142 terms

Immune System: Drugs for Inflammation and Fever

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WHAT IS A NONSPECIFIC DEFENSE SYSTEM OF THE BODY?
INFLAMMATION
THROUGH THE PROCESS OF INFLAMMATION, WHAT OCCURS?
A LARGE NUMBER OF POTENTIALLY DAMAGING CHEMICALS AND MICROORGANISMS MAY BE NEUTRALIZED.
INFLAMMATION IS A BODY DEFENSE MECHANISM THAT OCCURS IN RESPONSE TO MANY DIFFERENT STIMULI, INCLUDING?
PHYSICAL INJURY
EXPOSURE TO TOXIC CHEMICALS
EXTREME HEAT
INVADING MICROORGANISMS
DEATH OF CELLS
INFLAMMATION IS CONSIDERED WHAT TYPE OF DEFENSE?
IT IS CONSIDERED AN INNATE (NONSPECIFIC) DEFENSE MECHANISM BECAUSE INFLAMMATION PROCEEDS IN THE SAME MANNER, REGARDLESS OF THE CAUSE THAT TRIGGERED IT.
WHAT IS THE CENTRAL PURPOSE OF INFLAMMATION?
IS TO CONTAIN THE INJURY OR DESTROY THE MICROORGANISM.
BY NEUTRALIZING THE FOREIGN AGENT AND REMOVING CELLULAR DEBRIS AND DEAD CELLS?
REPAIR OF THE INJURED AREA IS ABLE TO PROCEED AT A FASTER PACE.
SIGNS OF INFLAMMATION INCLUDE?
SWELLING
PAIN
WARMTH
REDNESS OF THE AFFECTED AREA
INFLAMMATION MAY BE CLASSIFIED AS?
ACUTE OR CHRONIC
ACUTE INFLAMMATION HAS WHAT KIND OF ONSET?
HAS AN IMMEDIATE ONSET AND 8-10 DAYS ARE NORMALLY NEEDED FOR THE SYMPTOMS TO RESOLVE AND FOR REPAIR TO BEGIN.
IF THE BODY CANNOT CONTAIN OR NEUTRALIZE THE DAMAGING AGENT, INFLAMMATION MAY?
CONTINUE FOR LONG PERIODS AND BECOME CHRONIC.
CHRONIC INFLAMMATION HAS WHAT KIND OF ONSET?
HAS A SLOWER ONSET AND MAY CONTINUE FOR PROLONGED PERIODS.
WHEN MAY CHRONIC INFLAMMATION PERSIST FOR YEARS, WITH SYMPTOMS BECOMING PROGRESSIVELY WORSE OVER TIME?
IN AUTOIMMUNE DISORDERS SUCH AS SYSTEMIC LUPUS ERYTHREMATOSUS (SLE)
RHEUMATOID ARTHRITIS (RA)
OTHER CHRONIC DISORDERS SUCH AS WHAT MAY ARISE AT PREDICTABLE TIMES DURING EACH YEAR, AND INFLAMMATION MAY PRODUCE ONLY MINOR, ANNOYING SYMPTOMS?
SEASONAL ALLERGY
WHETHER THE INJURY IS DUE TO PATHOGENS, CHEMICALS, OR PHYSICAL TRAUMA, THE DAMAGED TISSUE RELEASES A NUMBER OF WHAT? AND WHAT DO THEY DO?
CHEMICAL MEDIATORS THAT ACT AS "ALARMS" TO NOTIFY THE SURROUNDING AREA OF THE INJURY.
CHEMICAL MEDIATORS OF INFLAMMATION INCLUDE?
HISTAMINE
LEUKOTRIENES
BRADYKININ
COMPLEMENT
PROSTAGLANDINS
SOME OF THESE INFLAMMATORY MEDIATORS ARE IMPORTANT TARGETS FOR?
ANTI-INFLAMMATORY DRUGS. FOR EXAMPLE, ASPIRIN AND IBUPROFEN ARE PROSTAGLANDIN INHIBITORS THAT ARE EFFECTIVE AT TREATING FEVER, PAIN, AND INFLAMMATION.
WHAT IS A KEY CHEMICAL MEDIATOR OF INFLAMMATION?
HISTAMINE
HISTAMINE IS STORED HOW?
IT IS STORED PRIMARILY WITHIN MAST CELLS LOCATED IN TISSUE SPACES UNDER EPITHELIAL MEMBRANES SUCH AS THE SKIN, BRONCHIAL TREE, DIGESTIVE TRACT, AND ALONG BLOOD VESSELS.
MAST CELLS DETECT?
FOREIGN AGENTS OR INJURY AND RESPOND BY RELEASING HISTAMINE, WHICH INITIATES THE INFLAMMATORY RESPONSE WITHIN SECONDS.
DRUGS THAT ACT AS ANTAGONISTS AT HISTAMINE RECEPTORS ARE IN WIDESPREAD THERAPEUTIC USE FOR THE TREATMENT OF?
ALLERGIC RHINITIS
WHEN RELEASED AT AN INJURY SITE, HISTAMINE DOES WHAT?
DILATES NEARBY BLOOD VESSELS, CAUSING CAPILLARIES TO BECOME MORE PERMEABLE.
WHAT CAN THEN ENTER THE AREA TO NEUTRALIZE FOREIGN AGENTS?
PLASMA, COMPLEMENT PROTEINS, AND PHAGOCYTES
THE AFFECTED AREA MAY BECOME?
CONGESTED WITH BLOOD, WHICH CAN LEAD TO SIGNIFICANT SWELLING AND PAIN.
THE RAPID RELEASE OF THE INFLAMMATORY MEDIATORS ON A LARGE SCALE THROUGHOUT THE BODY IS RESPONSIBLE FOR?
ANAPHYLAXIS, A LIFE-THREATENING ALLERGIC RESPONSE THAT MAY RESULT IN SHOCK AND DEATH.
A NUMBER OF CHEMICALS, INSECT STINGS, FOODS, AND SOME THERAPUETIC DRUGS CAN CAUSE THIS WIDESPREAD RELEASE OF?
HISTAMINE FROM MAST CELLS IF THE PERSON HAS AN ALLERGY TO THESE SUBSTANCES.
