Pharmacology Chapter 16: Anti-Inflammatory, Antiarthritis, and Related Agents
A nurse is assessing a client who has been taking nonsteroidal anti-inflammatory drugs (NSAIDs) for many months. What statement by the client indicates to the nurse that the client has a good understanding of the use of this therapy?
"I asked my doctor to check for blood in my stool regularly."
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 is used to prevent or treat hyperuricemia, which commonly occurs with gout."
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." Explanation: 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.
A client is being discharged following an allergic reaction after ingesting aspirin. When providing client education about the allergy, the nurse would provide the client with what information?
"Do not take any NSAIDs." Explanation: In people who have demonstrated hypersensitivity to aspirin, all nonaspirin NSAIDs are also contraindicated because cross-hypersensitivity reactions may occur with any drugs that inhibit prostaglandin synthesis.
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 an aspirin substitute for pain and fever."
Aspirin increases the risk of bleeding and should generally be avoided for how many weeks before and after surgery?
1-2 weeks
A client is receiving a salicylate for fever reduction. The nurse would instruct the client to notify the primary health care provider if their fever continues past which time frame?
24 hours Explanation: If the drug is used to reduce fever, the client should contact the primary health care provider if the temperature continues to remain elevated for more than 24 hours. Temperatures that decrease in 4 to 12 hours with salicylate use usually signify there is a short-term viral response but no underlying infection. Fever lasting over 24 hours need to be investigated for infection or disease process that the body's immune response cannot overcome.
A 7-year-old child with juvenile arthritis has been prescribed auranofin 0.125 mg/kg/day PO. The client weighs 88 lbs. How many mg of auranofin should the nurse administer each day?
5 mg
A client began taking acetylsalicylic acid several years ago to prevent platelet aggregation following a myocardial infarction. Which dose of aspirin is the client most likely taking daily?
81 mg
A client began taking acetylsalicylic acid several years ago to prevent platelet aggregation following a myocardial infarction. Which dose of aspirin is the client most likely taking daily?
81 mg Explanation: The dose of aspirin given depends mainly on the condition being treated. Low doses (325 mg initially and 8081 mg daily) are used for the drug's antiplatelet effects in preventing arterial thrombotic disorders such as myocardial infarction and stroke. Doses higher than 81 mg would produce undesired side effects while not adding additional benefit to the prevention of platelet aggregation.
Which client is at highest risk for developing hepatotoxicity related to the use of acetaminophen?
A male 30 years of age who drinks four beers per day Explanation: Clients who consume more than three drinks per day habitually are at increased risk for developing hepatotoxicity. Aspirin should be used cautiously in clients with a vitamin K deficiency and hypoprothrombinemia.
A parent has sought care from the nurse practitioner to treat a child's fever. The nurse practitioner is most likely to recommend what nonsalicylate drug?
Acetaminophen Explanation: 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.
Which agent would be least appropriate to administer to a client with joint inflammation and pain?
Acetaminophen Explanation: Acetaminophen has analgesic and antipyretic properties but does not exert an anti-inflammatory effect. Therefore, it would not be indicated for joint inflammation. Ibuprofen, naproxen, and diclofenac have anti-inflammatory properties and would be appropriate for use.
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?
Acetaminophen Explanation: 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?
Acetylsalicylic acid Explanation: 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 home care nurse is seeing a 66-year-old female who has just been released from the hospital after being treated for rotator cuff repair. The nurse knows that it is important to assess the client's knowledge of which area?
Adverse effects of NSAIDs Explanation: The nurse should review adverse drug effects with client. The other factors are also important but the priority is to esnure the client is aware of and understands which adverse effects need to be reported immediately if detected.
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. Explanation: 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.
A patient with arthritis is on nonsteroidal anti-inflammatory drug (NSAID) therapy. What should be evaluated by the nurse to determine the effectiveness of NSAID therapy?
Better mobility Explanation: The nurse should report better mobility in the patient after NSAID drug therapy for arthritis. The patient's blood sugar, respiratory rate, and body temperature are not affected and, hence, are not evaluated by the nurse after treatment.
A client is receiving anakinra as treatment for arthritis. The nurse understands that this drug acts in which manner?
Blocks interleukin-1 Explanation: 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 student nurse asks the nurse why acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) help to reduce cancer pain. What is the nurse's best explanation?
Cancer often produces chronic pain from tumor invasion of tissues or complications of treatment. These drugs prevent sensitization of peripheral pain receptors by inhibiting prostaglandin formation.
A nurse is overseeing the care of a young man whose ulcerative colitis is being treated with oral prednisone. Which action should the nurse take in order to minimize the potential for risks associated with prednisone treatment?
