NSG 116 Drug therapy to decrease pain,fever, inflammation and GOUT

What is pain

The sensation common with tissue injury or inflammation

A nurse is teaching a client about aspirin (ASA) therapy. Which statement by the client indicates a need for further teaching?

I can crush the interior coated tablets for easier swallowing

Which client is most at risk for developing Reye's Syndrome if given aspirin?

A seven-year-old with chickenpox

Rationale : aspirin is contraindicated in children with viral illnesses, like chickenpox or flu due to the risk of reye syndrome, which is a potentially fatal condition

A client taking acetaminophen is found to be consuming alcohol daily. What is the nurse’s primary concern?

Risk for hepatotoxicity

Rationale :Acetaminophen combined with alcohol significantly increases the risk of liver damage, as both substances are metabolized by the liver.

Which of the following is a contraindication for acetaminophen use?

Liver disease

Rationale: Liver disease is a major contraindication for acetaminophen due to its hepatotoxic effects, especially in high doses or chronic use.

Which lab values should be monitored in clients on long-term NSAID therapy?

BUN/Creatine

AST/ALT

Hemoglobin

Rationale: NSAIDs can cause renal and liver dysfunction and GI bleeding, so renal function (BUN/Creatinine), liver function (AST/ALT), and CBC (hemoglobin/platelets) are essential labs.

An older adult is taking ibuprofen for osteoarthritis. What is the most important assessment for the nurse to make?

Renal function

Rationale: NSAIDs like ibuprofen can impair renal function, especially in the elderly. Regular renal assessments are critical.

A nurse is administering meloxicam to a patient. Which co-administered medication requires immediate attention?

Lithium

Rationale: Meloxicam can increase lithium levels, risking lithium toxicity. Monitoring serum lithium levels is essential.

Why is ketorolac (Toradol) only used for a maximum of 5 days?

Severe GI and renal risks

Ratiotbake:

Ketorolac has a high risk for gastrointestinal bleeding and renal toxicity, limiting its use to short-term treatment (≤5 days).

Which finding is a sign of salicylate toxicity in a patient on aspirin?

Tinnitus

What should the nurse include in teaching about selective COX-2 inhibitors like celecoxib (Celebrex)?

Avoid use if you have a sulfa allergy

Rationale: Celecoxib is contraindicated in those with sulfonamide allergies

which statement indicates correct understanding of acetaminophen administration?

“I need to check all OTC meds for acetaminophen content.”

Rationale: Many OTC medications contain acetaminophen, increasing the risk of overdose and hepatotoxicity if combined unknowingly

What teaching should the nurse provide a client taking colchicine for gout?

“Take with food to reduce GI upset.”

Rationale: Colchicine often causes GI distress, and should be taken with food. Grapefruit juice should be avoided.

. What is a major adverse effect of allopurinol that should be immediately reported?

Skin rash or lesions

Skin reactions, especially Stevens-Johnson Syndrome, can occur with allopurinol and require immediate discontinuation.

A nurse is educating a client on NSAID-induced bleeding. What signs should the client report? (Select all that apply)

Tarry stool

Vomiting blood

Rationale: GI bleeding may present as tarry stools or hematemesis (vomiting blood). These require prompt evaluation.

What symptom would alert the nurse to stop ASA therapy immediately?

Dizziness and tinnitus

Rationale: Tinnitus and dizziness are signs of salicylate toxicity, requiring immediate assessment and discontinuation.

When teaching about allopurinol, the nurse includes which of the following instructions?

Drink 2000 mL of fluid per day.”

Rationale: Adequate hydration is important to prevent renal calculi and promote uric acid excretion while on allopurinol.

Which patient is most appropriate to receive acetaminophen over NSAIDs?

A patient with a history of GI ulcers

Rationale: Acetaminophen is preferred over NSAIDs for pain control in clients with GI ulcers, as it lacks gastric toxicity.

A patient with renal failure is prescribed an NSAID. What is the nurse’s first action?