WHAT IS BRADYKININ?
PRESENT IN AN INACTIVE FORM IN PLASMA AND MAST CELLS; VASODILATOR THAT CAUSES PAIN; EFFECTS ARE SIMILIAR TO THOSE OF HISTAMINS; BROKEN DOWN BY ANGIOTENSIN-CONVERTING ENZYME (ACE)
WHAT IS COMPLEMENT?
SERIES OF AT LEAST 20 PROTEINS THAT COMBINE IN A CASCADE FASHION TO NEUTRALIZE OR DESTROY AN ANTIGEN; STIMULATES HISTAMINE RELEASE BY MAST CELLS
WHAT IS HISTAMINE?
STORED AND RELEASED BY MAST CELLS; CAUSES VASODILATION, SMOOTH-MUSCLE CONSTRICTION, TISSUE SWELLING, AND ITCHING
WHAT IS LEUKOTRIENES?
STORED AND RELEASED BY MAST CELLS; EFFECTS ARE SIMILAR TO THOSE OF HISTAMINE; CONTRIBUTES TO SYMPTOMS OF ASTHMA AND ALLERGIES
WHAT IS PROSTAGLANDINS?
PRESENT IN MOST TISSUES AND STORED AND RELEASED BY MAST CELLS; INCREASE CAPILLARY PERMEABILITY, ATTRACT WHITE BLOOD CELLS TO SITE OF INFLAMMATION, CAUSE PAIN AND INDUCE FEVER
WHEN THERE IS CELLULAR INJURY IN ACUTE INFLAMMATION MAST CELLS RELEASE?
RELEASE OF CHEMICAL MEDIATORS: HISTAMINE, BRADYKININ, COMPLEMENT, AND LEUKOTRIENES
THESE CHEMICAL MEDIATORS DO WHAT?
VASODILATION (REDNESS, HEAT)
VASCULAR PERMEABILITY (EDEMA)
CELLULAR INFILTRATION (PUS)
THROMBOSIS (CLOTS)
STIMULATION OF NERVE ENDINGS (PAIN)
BC INFLAMMATION IS A NONSPECIFIC PROCESS AND MAY BE CAUSED BY SUCH A VARIETY OF ETIOLOGIES, IT MAY OCCUR IN VIRTUALLY ANY TISSUE OR ORGAN SYSTEM. WHEN TREATING INFLAMMATION, WHAT GENERAL PRINCIPLES APPLY?
INFLAMMATION IS NOT A DISEASE, BUT A SYMPTOM OF AN UNDERLYING DISORDER. WHENEVER POSSIBLE, THE CAUSE OF THE INFLAMMATION SHOULD BE IDENTIFIED AND TREATED.
INFLAMMATION IS A NATURAL PROCESS FOR RIDDING THE BODY OF ANTIGENS, AND IT IS USUALLY SELF-LIMITING. FOR MILD SYMPTOMS, NONPHARMACOLOGIC TREATMENTS SUCH AS ICE PACKS AND REST SHOULD BE USED WHENEVER APPLICABLE.
TOPICAL DRUGS SHOULD BE USED WHEN APPLICABLE BECAUSE THEY CAUSE FEW ADVERSE EFFECTS. INFLAMMATION OF THE SKIN AND MUCOUS MEMBRANES OF THE MOUTH, NOSE, RECTUM, AND VAGINA ARE BEST TREATED WITH TOPICAL DRUGS. THESE INCLUDE ANTI-INFLAMMATORY CREAMS, OINTMENTS, PATCHES, SUPPOSITORIES, AND INTRANASAL SPRAYS. MANY OF THESE PRODUCTS ARE AVAILABLE OTC.
THE GOAL OF PHARMACOTHERAPY WITH ANTI-INFLAMMATORY DRUGS IS?
TO PREVENT OF DECREASE THE INTENSITY OF THE INFLAMMATORY RESPONSE AND REDUCE FEVER, IF PRESENT.
MOST ANTI-INFLAMMATORY MEDICATIONS ARE NONSPECIFIC; THE DRUG WILL?
EXHIBIT THE SAME INHIBITORY ACTIONS REGARDLESS OF THE CAUSE OF THE INFLAMMATION.
COMMON DISEASES THAT BENEFIT FROM ANTI-INFLAMMATORY THERAPY INCLUDE?
ALLERGIC RHINITIS, ANAPHYLAXIS, ANKYLOSING SPONDYLITIS, CONTACT DERMATITIS, CHRON'S DISEASE, GLOMERULONEPHRITIS, HASHIMOTO'S THYROIDITIS, PUD, RA, SLE, AND ULCERATIVE COLITIS.
WHAT ARE THE TWO PRIMARY DRUG CLASSES USED FOR INFLAMMATION?
THE NSAIDS AND CORTICOSTEROIDS.
FOR MILD TO MODERATE PAIN, INFLAMMAITON, AND FEVER, WHAT ARE THE DRUGS OF CHOICE?
NSAIDS
SHOULD INFLAMMATION BECOME SEVERE OR DISABLING, WHAT IS USED?
CORTICOSTEROID THERAPY IS BEGUN.
DUE TO THEIR SERIOUS LONG-TERM ADVERSE EFFECTS, CORTICOSTEROIDS ARE USUALLY USED FOR?
ONLY 1-3 WEEKS TO BRING ACUTE INFLAMMATION UNDER CONTROL. THE PT IS THEN SWITCHED TO NSAIDS.
A FEW ANTI-INFLAMMATORY DRUG CLASSES ARE SPECIFIC FOR CERTAIN DISORDERS. FOR EXAMPLE, SULFASALAZINE (AZULFIDINE) IS SPECIFIC TO TREATING? COLCHICINE AND ALLOPURINOL (ZYLOPRIM) ARE USED FOR?
INFLAMMATORY BOWEL DISEASE
GOUTY ARTHRITIS
THESE MORE SPECIFIC ANTI-INFLAMMATORY DRUGS ARE LESS WIDELY PRESCRIBED BECAUSE?
THEY EXHIBIT MORE SERIOUS ADVERSE EFFECTS THAN THE NSAIDS
WHAT ARE TWO EXAMPLES OF NSAIDS AND WHAT DO THEY DO?
