Drug Therapy to Decrease Pain, Fever, and Inflammation (Chapters 15-17)

inflammatory response

local reaction of the body to invasion or injury; any insult to the body that injures cells or tissue will set this off

bradykinin, histamine, prostaglandins, leukocytosis

what are the chemicals released in the inflammatory response (4)

chemical release, capillary permeability, increase in WBC count

what are the 3 main things that happen during the inflammatory response?

swelling, fever, aches, pain, heat, redness, tenderness

what are the symptoms of an inflammatory response? (7)

cellular injury → arachidonic acid → COX-1 or COX-2 → prostaglandins

give the basic cascade of the inflammatory response (4)

blood clotting, protecting stomach lining, kidney

what are the 3 main functions that COX-1 is involved in?

COX-2

active at site of trauma or injury

pain, inflammation, vasodilation, bleeding

COX-2 leads to… (4)

frostbite, lacerations/cuts/wounds, burns, trauma injury, infection, chemical irritants, allergic reaction

what are causes of acute inflammation? (7)

cardiovascular disease, neurological disease, autoimmune disease, rheumatoid arthritis, cancer, lupus, fibromyalgia, chronic fatigue syndrome

what are some causes of chronic inflammation? (8)

pain, redness, swelling, exudate, fever

what are symptoms of acute inflammation? (5)

tissue destruction, scar tissue, diminished function

what happens with chronic inflammation/characteristics? (3)

A, B, C

Which chemicals are part of the inflammatory response? (select all that apply)

A. bradykinin
B. prostaglandins
C. histamine
D. glucocorticoids

acetaminophen

most frequently used OTC medication in children

acetaminophen

this meds helps to reduce fever and pain but has no anti-inflammatory benefits

prostaglandins

acetaminophen blocks ______

liver failure, renal failure

adverse effects of acetaminophen (2)

liver dysfunction (cirrhosis, alcohol abuse, fatty liver)

contraindications for acetaminophen (1)

4g

what is the max dose per day of acetaminophen?

acetylcysteine

what is the antidote for acetaminophen OD?

be aware of other meds containing acetaminophen (percocet, vicodin), available in multiple routes (PO, IV, rectal), monitor liver functions

nursing considerations for acetaminophen (3)

many OTC drugs have acetaminophen (AKA tylenol), do not exceed recommended dose, avoid alcohol

what is the patient education for acetaminophen? (3)

anti-inflammatory agents

block or alter the chemical reactions associated with the inflammatory response; stop one or more of the signs and symptoms of inflammation

pain, fever, many “-itis” conditions

what are anti-inflammatory agents used to treat? (3)

aspirin

what is our example of salicylates?

aspirin

this med blocks prostaglandin production and is an antiplatelet

pain relief, antipyretic, osteoarthritis, 81mg prevents CVA/MI

uses for aspirin (4)

GI bleeding, bleeding/bruising, toxicity

what are the adverse effects of aspirin? (3)

children (reye’s syndrome), renal failure, bleeding abnormalities

what are the contraindications for aspirin? (3)

vitals (temp), don’t crush/chew EC tabs, assess for s/sx of bleeding, follow up labs (Hbg, liver function), give with food, encourage hydration

what are the nursing considerations for aspirin? (6)

do not overuse medication, take with food, do not crush/chew EC tabs, call MD for s/sx of toxicity, hold at least 1 week before & after surgery

patient education for aspirin (5)

ringing in ears, hearing loss, bleeding

signs and symptoms of toxicity (aspirin) (3)

ibuprofen, naproxen

what are the two NSAID propionic acid derivatives examples?

ibuprofen, naproxen

these meds block Cox-1 & 2, block prostaglandin production, stops inflammatory cascade

mild pain relief (RA & OA), fever reduction in adults & kids, anti-inflammatory

uses of ibuprofen & naproxen (3)

GI effects, GI bleeding, kidney damage

what are the adverse effects of ibuprofen? (3)

GI bleeding, renal dysfunction

what are the contraindications of ibuprofen? (2)

blocks Cox-1 & 2, blocks prostaglandin production, stops inflammatory cascade

what are the actions of NSAIDs? (3)

meloxicam

what is the example of a NSAID oxicam derivative?

meloxicam

this medication blocks cox-1 & 2, prostaglandin production, stops inflammatory cascade, and is more specific to bone and cartilage

osteoarthritis and rheumatoid arthritis

uses for meloxicam (2)

bleeding, platelet inhibition, BBW (GI bleeding, MI)

adverse effects of meloxicam (4)

GI bleeding, recent MI

what are the contraindications of meloxicam (2)

indomethacin, ketorolac

what are 2 examples of NSAIDs acetic acid derivatives?

