed antiinflamatory, analgesic and antipyretic. What is a positive aspect of this drug in relation to other NSAIDs?

a. Advise the patient to avoid alcohol whole taking aspirin. c. instruct the patient to inform the dentist of the aspirin dosage before having dental work d. Instruct the patient to inform the surgeon of the aspirin dosage before having surgery

The nurse is teaching a patient about taking aspirin. Which are important points to include? select all that apply a. Advise the patient to avoid alcohol whole taking aspirin. b. Instruct the patient to take aspirin before meals on an empty stomach c. instruct the patient to inform the dentist of the aspirin dosage before having dental work d. Instruct the patient to inform the surgeon of the aspirin dosage before having surgery. e. Suggest that aspirin may be given to children for flu symptoms.

b. Avoid taking aspirin concurrently. Aspirin use should be avoided because it causes uric acid retention. Blood dyscrasias occur rarely. Calcium does not affect drug levels, and taking the pulse is not indicated.

The nurse providing patient education to the patient starting probenecid for treatment of gout should include which fact in the teaching plan? a. Increase intake of calcium. b. Avoid taking aspirin concurrently. c.Take pulse daily. d. Watch for tarry stools.

Bring the patient to the emergency department or clinic for further evaluation

The patient has been prescribed infliximab for severe rheumatoid arthritis.Her spouse calls the clinic and states his wife has a fever of 101.9 F, chills, nausea, vomiting ans is very dizzy. What will the nurse advise the patients spouse to do?

a. "Do not take this medication during an acute attack of gout." Allopurinol should not be taken during an acute attack because the initial response to allopurinol is an exacerbation of the symptoms. It is used prophylactically to prevent gout and treat hyperuricemia. It should not be taken with an antacid, will not be affected by the patient's usual diet, and will not result in a change in the color of the urine.

What is the most important information for the nurse to include in a teaching plan for the patient receiving allopurinol? a. "Do not take this medication during an acute attack of gout." b. "Include salmon and organ meats in your diet weekly." c. "Take the medication with an antacid to minimize gastrointestinal distress." d. "This medication may cause your urine to turn orange."

d. Administer ketorolac IV every 4 hours PRN Ketorolac is the only NSAID that can be administered by injection (intramuscularly or intravenously) and is indicated for short-term use for severe to moderate pain. Acute postoperative pain cannot be effectively managed on oral medication.

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

a. Uloric reduces the synthesis of uric acid. Uloric blocks hypoxanthine and xanthine metabolism to reduce uric acid synthesis to decrease uric acid blood and urine concentrations

Which statement best describes the method of actions of Uloric? a. Uloric reduces the synthesis of uric acid. b. Uloric increases the renal excretion of uric acid. c. Uloric reduces inflammation associated with gout. d. Uloric increases purine metabolism.

d. "Take an aspirin every day even though you are on nabumetone." Nabumetone is a COX-2 inhibitor and does not inhibit platelet aggregation. Patients at risk for stroke or heart attack who take aspirin to prevent blood clotting (decrease platelet aggregation) would not benefit from COX-2 inhibitors. The nurse should not reinforce the patient's ideas about the medication that are erroneous.

at risk for stroke tells the nurse that the doctor "told me to take aspirin every day." The patient states that he is on nabumetone daily, so he does not need to take the aspirin also. What is the nurse's best response to the patient? a. "You are correct." b. "You should take Tylenol every day instead." c. "Ask your doctor to increase your dose of Relafen." Nabumetone is a COX-2 inhibitor and does not inhibit plate d. "Take an aspirin every day even though you are on nabumetone."