NSAIDS SUCH AS ASPIRIN AND IBUPROFEN HAVE ANALGESIC, ANTIPYRETIC, AND ANTI-INFLAMMATORY PROPERTIES. THEY ARE WIDELY PRESCRIBED FOR MILD TO MODERATE INFLAMMATION.
BC OF THEIR RELATIVELY HIGH SAFETY MARGIN AND AVAILABILITY AS OTC DRUGS, THE NSAIDS ARE DRUGS OF CHOICE FOR THE TREATMENT OF?
MILD TO MODERATE INFLAMMATION.
THE NSAID CLASS INCLUDES SOME OF THE MOST FREQUENTLY USED DRUGS IN MEDICINE, INCLUDING ASPIRIN AND IBUPROFEN. ALL NSAIDS HAVE APPROXIMATELY THE SAME EFFICACY, ALTHOUGH THE ADVERSE EFFECT PROFILES VARY AMONG THE DIFFERENT DRUGS. NSAIDS ALSO EXHIBIT?
ANALGESIC AND ANTIPYRETIC ACTIONS.
ALTHOUGH ACETAMINOPHEN SHARES THE ANALGESIC AND ANTIPYRETIC PROPERTIES OF THESE OTHER DRUGS, IT HAS NO WHAT?
ANTI-INFLAMMATORY ACTION AND IS NOT CLASSIFIED AS AN NSAID.
NSAIDS ACT BY?
INHIBITING THE SYNTHESIS OF PROSTAGLANDINS
PROSTAGLANDINS ARE?
LIPIDS FOUND IN ALL TISSUES THAT HAVE POTENT PHYSIOLOGICAL EFFECTS, IN ADDITION TO PROMOTING INFLAMMATION, DEPENDING ON THE TISSUE IN WHICH THEY ARE FOUND.
NSAIDS BLOCK INFLAMMATION BY?
INHIBITING CYCLOOXYGENASE (COX), THE KEY ENZYME IN THE BIOSYNTHESIS OF PROSTAGLANDINGS.
THERE ARE TWO FORMS OF COX?
COX-1 AND COX-2
COX-1 IS PRESENT IN ALL TISSUES AND SERVES?
PROTECTIVE FUNCTIONS SUCH AS REDUCING GASTRIC ACID SECRETION, PROMOTING RENAL BLOOD FLOW, AND REGULATING SMOOH MUSCLE TONE IN BLOOD VESSELS AND THE BRONCHIAL TREE.
COX-2, ON THE OTHER HAND, IS FORMED ONLY AFTER?
TISSUE INJURY AND SERVES TO PROMOTE INFLAMMATION.
THUS, TWO NEARLY IDENTICAL ENZYMES SERVE VERY DIFFERENT FUNCTIONS. FIRST-GENERATION NSAIDS SUCH AS WHAT DO WHAT?
ASPIRIN AND IBUPROFEN BLOCK BOTH COX-1 AND COX-2
ALTHOUGH THIS INHIBITION REDUCES INFLAMMATION, THE INHIBITION OF COX-1 RESULTS IN?
UNDESIRABLE EFFECTS SUCH AS BLEEDING, GASTRIC UPSET, AND REDUCED KIDNEY FUNCTION.
MOST OF THE ADVERSE EFFECTS OF ASPIRIN AND IBUPROFEN ARE DUE TO?
INHIBITION OF COX-1, THE PROTECTIVE FORM OF THE ENZYME.
ASPIRIN BELONGS TO THE CHEMICAL FAMILY KNOWN AS THE?
SALICYLATES
SINCE THE DISCOVERY OF SALICYLATES IN 1828, ASPRIIN HAS BECOME ONE OF THE MOST HIGHLY USED DRUGS IN THE WORLD. ASPRIIN BINDS TO?
BOTH COX-1 AND COX-2 ENZYMES, CHANGING THEIR STRUCTURES AND PREVENTING THEM FROM FORMING INFLAMMATORY PROSTAGLANDINS.
THIS INHIBITION OF COX IS PARTICULARLY PROLONGED IN PLATELETS; A SINGLE DOSE OF ASPIRIN MAY CAUSE TOTAL INHIBITION FOR THE ENTIRE 8- TO 11- DAY LIFE SPAN OF A PLATELET. ASPIRIN IS OFTEN A PREFERRED DRUG FOR TREATING MILD PAIN AND INFLAMMATION BECAUSE?
IT IS READILY AVAILABLE, INEXPENSIVE, AND EFFECTIVE
ASPIRIN ALSO HAS A PROTECTIVE EFFECT ON THE CARDIOVASCULAR SYSTEM AND IS TAKEN DAILY IN SMALL DOSES TO PREVENT?
ABNORMAL CLOT FORMATION, MIS, AND STROKES
UNFORTUNATELY, THE LARGE DOSES OF ASPIRIN THAT ARE NEEDED TO SUPPRESS SEVERE INFLAMMATION MAY RESULT IN A HIGH INCIDENCE OF?
ADVERSE EFFECTS, ESPECIALLY ON THE DIGESTIVE SYSTEM.
WHAT ARE THE ADVERSE EFFECTS IT CAUSES AND HOW?
BY INCREASING GASTRIC ACID SECRETION AND IRRITATING THE STOMACH LINING, ASPIRIN CAN CAUSE EPIGASTRIC PAIN, HEARTBURN, AND EVEN BLEEDING DUE TO ULCERATION.
SOME ASPIRIN FORMULATIONS ARE BUFFERED OR GIVEN AN ENTERIC COATING TO MINIMIZE ADVERSE GI EFFECTS. IN SOME PTS, HOWEVER, EVEN SMALL DOSES MAY CAUSE GI BLEEDING. RISK FACTORS FOR ASPIRIN-INDUCED GI BLEEDING INCLUDE?
HX OF PEPTIC ULCERS, AGE GREATER THAN 60, USE OF ANTICOAGULANTS OR CORTICOSTEROIDS, H. PYLORI INFECTION, SMOKING, AND USE OF ALCOHOL.
BC ASPIRIN ALSO HAS A POTENT ANTIPLATELET EFFECT, THE POTENTIAL FOR BLEEDING MUST BE CAREFULLY MONITORED. HIGH DOSES MAY PRODUCE?