Carefully assess the client for infections.
A group of nursing students are reviewing the pain-relieving action of NSAIDs. The students demonstrate understanding of the information when they identify which actions as being blocked to achieve pain relief?
Cyclooxygenase 2
The nurse Is caring for a client with joint pain whose primary health care provider has recommended the use of ibuprofen 400 mg PO t.i.d. What is the nurse's best response to this prescription?
Educate the client about possible adverse effects
The nurse is caring for a client with gout that is taking colchicine. In addition to the administration of this medication, what education can the nurse provide to help with the prevention of future episodes of gout?
Follow a low purine diet
The nurse is caring for a client with gout that is taking colchicine. In addition to the administration of this medication, what education can the nurse provide to help with the prevention of future episodes of gout?
Follow a low purine diet Explanation: The nurse should encourage the client to follow a low-purine diet which would exclude items such as any alcohol products, organ and game meat, sardines, anchovies, scallops, asparagus, spinach, and peas. Alcohol should not be used at all even in moderation to avoid future attacks of gout. For acute gouty flare-ups, take one dose and the second dose 1 hour later. The dose should not be doubled. Although severe diarrhea may occur, it is not an expected or therapeutic response and should be immediately reported to the health care provider.
An 80-year-old male client presents to the health care provider's office with reports of fatigue and a change in the color of stools. He self-administers ibuprofen 400 mg each night for general discomfort. The provider orders a stool test for guaiac, which yields positive results. The provider discontinues the ibuprofen. The nurse is responsible for a client education plan. The client should be educated regarding what as a risk with chronic use of NSAIDs?
GI bleed
A nurse is conducting a medication reconciliation for an older adult client who has just relocated to the long-term care facility. The nurse notes that the resident has been taking colchicine on a regular basis. Which medication regimen should signal the nurse to the possibility of what diagnosis?
Gout
A nurse has admitted a 10-year-old to the short-stay unit. The child reports chronic headaches, and his mother states that she gives the child acetaminophen at least twice a day. What will the nurse evaluate?
Hepatic function Explanation: The nurse should evaluate the patient's hepatic function. Severe hepatotoxicity can occur from over use of acetaminophen. Significant interferences do not occur in the kidney, heart, or lung with acetaminophen.
The client is taking antihypertensive medications. The client has now been diagnosed with osteoarthritis, and ketorolac has been added to the treatment regimen. The nurse evaluates the client for which potential interaction?
Hypertension
The client is taking antihypertensive medications. The client has now been diagnosed with osteoarthritis, and ketorolae has been added to the treatment regimen. The nurse evaluates the client for which potential interaction?
Hypertension
A nurse is caring for a client who has just been diagnosed with rheumatoid arthritis. What first-line treatment should the nurse anticipate?
Ibuprofen Explanation: NSAIDs such as ibuprofen are indicated for relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis, for relief of mild to moderate pain, for treatment of primary dysmenorrhea, and for fever reduction. Balsalazide is used to treat ulcerative colitis. Ketorolac is used to treat acute pain in the short term. Auranofin is a gold salt that is not a first-line treatment.
A salicylate is contraindicated in clients who have had surgery within the past week for which reason?
Increased risk for bleeding Explanation: Salicylates are contraindicated for clients who have had surgery within the past week because of the increased risk for bleeding. Their use in clients with an allergy to salicylates or tartrazine would increase the risk for an allergic reaction. Their use in clients with impaired renal function may increase the risk for toxicity because the drug is excreted in the urine. There is no associated risk for fluid imbalance and salicylate therapy.
What best describes the action of nonsteroidal anti-inflammatory drugs (NSAIDs)?
Inhibit prostaglandin synthesis Explanation: Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit prostaglandin synthesis. Salicylates block prostaglandin activity. Acetaminophen acts directly on thermoregulatory cells in the hypothalamus. Gold salts inhibit phagocytosis.
A patient with muscle ache would like to use an over-the counter nonsteroidal anti-inflammatory drug (NSAID). The patient informs a nurse that he is taking antihypertensive drugs for blood pressure control. Why should the nurse caution the patient against the use of an NSAID while on antihypertensive drug therapy?
It causes decreased effectiveness of the antihypertensive drug.
A client with mild low back pain has been advised to take acetaminophen. The nurse teaching the client about this medication would include that excessive intake of acetaminophen may result in which?
Liver damage Explanation: A client taking acetaminophen should be taught the common adverse effects of the drug, which include rash, urticaria, and nausea. Nausea, not gastrointestinal distress, is a common adverse effect of acetaminophen. Flushing, dizziness, and feelings of tingling, heat, and fatigue are the most common adverse effects of sumatriptan, not acetaminophen.