Notify the provider

NSAIDs are contraindicated in severe renal disease. The provider should be notified to adjust therapy.

What is a contraindication for the use of indomethacin (Indocin)?

NSAIDs, including indomethacin, should not be used post-CABG surgery due to increased risk of MI and stroke.

What is fever

The elevation of body temperature

Inflammation is a

Normal body response to tissue damage, it’s the body responding to the “Itis” and trying to repair

Fever is controlled by

The hypothalamus

Pain occurs with

Tissue injury or inflammation

Anti prostaglandins are

Chemical mediators that inhibit the forming of prostaglandins

Prostaglandins are a group of

Lipids at the site of damage or infection, they control processes like: inflammation,blood flow, formation of blood

What are the anti prostaglandins

ASA

Acetaminophen

NSAIDS

What are the COX Enzymes

COX 1

COX

COX 2 enzymes are produced in

Response to inflammatory process and are involved in production of prostaglandins that mediate pain and support the inflammatory process

COX 1 enzymes produce

Prostaglandins and are present in all tissues and cell types.

Salicyclates are used to for

Antipyretic,analgesic , and anti-inflammatory

Use with cautions with pt with

Contraindications to ASA

Patients with sensitivity or allergy to ASA

Patient allergic to tartrazine

Pt who is at risk of bleeding

ASA is a platelet inhibitor that reduces the risk of

MI

CVA

What are the selective cox 2 inhibitors

Celcoxib (Celebrex )

Why is acetaminophen better than aspirin for children

Because ASA (aspirin) has a risk of Reyes Syndrome in kids

What drug is given to reverse acetaminophen overdose

N acetylcysteine which smells like rotten egg

What 2 organs are primarily effected by acetaminophen

The liver and kidneys

In the instance of MI what dose of aspirin should be given

A small dose of 325 mg in a chewable tablet to speed up the delivery time

Meloxicam (Mobic) is used to treat

Osteoarthritis and rheumatoid arthritis

why do we use aspirin for chest pain and arthritis

Because it has anti inflammatory effects to treat arthritis and anti platelet effects to prevent CVA/MI by preventing blood clots

Does aspirin fix heart attacks

No but it stops further blood clots

Two major adverse effects of taking aspirin long term

Renal damage

Renal toxicity

GI bleeding

What is the oxicam derivative

Meloxicam (Mobic)

What is a Propionic Acid Derivative

Ibuprofen (Motrin /Advil)

What is ibuprofen used for

Mild to moderate pain

Inflammation

As an antipyretic

To treat arthritis and initial stages of gout

Acetaminophen should be given

Q 4-6 hours

Acetaminophen should be given with

Food to reduce GI upset

What is the max dose for acetaminophen per day

4000 mg

UPPER GI bleeds

• Occurs in the esophagus, stomach, or duodenum 

• Can cause bright red vomit, dark flecks or clots, or black stools 

• Can be caused by ulcers, esophagitis, abnormal blood vessels, hiatal hernias, or growths 

What is indomethacin (indocin, tivorbex) used for

Pain associated with rheumatoid and osteoarthritis

Ankylosing spondylitis

Bursitis

Tendinitis

Gouty arthritis

What are the chemical categories of NSAIDS

Propionic acid derivatives

Oxicam derivatives

Acetic Acid derivatives

Selective Cox -2 inhibitor

What is Celcoxib (celebrex) used for

For acute and long term treatment of rheumatoid and osteoarthritis

For ankylosing spondylitis

Acute dysmenorrhea

LOWER GI bleeds

• Occurs in the large intestine or anus

• Can cause bright red blood in the stool or clots

• Can be caused by bleeding in the large intestine or rectum

Contraindications of acetaminophen

Drug allergy

Pregnancy/ lactation

Liver disease

Kidney disease

Use with certain meds/OTC drugs

Alcohol use

Rectal suppositories of acetaminophen have

An onset action of 1-2 hrs

Acetaminophen comes in

liquid and chewable oral form

Oral acetaminophen is used for

minor pain and fever

Acetaminophen doesn’t have

Anti platelet or anti inflammatory qualities

Acetaminophen (Tylenol) quality

Analgesic

Antipyretic

(ASA) Aspirin qualities

Anti platelet

Antipyretic

Analgesics

Anti inflammatory

ASA (aspirin) vs. Acetaminophen both have

Analgesic properties

Antipyretic qualities

Assess the therapeutic effects of salicylates (ASA/ aspirin)