SALICYLISM, A SYNDROME THAT INCLUDES SYMPTOMS SUCH AS TINNITUS (RINGING IN THE EARS), DIZZINESS, HEADACHE, AND EXCESSIVE SWEATING.
CHILDREN UNDER THE AGE OF WHAT SHOULD NEVER BE ADMINISTERED PRODUCTS THAT CONTAIN ASPIRIN WHEN THEY HAVE FLU SYMPTOMS, FEVER, OR CHICKENPOX DUE TO THE RISK OF?
19 BC REYE'S SYNDROME, A POTENTIALLY FATAL DISEASE.
WHAT ARE THE ADVERSE EFFECTS OF NSAIDS?
STOMACH PAIN, HEARTBURN, N/V, TINNITUS, PROLONGED BLEEDING TIME
IBUPROFEN (MOTRIN, ADVIL) AND A LARGE NUMBER OF IBUPROFEN-LIKE DRUGS ARE NSAIDS THAT WERE DEVELOPED AS ALTERNATIVES TO ASPIRIN. LIKE ASPIRIN, HOW DO THEY EXHIBIT THEIR EFFECTS?
THEY EXHIBIT THEIR EFFECTS THROUGH INHIBITION OF BOTH COX-1 AND COX-2, ALTHOUGH THE INHIBITION BY THESE DRUGS IS REVERSIBLE.
SHARING THE SAME MECHANISM OF ACTION, ALL DRUGS IN THIS CLASS HAVE SIMILAR EFFICACY FOR TREATING PAIN, FEVER, AND INFLAMMATION. FOR SOME PTS, THE CHOICE OF NSAID IS BASED ON COST AND AVAILABILITY: ASPIRIN, IBUPROFEN, AND NAPROXEN (ALEVE) ARE THE ONLY NSAIDS SOLD OTC. NSAIDS DIFFER IN THIER DURATION OF ACTION, WHICH?
MAY BE IMPORTANT WHEN PTS ARE TAKING THESE DRUGS ON AN ONGOING BASIS.
ALTHOUGH DRUGS IN THIS CLASS HAVE SIMILAR OVERALL EFFECTIVENESS, THERE IS VARIABILITY IN RESPONSE TO NSAIDS, WITH SOME PTS RESPONDING BETTER TO A PARTICULAR DRUG. THE CHOICE OF PRESCRIPTION NSAID IS OFTEN BASED ON THE?
CLINICAL EXPERIENCES AND PREFERENCE OF THE PRESCRIBER.
MOST IBUPROFEN-LIKE NSAIDS SHARE A LOW INCIDENCE OF ADVERSE EFFECTS. THE MOST COMMON ADVERSE EFFECTS ARE?
N/V
THESE MEDS HAVE THE POTENTIAL TO CAUSE?
GASTRIC ULCERATION AND BLEEDING; HOWEVER, THE INCIDENCE IS LESS THAN THAT OF ASPIRIN. ADVERSE GASTRIC EFFECTS ARE ESPECIALLY PROMINENT IN OLDER PTS AND THSOE WITH PUD.
SOME NEWER FORMULATIONS COMBINE AN NSAID WITH A DRUG THAT PROTECTS THE GASTRIC MUCOSA, SUCH AS?
VIMOVO(NAPROXEN WITH OMEPRAZOLE) AND DUEXIS(IBUPROFEN WITH FAMOTIDINE)
WHAT IS POSSIBLE, AND WHAT SHOULD BE CONDUCTED PERIODICALLY?
KIDNEY TOXICITY AND RENAL ASSESSMENTS
PTS WITH SIG PRE-EXISTING RENAL IMPAIRMENT USUALLY RECEIVE?
ACETAMINOPHEN FOR PAIN OR EVER, RATHER THAN AN NSAID.
IBUPROFEN-LIKE NSAIDS AFFECT?
PLATELET FUNCTION AND INCREASE THE POTENTIAL FOR BLEEDING, ALTHOUGH THIS RISK IS LOWER THAN THE RISK FROM ASPIRIN.
AN FDA BOXED WARNING STATES THAT IBUPROFEN AND OTEHR NSAIDS ARE ASSOCIATED WITH AN INCREASED RISK OF?
THROMBOEMBOLIC EVENTS (INCLUDING STROKE AND MI) AND THAT THE DRUGS MAY CUASE OR WORSEN HTN.
FOR THE OCCASIONAL USER WHO TAKES THE MEDICATIONS AT RECOMMENDED DOSES AND WHO HAS NO RISK FACTORS, THE DRUGS ARE?
SAFE AND RARELY PRODUCE ANY SIG. ADVERSE EFFECTS
WHAT ARE THE ADVERSE EFFECTS OF IBUPROFEN AND IBUPROFEN-LIKE DRUGS?
DYSPEPSIA, DIZZINESS, HA, DROWSINESS, TINNITUS, RASH, PRURITUS, INCREASED LIVER ENZYMES, PROLONGED BLEEDING TIME, EDEMA, NAUSEA, VOMITING, OCCULT BLOOD LOSS
WHAT IS THE ACTION AND USE OF IBUPROFEN?
OLDER DRUG PRESCRIBED FOR THE TREATMENT OF MILD TO MODERATE PAIN, FEVER, AND INFLAMMATION. ITS EFFECTIVENESS IS EQUIVALENT TO THAT OF ASPIRIN AND OTHER NSAIDS. ITS ACTIONS ARE PRIMARILY DUE TO INHIBITION OF PROSTAGLANDIN SYNTHESIS. COMMON INDICATIONS INCLUDE PAIN ASSOCIATED WITH CHRONIC MUSCKULOSKELETAL DISORDERS SUCH AS RA AND OA, HA, DENTAL PAIN, AND DYSMENORRHEA. CHEWABLE TABLETS, DROPS, AND SOLUTIONS ARE AVAILABLE IN LOW DOSES FOR ADMINISTRATION TO CHILDREN.
WHAT ARE THE ADMINISTRATION ALERTS?
GIVE THE DRUG ON AN EMPTY STOMACH AS TOLERATED. IF N/V OR ADB PAIN OCCURS, GIVE WITH FOOD.
