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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