indomethacin, ketorolac

these medications inhibits mainly Cox-1, stronger anti-inflammatory effects

anti-inflammatory (RA, OA, gout), analgesia, antipyretic

what are the uses of indomethacin & ketorolac? (3)

bleeding, renal failure, BBW (GI bleeding, MI)

adverse effects for indomethacin, ketorolac (4)

GI bleeding, recent surgery, bleeding disorders, recent MI, renal failure

contraindications for indomethacin, ketorolac (5)

celecoxib

example of a NSAID selective Cox-2 inhibitor

celecoxib

this med blocks Cox-2 without blocking Cox-1’s protective effects

acute and long term treatment of RA, OA, and juvenile RA

what is the use of celecoxib? (3)

BBW (risk of MI or CVA), renal failure

what are the adverse effects of celecoxib? (2)

renal failure, recent MI or CVA

what are the contraindications of celexocib? (2)

give after meals to decrease GI effects, monitor for s/sx bleeding (nose bleeds, bruising, bloody urine/stool), use caution with other blood thinners

what are the nursing considerations for NSAIDs? (3)

take after meals, report s/sx of bleeding to MD, only take as directed

patient education for NSAIDs (3)

B

A toddler is running a fever of 103 F. Which of the following medications is alternated to treat a fever in children?

A. aspirin and acetaminophen
B. acetaminophen and ibuprofen
C. naproxen and ibuprofen
D. aspirin and ibuprofen

uric acid

gout is an arthritis caused by the buildup of _______ which deposits crystals in the joints

big toe

gout is typically found in the ______

colchicine

mitotic agent example (gout treatment)

colchicine

this medication causes a decrease in the inflammatory reaction from the crystals

colchicine

most common gout medication that treats and prevents it

GI upset, hepatotoxicity

adverse effects of colchicine (2)

hepatic failure

contraindications for colchicine (1)

allopurinol

example of a uricosuric agent (antigout)

allopurinol

this medication reduces uric acid production and is used to treat gout

drowsiness, HA, GI upset

what are the adverse effects of allopurinol? (3)

drug to drug interactions with many antibiotics, give with food, avoid grapefruit juice, encourage hydration

what are the nursing considerations for antigout medications? (4)

avoid alcohol, avoid grapefruit juice, increase fluid intake, take with food to decrease GI upset

what is the patient education for antigout medication? (4)

A, C, D

A patient is scheduled for surgery tomorrow. Which medications may increase risk of bleeding? (select all that apply)

A. aspirin
B. acetaminophen
C. indomethacin
D. meloxicam

adrenal glands

corticosteroids are released by the…

hypothalamus

corticosteroids are regulated by the…

glucocorticoids, mineralocorticoids, androgens

what are the 3 main steroid hormones?

supressess inflammatory hormones, reduces capillary permeability, impairs phagocytosis, inhibits tissue repair, impairs lymphocytes, decreases inflammatory & immune response

what are the effects of corticosteroids? (6)

prednisone

what is the example med for corticosteroid therapy?

prednisone

this medication decreases inflammatory and immune response

symptom control (not cure), treat broad spectrum of inflammatory & immune conditions (allergic reactions, autoimmune diseases (lupus, RA, Crohn’s), skin conditions, endocrine disorders, neurologic conditions, respiratory disorders

uses for prednisone (2+6)

adrenocortical insufficiency/excess, dizziness, insomnia, dysrhythmias, decreased immunity, hyperglycemia, fluid retention, thin skin/delayed wound healing, osteoporosis

what are the adverse effects of corticosteroid therapy prednisone? (9)

live vaccines, kidney/liver/endocrine disease, immunosupression

what are the contraindications for prednisone? (3)

taper dose if necessary, give locally if possible, many medication interactions, give in AM if for replacement therapy to simulate normal body function, may need to increase replacement in times of stress

what are the nursing considerations for corticosteroid therapy? (5)

do NOT stop abruptly must wean, rinse mouth after steroid inhaler, avoid exposure to sick people, weight gain/fluid retention is likely, may need additional doses in times of stress/illness, corticosteroids are not same as muscle building steroids

what is the patient education for corticosteroid therapy? (6)

A

A nurse is teaching patient about taking acetaminophen for arthritis pain. Which of the following statements is most appropriate?

A. acetaminophen will only help relieve pain but not the inflammation from arthritis
B. acetaminophen is appropriate for treatment of inflammation from arthritis
C. your PCP should consider a narcotic prescription
D. the acetaminophen should be taken on an empty stomach

A

A patient is taking systemic corticosteroids. Which of the following nursing interventions is the most important?

A. Assess for s/sx of adrenocortical excess
B. hold cortisone before surgery
C. assess for fluid volume deficit
D. decrease intake of vitamin D

A

A patient is receiving prednisone 10mg orally every day to reduce the symptoms of Crohn’s disease. Which of the following effects is associated with daily prednisone?

A. atrophy of adrenal gland
B. decrease serum glucose
C. weight loss
D. fluid volume deficit