BE AWARE THAT PTS WITH ASTHMA OF WHO HAVE ALLERGIES TO ASPIRIN ARE MORE LIKELY TO EXHIBIT A HYPERSENSITIVITY REACTION TO IBUPROFEN.
WHAT ARE THE ADVERSE EFFECTS OF IBUPROFEN?
ARE GENERALLY MILD AND INCLUDE NAUSEA, HEARTBURN, EPIGASTRIC PAIN, AND DIZZINESS. GI ULCERATION WITH OCCULT OR GROSS BLEEDING MAY OCCUR, ESPECIALLY IN PTS WHO ARE TAKING HIGH DOSES FOR PROLONGED PERIODS. CHRONIC USE OF IBUPROFEN MAY LEAD TO RENAL IMPAIRMENT.
WHAT IS THE BLACK BOX WARNING FOR NSAIDS?
NSAIDS MAY CUASE AN INCREASED RISK OF SERIOUS THROMBOTIC EVENTS, MI, AND STROKE, WHICH CAN BE FATAL. THIS RISK MAY INCREASE WITH DURATION OF USE. PTS WITH CARDIOVASCUALR DISEASE OR RISK FACTORS FOR CARDIOVASCULAR DISEASE MAY BE AT GREATER RISK.
NSAIDS ARE CONTRAINDICATED FOR THE TREATMENT OF?
PERIOPERATIVE PAIN IN THOSE UNDERGOING CORONARY ARTERY BYPASS GRAFT SURGERY. NSAIDS INCREASE THE RISK OF SERIOUS GASTROINTESTINAL ADVERSE EVENTS INCLUDING BLEEDING, ULCERATION, AND PERFORATION OF THE STOMACH OR INTESTINES, WHICH CAN BE FATAL. THESE EVENTS OCCUR MORE FREQUENTLY IN OLDER ADULTS AND CAN OCCUR AT ANY TIME DURING USE OR WITHOUT WARNING SYMPTOMS.
WHAT ARE THE CONTRAINDICATIONS OF IBUPROFEN?
PTS WITH ACTIVE PEPTIC ULCERS SHOULD NOT TAKE IBUPROFEN. THIS DRUG IS ALSO CONTRAINDICATED IN PTS WITH SIG. RENAL OR HEPATIC IMPAIRMENT AND IN THOSE WHO HAVE A SYNDROME OF NASAL POLYPS, ANGIOEDEMA, OR BRONCHOSPASM, DUE TO ASPIRIN OR OTEHR NSAID USE. IT SHOULD BE USED CATIOUSLY IN PTS WHO HAVE HF, SERIOUS HTN, OR A HX OF STROKE OR MI.
WHAT ARE THE DRUG-DRUG INTERACTIONS OF IBUPROFEN?
BC IBUPROFEN CAN AFFECT PLATELET FUNCTION, ITS USE SHOULD BE AVOIDED WHEN TAKING ANTICOAGULANTS AND OTHER COAGULATION MODIFIERS. ASPIRIN USE CAN DECREASE THE ANTI-INFLAMMATORY ACTION OF IBUPROFEN. THE ANTIHYPERTENSIVE ACTION OF DIURETICS, BETA BLOCKERS, AND ACE INHIBITORS MAY BE REDUCED IF TAKEN WITH IBUPROFEN. THE ACTIONS OF CERTAIN DIURETICS MAY BE DIMINISHED WHEN TAKEN CONCURRENTLY WITH IBUPROFEN. USE WITH OTHER NSAIDS, ALCOHOL, OR CORTICOSTEROIDS MAY CAUSE SERIOUS ADVERSE GI EVENTS.
LAB TESTS WITH IBUPROFEN?
IBUPROFEN MAY INCREASE BLEEDING TIME, AST, ALT LEVELS. IT MAY DECREASE HEMOGLOBIN AND HEMATOCRIT.
TREATMENT OF OVERDOSE WITH IBUPROFEN?
THERE IS NO SPECIFIC TREATMENT FOR OVERDOSE. ADMINISTRATION OF AN ALKALINE DRUG MAY INCREASE THE URINARY EXCRETION OF IBUPROFEN.
WHAT DO COX-2 INHIBITORS DO?
SELECTIVE INHIBITION OF COX-2 PRODUCES ANALGESIC, ANTI-INFLAMMATORY, AND ANTIPYRETIC EFFECTS WITHOUT CAUSING SOME OF THE SERIOUS ADVERSE EFFECTS OF THE OLDER NSAIDS.
BECAUSE COX-2 INHIBITORS DO NOT INHIBIT COX-1, THESE DRUGS?
DO NOT PRODUCE ADVERSE EFFECTS ON THE DIGESTIVE SYSTEM AND LACK ANY EFFECT ON ON BLOOD COAGULATION.
UPON THEIR APPROVAL BY THE FDA, THE COX-2 INHIBITORS QUICKLY BECAME?
THE TREATMENT OF CHOICE FOR MODERATE TO SEVERE INFLAMMATION.
WHAT IS THE ONLY COX-2 INHIBITOR DRUG?
CELECOXIB (CELEBREX)
IN ADDITION TO ITS ANTI-INFLAMMATORY INDICATIONS, CELECOXIB (CELEBREX) IS USED TO REDCUCE?
THE NUMBER OF COLORECTAL POLYPS IN ADULTS WITH FAMILIAL ADENOMATOUS POLYPOSIS (FAP). PTS WITH FAP HAVE AN INHERITED MUTATION IN A GENE THAT RESULTS IN HUNDREDS OF POLYPS AND AN ALMOST 100% RISK OF COLON CANCER.
WHAT ARE THE ADVERSE EFFECTS OF SELECTIVE COX-2 INHIBITOR CELEBREX?
BACK PAIN, PERIPHERAL EDEMA, ABD PAIN, DYSPEPSIA, FLATULENCE, DIZZINESS, HEADACHE, INSOMNIA, HTN
CORTICOSTEROIDS HAVE NUMEROUS THERAPEUTIC APPLICATIONS. ONE OF THEIR MOST USEFUL PROPERTIES IS THE ABILITY TO?
SUPPRESS SEVERE INFLAMMATION.
BC OF POTENTIALLY SERIOUS ADVERSE EFFECTS, HOWEVER, SYSTEMIC CORTICOSTEROIDS ARE RESERVED FOR?