For pain- lower number on the pain scale

For fever- temperature should decrease

For inflammation- signs of inflammation should decrease

Salicylates (ASA) do contain sodium so

if you are on a sodium restriction you need to be aware of it’s content (553mg) per tab

Stop taking salicylates

2 weeks before and after the surgery because of the potential of bleeding

Enteric coated salicylates

Cannot be chewed or crushed

What is meloxicam used for

Rhematoid and osteo arthritis

How do you take salicylates (ASA ) aspirin

If PO take it with a full glass of water with a meal if possible

Chew if chewable

Avoid alcohol

What is gout

A form of arthritis that causes severe pain, swelling, redness and tenderness in joints.

a complex form of arthritis caused by too much uric acid that crystallizes and is deposited in joints.

What is the main reason aspirin is given for

To reduce stroke/ cardiac arrest by being a platelet reducer

What drugs helps decrease uric acid

Salicylate toxicity with chronic use

Dizziness

N/V/D

Mental confusion

Difficulty hearing

Tinnitus

Salicylate toxicity with acute use

N/V/D

Tachypnea

Hyperpnea

Hemorrhage

Confusion

Seizure

Coma

Fever

Muscle spasms

Pulmonary edema

Cardiovascular collapse

What are CABG patients

Coronary artery bypass graft surgery, or CABG (pronounced "cabbage")

a procedure that uses your own veins (usually from the legs) or arteries (usually from the chest or arm) to bypass narrowed areas and restore blood flow to heart muscle.

What cannot be taken with meloxicam

alcohol, blood thinners, or other NSAIDs

COX 2 is less likely to cause

Cardiovascular events but they should not be given to those who have had CABBAGE

Why cant you drink coffee while taking meloxicam

NSAIDs can interact with caffeine.

The combination can cause side effects like stomach upset, headache, and dizziness.

NSAIDS cannot be taken with

Ginger

Ginseng

Garlic

Alcohol

Always assess

Pre and post administration and document

NSAID Propionic ACId derivatives end in

Pro

In liver/renal patients Propionic acid based derivatives should be

Avoided or reduced in dose

When using Propionic acid derivatives in older adults, evaluate

Renal function

Edema

Hypertension

GI bleeding

Propionic acid derivatives last

6-8 hrs

Propionic acid derivatives like ibuprofen are used in

Mild to moderate pain and have an onset of action of 1 hr

NSAIDs are contraindicated by

ASA triad( asthma, rhinitis, and nasal polyps)

Most NSAIDs are available

Over the counter and have a risk for abuse

Take a full glass of water with meloxicam

Drink a full glass of water (8 ounces or 240 milliliters) with it unless your doctor tells you otherwise

NSAIDS should be taken with food because

They can cause GI tract irritation

What drugs should we not also take with NSAIDs

Aspirin because it can lead to acetaminophen overdose

What is the max daily amount of ASA (aspirin)

4000 mg in adults

For anti inflammatory effects (ASA) aspirin should be given at

325-650 mg Q4

How much (ASA) aspirin should be given to prevent cardiac events

75-81 mg per day for antiplatelet effects

Chewable aspirin (ASA) is given if

Myocardial infarction is suspected

ASA (aspirin ) has a longer onset if

It’s enteric coated

What is the duration of action for Oral (ASA) aspirin

6-8 hours

What is the onset of action for oral (ASA) aspirin

5-30 minutes

What are hepatoxic substances

Substances that can cause damage to the liver such as acetaminophen (Tylenol)