Chapter 24 Pharmacology

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inflammation

occurs in response to many different stimuli, including physical injury; exposure to toxic chemicals, extreme heat, or invading microorganisms, or death of cells.

signs of inflammation

swelling, pain, warmth, and redness of affected area.

inflammation may be classified as?

acute or chronic

histamine

key chemical mediator of inflammation. stored and released by mast cells; causes dilation of blood vessels, smooth muscle constriction, tissue swelling, and itching

anaphylaxis

rapid release of histamine on a larger scale throughout the body. this is a life-threatening allergic response that may result in shock and death

goal of pharmacotherapy with anti-inflammatory drugs

to prevent or decrease the intensity of the inflammatory response and reduce fever, if present.

two primary drug classes used for inflammation

NSAIDs and the glucocorticoids (corticosteroids)

preferred drugs for mild to moderate pain, inflammation, and fever

NSAIDs

preferred drugs for severe inflammation

corticosteroids. due to their serious long-term effects, glucocorticoids are usually used for only 1-3 weeks to bring inflammation under control, and then the pt is switched to NSAIDs

this drug is not considered an NSAID

acetaminophen. it can reduce pain and fever, but it has no anti-inflammatory action

sometimes drug of first choice for treating mild inflammation

aspirin. because it is readily available, inexpensive, and effective

most common adverse effect of aspirin

relate to the digestive system. pain, heartburn, and even bleeding due to ulceration

salicylism

syndrome that includes symptoms such as ringing in the ears, dizziness, headache, and sweating. Pts with preexisting kidney disease should be monitored carefully because aspirin and other NSAIDs may affect kidney function

most common adverse effects of ibuprofen and ibuprofen-like drugs

nausea and vomiting, although the incidence of gastric ulceration and bleeding is less that that of aspirin

contraindication of glucocorticoid therapy

active infection. because of their effectiveness at reducing the signs and symptoms of inflammation, these drugs can mask infectinos that may be present in the pt.

Cushing's syndrome

overtreatment. signs include bruising and a characteristic pattern of fat deposits in the cheeks (moon face), shoulders (buffalo hump), and abdomen

alternate-day therapy

the medication is taken every other day to encourage the pt's adrenal glands to functino on the days when no drug is taken

antigens

foreign substances that cause a specific immune response. proteins such as those present of the surfaces of pollen grains, bacteria, and viruses are the strongest ones

lymphocyte

primary cell of the immune system that interacts with antigens.

Humoral immunity

initiated when an antigen encounters a type of lymphocyte knows as a B cell. the antigen activates the B cell, which then divides rapidly to form many copies, or clones of itself.

vaccination (immunization)

process of introducing a foreign substance into the body to trigger immune activation before the pt is exposed to the real pathogen. These biologic immune stimulators are called...?

goal of vaccine adminstration

is to induce long-lasting immunity to a pathogen without producing an illness in an otherwise healthy person

attenuated (live) vaccines

contain microbes that are alive but weakened so they are unable to produce disease. Some can cause mild or subclinical symptoms of the disease. example is MMR vaccine

inactivated (killed) vaccines

contain microbes that are unable to replicate or cause disease. example is influenza vaccine

toxoids

types of vaccines that contain bacterial toxins that have been chemically modified to be incapable of causing disease.

recombinant vaccines

thsoe that contain partial organisms or bacterial proteins that are generated in the laboratory using biotechnology. example is Hep B vaccine

most vaccines are pregnancy category?

C

active immunity

body produces its own antibodies in response to exposure. this type of immunity induced by vaccines closely resembles that caused by natural exposure to the antigen, including the generation of memory cells

passive immunity

occurs when preformed antibodies are transferred or "donated" from one person to another. Drugs for this type of immunity are usually administered when the patient has already been exposed to a pathogen or is at very high risk to exposure, and there is not sufficent time to develop active immunity. Examples: gamma globulin, antivenoms, and sera. usually only last 2-3 weeks

Hepatitis B vaccine schedule

three doses, with the second dose 30 days after the first, and the final dose 6 months after the first

influenza vaccine schedule

single annual dose

MMR II vaccine schedule

children: first dose at age 12-15 months and booster at age 4-6 years

CDC recommends anthrax vaccinations for these populations:

laboratory personnel who work with anthrax, military personnel deployed to high-risk areas, and individuals who deal with animal products imported from areas with a high incidence of the disease

biologic response modifiers

administered to boost certain functions of the immune system

Indications for interferon (IFN) alpha therapy:

cancers, such as hairy cell leukemia and AIDS-related Kaposi's sarcoma, and chronic hepatitis virus B or C infections. Interferon is featured as a antineoplastic drug

azathioprine (Imuran)

severe RA. immunosuppressant

basiliximab (Simulect)

kidney transplant. immunosuppressant

cyclosporine (Neoral)

RA, severe psoriasis. immunosuppressant. primary adverse effect occurs in the kidney, with up to 75% of pts experiencing reduction in urine output. Frequent lab test of kidney function are necessary. Because this drug can damage the kidneys, other nephrotoxic drugs such as amphotericin B, NSAIDs, or aminoglycosides should be administered with great caution

what pts need to know regarding anti-inflammatory meds

take NSAIDs with food to decrease stomach irritation. avoid drinking alcohol. If ringing in the ears, dizziness, headache, or signs of bleeding or bruising occur, discontinue aspirin use immediately and report the incident to the HCP

never take cyclosporine with?

grapefruit juice; blood levels of the drug are increased by this combination

what pts need to know regarding immunosuppressants:

immediately report an elevation in temp, unusual bleeding, sore throat, mouth ulcers, and fatigue to the HCP

aspirin (Acetylsalicylic Acid, ASA)

inhibits formation of prostaglandins; also for fever, pain, and prevention of stroke and MI. NSAID

ibuprofen (Advil, Motrin)

blocks prostaglandin synthesis as well as modulates T-cell function; also for dysmenorrhea. NSAID

naproxen (Naprosyn)

also for dysmenorrhea. adverse effects iclude GI upset, dizziness, and drowsiness. NSAID

hydrocortisone (Cortef, Hydrocortone, Solu-Cortef)

used widely for skin inflammation. corticosteroid

methylprednisolone (Deop-Medrol, Medrol)

also for neoplasia and adrenal insufficiency. corticosteroid

prednisone

used for inflammation. corticosteroid. long-term therapy may result in Cushing's syndrome. Can raise blood glucose levels

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