THE SHORT-TERM TREATMENT OF SEVERE DISEASE.
CORTICOSTEROIDS ARE OFTEN REFERRED TO AS?
GLUCOCORTICOIDS
CORTICOSTEROIDS ARE NATURAL HORMONES RELEASED BY?
THE ADRENAL CORTEX THAT HAVE POWERFUL EFFECTS ON NEARLY EVERY CELL IN THE BODY.
WHEN CORTICOSTEROIDS ARE USED AS DRUGS TO TREAT INFLAMMATORY DISORDERS, THE DOSES ARE?
MANY TIMES HIGHER THAN THE AMOUNT OF NATURALLY PRESENT IN THE BLOOD.
THE USES OF CORTICOSTEROIDS INCLUDE THE TREATMENT OF?
NEOPLASIA, ASTHMA, ARTHRITIS, AND CORTICOSTEROID DEFICIENCY.
LIKE THE NSAIDS, CORTICOSTEROIDS INHIBIT?
THE BIOSYNTHESIS OF PROSTAGLANDINS.
CORTICOSTEROIDS, HOWEVER, AFFECT INFLAMMATION BY MULTIPLE MECHANISMS. THEY HAVE THE ABILITY TO?
SUPPRESS HISTAMINE RELEASE AND CAN INHIBIT CERTAIN FUNCTIONS OF PHAGOCYTES AND LYMPHOCYTES.
THESE MULTIPLE ACTIONS, DO WHAT?
MARKEDLY REDUCE INFLAMMATION, MAKING CORTICOSTEROIDS THE MOST EFFECTIVE MEDICATIONS AVAILABLE FOR THE TREATMENT OF SEVERE INFLAMMATORY DISORDERS.
WHEN GIVEN BY THE ORAL OR PARENTERAL ROUTES, CORTICOSTEROIDS HAVE?
A NUMBER OF SERIOUS ADVERSE EFFECTS THAT LIMIT THEIR THERAPEUTIC UTILITY.
THESE ADVERSE EFFECTS INCLUDE?
SUPPRESSION OF THE NORMAL FUNCTIONS OF THE ADRENAL GLAND (ADRENAL INSUFFICIENCY), HYPERGLYCEMIA, MOOD CHANGES, CATARACTS, PEPTIC ULCERS, ELECTROLYTE IMBALANCES, AND OSTEOPOROSIS.
BC OF THEIR EFFECTIVENESS AT REDUCING THE S/S OF INFLAMMATION, CORTICOSTEROIDS CAN?
MASK INFECTIOSN THAT MAY BE PRESENT IN A PT. THIS COMBINATION OF MASKING SIGNS OF ACTIVE INFECTION AND SUPPRESSING THE IMMUNE RESPONSE CREATES A POTENTIAL FOR INFECTIONS TO GROW RAPIDLY AND REMAIN UNDETECTED.
WHAT IS USUALLY A CONTRAINDICATION FOR CORTICOSTEROID THERAPY?
AN ACTIVE INFECTION.
BC THE APPEARANCE OF THESE ADVERSE EFFECTS IS A FUNCTION OF THE DOSE AND DURATION OF THERAPY, TREATMENT IS OFTEN?
LIMITED TO THE SHORT-TERM CONTROL OF ACUTE DISEASE.
WHEN LONGER THERAPY IS INDICATED, DOSES ARE KEPT?
AS LOW AS POSSIBLE AND ALTERNATE-DAY THERAPY IS SOMETIMES IMPLEMENTED; THE MEDICATION IS TAKEN EVERY OTHER DAY TO ENCOURAGE THE PT'S ADRENAL GLANDS TO FUNCTION ON THE DAYS WHEN NO DRUG IS GIVEN.
DURING LONG-TERM THERAPY, NURSES MUST BE ALERT FOR SIGNS OF OVERTREATMENT WITH CORTICOSTEROIDS, A CONDITION KNOWN AS?
CUSHING'S SYNDROME.
BC THE BODY BECOMES ACCUSTOMED TO HIGH DOSES OF CORTICOSTEROIDS, PTS MUST?
DISCONTINUE THESE DRUGS GRADUALLY; ABRUPT WITHDRAWAL CAN RESULT IN ACUTE LACK OF ADRENAL FUNCTION.
WHAT ARE EXAMPLES OF CORTICOSTEROIDS USED FOR SEVERE INFLAMMATION?
BETAMETHASONE (CELESTONE)
CORTISONE
DEXAMETHOSONE
HYDROCORTISONE (CORTEF)
METHYLPREDNISONE (MEDROL)
PREDNISOLONE
PREDNISONE
WHAT ARE THE ADVERSE EFFECTS OF CORTICOSTEROIDS?
MOOD SWINGS, WT GAIN, ACNE, FACIAL FLUSHING, NAUSEA, INSOMNIA, SODIUM AND FLUID RETENTION, IMPAIRED WOUND HEALING, MENSTRUAL ABNORMALITIES
WHAT IS THE ACTION AND USES OF PREDNISONE?
PREDNISONE IS A SYNTHETIC CORTICOSTEROID. ITS ACTIONS ARE THE RESULT OF BEING METABOLIZED TO AN ACTIVE FORM, WHICH IS ALSO AVAILABLE AS A DRUG CALLED PREDNISOLONE. WHEN USED FOR INFLAMMATION, DURATION OF THERAPY IS COMMONLY LIMITED TO 4-10 DAYS. FOR LONG-TERM THERAPY, ALTERNATE-DAY DOSING IS USED. PREDNISONE IS OCCASIONALLY USED TO TREMINATE ACUTE BRONCHOSPASM IN PTS WITH ASTHMA AND AS AN ANTINEOPLASTIC AGENT FOR PTS WITH CERTAIN CANCERS SUCH AS HODGKIN'S DISEASE, ACUTE LEUKEMIA, AND LYMPHOMAS. IT IS AVAILABLE IN TABLET AND ORAL SOLUTION FORMS.
WHAT ARE THE ADMINISTRATION ALERTS OF PREDNISONE?