An 8-year-old child is experiencing pain following tonsillectomy. Which drug would be an appropriate pain reliever for this client?
Nonsalicylates
A client is recelving auranofin as treatment for rheumatold arthritis, The nurse should expect this drug to be given by which route?
Oral
When acetylsalicylic acid is administered in low doses, it blocks the synthesis of thromboxane A2. What physiologic effect results from this action?
Platelet aggregation is inhibited. Explanation: 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.
Which would a nurse include when explaining the actions of glucocorticoids?
Prostaglandin formation decreases.
An 11-year-old client is having a cavity filled in the left mandibular first molar. The health care provider has prescribed aspirin for pain relief after the procedure. The nurse discovers upon assessment that the child is suffering from a flulike illness. The nurse contacts the health care provider about the prescribed medication for pain. What is the risk if aspirin is administered to this client?
Reye syndrome Explanation: Aspirin is contraindicated in children with varicella or flulike illness because it is associated with the occurrence of Reye syndrome, a potentially fatal disease characterized by swelling in the brain, increased intracranial pressure, and seizures. Administration of the drug during flulike illness is not known to cause excess antiplatelet action, asthma, or salicylate poisoning.
A patient enters the emergency room with reports of visual changes, drowsiness, and tinnitus. The patient is confused and hyperventilating. These symptoms may be attributable to:
Salicylate intoxication Explanation: Salicylate intoxication may occur with an acute overdose of aspirin. Manifestations of salicylism include nausea, vomiting, fever, fluid and electrolyte deficiencies, tinnitus, decreased hearing, visual changes, drowsiness, confusion, hyperventilation, and others. Acute acetaminophen toxicity results in potentially fatal hepatotoxicity. Ibuprofen overdose will cause gastric mucosal damage. Caffeine overdose will produce tachycardia.
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 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 your risk of a second heart attack.
The nurse would question the health care provider who prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) for which client?
The client diagnosed with peptic ulcers Explanation: 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 health care provider 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 following vaginal birth and this order need not to be questioned.
A patient has been diagnosed with rheumatoid arthritis and Is experiencing pain and decreased mobility. Etanercept has been proposed as possible treatment option. Which characteristic of this patient would likely preclude the use of etanercept?
The patient has chronic osteomyelitis resulting from a diabetic foot ulcer.
Rheumatoid factor (RF) interacts with circulating IgG to form immune complexes that deposit in the joints precipitating an inflammatory reaction.
True Explanation: 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.
Which agent would be least appropriate to administer to a client with joint inflammation and pain?
acetaminophen
How should a nurse best explain the presence of the inflammation process?
as an attempt by the body to remove the damaging agent and repair the damaged tissue
A male patient has been prescribed methotrexate. The nurse should caution the patient against using which over-the counter medication?
aspirin
Prior to administering NSAIDs, the nurse asks the client about an allergy to:
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
A client's current drug regimen includes a nonsteroidal anti-inflammatory drug (NSAID) and a loop diuretic. What assessment should the nurse consequently prioritize
blood pressure
Which nonsteroidal anti-inflammatory drug (NSAID) appears to work by specifically inhibiting cyclooxygenase-2 (COX-2) without inhibiting cyclooxygenase-1 (COX-1);
celecoxib
A client with rheumatoid arthritis is taking a maintenance dose of prednisone every day. Which assessment findings indicate to the nurse that the medication has been effective? Select all that apply.
decreased pain increased mobility reduced edema of the joints ease of performing activities of daily living
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 inflammation moderate pain Explanation: 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.
A nurse is preparing to teach a client about the adverse effects of the prescribed NSAID therapy. Which system would the nurse include as being involved?
gastrointestinal
What drugs used to treat rheumatoid arthritis are contraindicated in a client who has a history of toxic levels of heavy metals?
gold salts Explanation: 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 patient enters the emergency room with reports of visual changes, drowsiness, and tinnitus. The patient is confused and hyperventilating. These symptoms may be attributable to:
salicylate intoxication. Explanation: Salicylate intoxication may occur with an acute overdose of aspirin. Manifestations of salicylism include nausea, vomiting, fever, fluid and electrolyte deficiencies, tinnitus, decreased hearing, visual changes, drowsiness, confusion, hyperventilation, and others. Acute acetaminophen toxicity results in potentially fatal hepatotoxicity. Ibuprofen overdose will cause gastric mucosal damage. Caffeine overdose will produce tachycardia.