ADMINISTER IM INJECTIONS DEEP INTO THE MUSCLE MASS TO AVOID ATROPHY OR ABSCESSES. DO NOT USE IF IF SIGNS OF A SYSTEMIC INFECTION ARE PRESENT. WHEN USING THE DRUG FOR MORE THAN 10 DAYS, THE DOSE MUST BE SLOWLY TAPERED.
ADVERSE EFFECTS OF PREDNISONE?
WHEN USED FOR SHORT-TERM THERAPY, PREDNISONE HAS FEW SERIOUS ADVERSE EFFECTS. LONG-TERM THERAPY MAY RESULT IN CUSHING'S SYNDROME, A CONDITION THAT INCLUDES HYPERGLYCEMIA, FAT REFISTRIBUTION TO THE SHOULDERS AND FACE, MUSCLE WEAKNESS, BRUISING AND BONES THAT EASILY FRACTURE. BC GASTRIC ULCERS MAY OCCUR WITH LONG-TERM THERAPY, AN ANTIULCER MEDICATION MAY BE PRESCRIBED PROPHYLACTICALLY. USE WITH CAUTION IN PTS WITH PEPTIC ULCER, ULCERATIVE COLITIS, OR DIVERTICULITIS.
WHAT ARE THE CONTRAINDICATIONS OF PREDNISONE?
PTS WITH ACTIVE VIRAL, BACTERIAL, FUNGAL, OR PROTOZOAN INFECTIONS SHOULD NOT TAKE PREDNISONE.
LIKE INFLAMMATION, WHAT ELSE IS A NATURAL DEFENSE MECHANISM FOR NEUTRALIZING FOREIGN ORGANISMS?
FEVER
MANY SPECIES OF BACTERIA ARE?
KILLED BY HIGH FEVER. OFTEN, THE HEALTH CARE PROVIDER MUST DETERMINE WHETHER THE FEVER NEEDS TO BE DEALT WITH AGGRESSIVELY OR ALLOWED TO RUN ITS COURSE.
DRUGS USED TO TREAT FEVER ARE CALLED?
ANTIPYRETICS
IN MOST PTS, FEVER IS MORE OF A DISCOMFORT THAN A LIFE-THREATENING PROBLEM. PROLONGED, HIGH FEVER, HOWEVER, CAN BECOME DANGEROUS, ESPECIALLY IN?
YOUNG CHILDREN IN WHOM FEVER CAN STIMULATE FEBRILE SEIZURES.
IN ADULTS, EXCESSIVELY HIGH FEVERS CAN?
BREAK DOWN BODY TISSUES, REDUCE MENTAL ACUITY, AND LEAD TO DELIRIUM OR COMA, PARTICULARLY AMONG ELDERLY PTS. IN RARE INSTANCES, AN ELEVATED BODY TEMPERATURE MAY BE FATAL.
THE GOAL OF ANTIPYRETIC THERAPY IS TO?
LOWER BODY TEMPERATURE WHILE TREATING THE UNDERLYING CAUSE OF THE FEVER, USUALLY AN INFECTION.
WHAT ARE SAFE, INEXPENSIVE, AND EFFECTIVE DRUGS USED FOR REDUCING FEVER?
ASPIRIN, IBUPROFEN, AND ACETAMINOPHEN. MANY OF THESE ANTIPYRETICS ARE MARKETED FOR DIFFERENT AGE GROUPS, INCLUDING SPECIAL, FLOAVORED BRANDS FOR INFANTS AND CHILDREN.
FOR FAST DELIVERY AND EFFECTIVENESS, DRUGS MAY COME IN VARIOUS FORMS INCLUDING GELS, CAPLETS, ENTERIC-COATED TABLETS, AND SUSPENSIONS. ASPIRIN AND ACETAMINOPHEN ARE ALSO AVAILABLE AS SUPPOSITORIES. THE ANTIPYRETICS COME IN VARIOUS DOSAGES AND CONCENTRATIONS, INCLUDING EXTRA STRENGTH. ALTHOUGH MOST FEVERS ARE CAUSED BY?
INFECTIOUS PROCESSES, DRUGS THEMSELVES MAY BE THE CAUSE. WHEN THE ETIOLOGY OF FEVER CANNOT BE DIAGNOSED, NURSES SHOULD CONSIDER DRUGS AS A POSSIBLE SOURCE.
IN MANY CASES, WITHDRAWAL OF THE AGENT CAUSING HTE DRUG-INDUCED FEVER WILL QUICKLY RETURN BODY TEMPERATURE TO NORMAL. IN RARE CASES, DRUG-INDUCED FEVER MAY BE LETHAL. IT IS IMPORTANT FOR NURSES TO?
RECOGNIZE DRUGS THAT ARE MOST LIKELY TO CAUSE DRUG-INDUCED FEVER.
WHAT IS THE FIRST OF THESE DRUGS?
ANTI-INFECTIVES: ANTI-INFECTIVES, ESPECIALLY THOSE DERIVED FROM MICROORGANISMS SUCH AS AMPHOTERICIN B OR PENICILLIN G, MAY BE SEEN AS FOREIGN BY THE BODY AND PRODUCE FEVER. WHEN ANTIBIOTICS KILL MICROORGANISMS, FEVER-PRODUCING CHEMICALS KNOWN AS PYROGENS MAY BE RELEASED. ANTI-INFECTIVES ARE THE MOST COMMON DRUGS KNOWN TO INDUCE FEVER.
WHAT IS THE SECOND OF THESE DRUGS?
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS). USE OF SSRIS SUCH AS PAROXETINE (PAXIL) FOR DEPRESSION OR OTHER MOOD DISORDERS CAN RESULT IN A HIGH FEVER ACCOMPANIED BY SERIOUS MENTAL STATUS AND CARDIOVASCULAR CHANGES, KNOWN AS SEROTONIN SYNDROME.
WHAT IS THE THIRD OF THESE DRUGS?
CONVENTIONAL ANTIPSYCHOTIC DRUGS. DRUGS SUCH AS CHLORPROMAZINE (THORAZINE) MAY PRODUCE AN ELEVATED TEMPERATURE WITH SERIOUS CARDIOVASCULAR AND RESPIRATORY DISTRESS, CALLED NEUROLEPTIC MALIGNANT SYNDROME (NMS).
WHAT IS THE FOURTH OF THESE DRUGS?
VOLATILE ANESTHETICS AND DEPOLARIZING NEUROMUSCULAR BLOCKERS. DRUGS SUCH AS SUCCINYLCHOLINE CAN CAUSE LIFE-THREATENING MALIGNANT HYPERTHERMIA.
WHAT IS THE FIFTH OF THESE DRUGS?
IMMUNOMODULATORS. INTERFERONS AND MONOCLONAL ANTIBODIES SUCH AS MUROMONAB-CD3 MAY CAUSE A FLULIKE SYNDROME BC THEY CAUSE THE RELEASE OF FEVER-PRODUCING CYTOKINES.
WHAT IS THE SIXTH OF THESE DRUGS?
CYTOTOXIC DRUGS. CERTAIN DRUGS USED IN CANCER CHEMOTHERAPY AND TO PREVENT TRANSPLANT REJECTION PROFOUNDLY DAMPEN THE IMMUNE RESONSE AND RESULT IN FEVERS DUE TO SECONDARY INFECTIONS.
WHAT IS THE SEVENTH OF THESE DRUGS?
NEUTROPENIC DRUGS. DRUGS SUCH AS NSAIDS, PHENOTHIZAINES, ANTITHYROID DRUGS, AND ANTIPSYCHOTIC MEDICATIONS CAN CAUSE NEUTROPENIA AND A SUBSEQUENT FEVER.
WHAT IS THE ACTION AND USE OF ACETAMINOPHEN (TYLENOL) CENTRALLY ACTING COX INHIBITOR?
ACETAMINOPHEN REDUCES FEVER BY DIRECT ACTION AT THE LEVEL OF THE HYPOTHALAMUS AND DILATION OF PERIPHERAL BLOOD VESSLES, WHICH ENABLES SWEATING AND DISSIPATION OF HEAT. ACETAMINOPHEN, IBUPROFEN, AND ASPIRIN HAVE EQUAL EFFICACY IN RELIEVING PAIN AND REDUCING FEVER.
ACETAMINOPHEN HAS NO WHAT?
ANTI-INFLAMMATORY PROPERTIES; THEREFORE, IT IS NOT EFFECTIVE IN TREATING ARTHIRIS OR PAIN CAUSED BY TISSUE SWELLING FOLLOWING INJURY.
WHAT IS THE PRIMARY THERAPEUTIC USEFULNESS OF ACETAMINOPHEN?
FOR THE TREATMENT OF FEVER IN CHILDREN AND FOR RELIEF OF MILD TO MODERATE PAIN WHEN ASPIRIN IS CONTRAINDICATED.
IN THE TREATMENT OF SEVERE PAIN, ACETAMINOPHEN IS?
MAY BE COMBINED WITH OPIOIDS. THIS ALLOWS THE DOSE OPIOID TO BE REDUCED, THUS DECREASING THE RISK OF DEPENDENCE AND SERIOUS OPIOID TOXICITY. IT IS AVAILABLE AS TABLETS, CAPLETS, SOLUTIONS, AND SUPPOSITORIES.
ACETAMINOPHEN HAS NO EFFECT ON?
PLATELET AGGREGATION AND DOES NOT EXHIBIT CARDIOTOXICITY. MOST IMPORTANTLY, IT DOES NOT CAUSE GI BLEEDING OR ULCERS, AS DO THE NSAIDS.
WHAT IS THE ADMINISTRATION ALERT OF TYLENOL?
LIQUID FORMS ARE AVAILBEL IN VARYING CONCENTRATIONS. USE THE APPROPRIATE STRENGHT PRODUCT IN CHILDREN TO AVOID TOXICITY. NEVER ADMINISTER TO PTS WHO CONSUME ALCOHOL REGULARLY DUE TO THE POTENTIAL FOR HEPATOTOXICITY. ADVISE PTS THAT ACETAMINOPHEN IS FOUND IN MANY OTC PRODUCTS AND THAT EXTREME CARE MUST BE TAKEN TO NOT DUPLICATE DOSES BY TAKING SEVERAL OF THESE PRODUCTS CONCURRENTLY.
WHAT ARE THE ADVERSE EFFECTS OF TYLENOL?
ACETAMINOPHEN IS GENERALLY SAFE, AND ADVERSE EFFECTS ARE UNCOMMON AT THERAPEUTIC DOSES. ACETAMINUPHEN CAUSES LESS GASTRIC IRRITATION THAN ASPIRIN DIES NOT AFFECT BLOOD COAGULATION. IT IS NOT RECCOMENDED IN PTS WHO ARE MALNOURISHED. IN SUCH CASES, ACUTE TOXICITY MAY RESULT, LEADING TO RENAL FAILURE, WHICH CAN BE FATAL. OTHER SIGNS OF ACUTE TOXICITY INCLUDE N/V, CHILLS, ABD DISCOMFORT, AND FATAL HEPATIC NECROSIS.
A MAJOR CONCERN WITH THE USE OF HIGH DOSES OF ACETAMINOPHEN IS THE RISK FOR?
LIVER DAMAGE, WHICH IS ESPECIALLY IMPORTANT FOR PTS WHO CONSUME ALCOHOL.
WHAT IS THE BLACK BOX WARNING FOR ACETAMINOPHEN?
HAS THE POTENTIAL TO CAUSE SEVERE AND EVEN FATAL LIVER INJURY AND MAY CAUSE SERIOUS ALLERGIC REACTIONS WITH SYMPTOMS OFANGIOEDEMA, DIFFICULTY BREATHING, ITHCING, OR RASH. ACETAMINOPHEN-INDUCED HEPATOTOXICITY.
WHAT ARE THE CONTRAINDICATIOS OF HEPATOTOXICITY?
HYPERSENSITIVITY TO ACETAMINOPHEN OR PHENACETIN AND CHRONIC ALCOHOLISM.
WHAT IS THE TREATMENT OF OVERDOSE?
ORAL OR IV ADMINISTRATION OF N-ACETYLCYSTEINE (ACETADOTE) AS SOON AS POSSIBLE AFTER THE OVERDOSE. THIS DRUG PROTECTS THE LIVER FROM TOXIC METABOLITES OF ACETAMINPHEN.
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