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What is the vascular phase in inflammation?
Associated with vasodilation and increased capillary permeability; fluid and blood substances move to injured site
What is the delayed phase in inflammation?
Leukocytes infiltrate inflamed tissue
What are the cardinal signs of inflammation?
Redness, swelling, heat, pain, and loss of function
What classes of drugs fall under anti-inflammatory?
NSAIDS, corticosteroids, disease modifying anti-rheumatic drugs, and anti-gout drugs
What is the action of NSAIDS?
Inhibit prostaglandin synthesis, inhibit platelet aggregation, mimic effects of corticosteroids, inhibit COX enzymes
What two effects do NSAIDS have?
Analgesic (pain) and Antipyretic (fever)
What do COX enzymes do?
Convert arachidonic acid to prostaglandins
What does COX-1 do?
Protects stomach lining and regulates blood platelets
What does COX-2 do?
Triggers inflammation and pain
What is gout?
Inflammatory disease of joints, tendons, and other tissues
What drug falls under salicylates?
Aspirin (acetylsalicylic acid)
How do you discontinue corticosteroids?
Taper off over 5-10 days
What drug falls under disease modifying anti-rheumatics?
Infliximab
What ending does disease modifying anti-rheumatic drugs have?
“MAB”
What is the therapeutic level for salicylate?
15-30 mg/dL
What foods contain salicylates?
Prunes, raisins, licorice, seasonings like curry and paprika
Why can’t you give a pregnant woman aspirin in the third trimester?
Ductus arteriosus closes early in the baby
What are the side effects for aspirin?
Tinnitus, hearing loss, thrombocytopenia, leukopenia, hepatotoxicity, hypersensitivity
What drug falls under para-chlorobenzoic acid?
Indomethacin
Is indomethacin 99% protein bound? What do we need to monitor?
Yes; monitor labs
What are the side effects of indomethacin?
Sodium and water retention, hypertension
What drugs falls under phenylacetic acid derivatives?
Diclofenace sodium and ketorolac
What are the side effects of ketorolac?
Weakness, stroke
Is ketorolac used for long or short term pain?
Short term
What drug falls under propionic acid derivatives?
Ibuprofen, naproxen, ketaprophen
What drugs fall under antigout?
Colchine, allopurinol, febuxostat, probenecid
What is the action of colchine?
Inhibits migration of leukocytes to inflamed sites → inflammatory response
What are the types of disease modifying anti-rheumatic drugs?
GI distress
What are the side effects of infliximab?
fever, infection, elevated hepatic enzymes, leukopenia, neutropenia, thrombocytopenia
What drug falls under fenamates?
Meclofenamate
What kind of pain is meclofenamate used to treat?
Menstrual pain
What are the side effects of meclofenamate?
Tinnitus, pruritus, edema, renal dysfunction, elevated hepatic enzymes, stroke
What history does a nurse need to assess for before administering meclofenamate?
History of peptic ulcer
What drug falls under oxicams?
Meloxicam
What enzyme is meloxicam selective to?
COX-2
What are the side effects for meloxicam?
Insomnia, edema, renal dysfunction, angioedema, elevated hepatic enzymes, stroke
What drug falls under selective COX-2 inhibitors?
Celecoxib
What drug does celecoxib have similar agents to?
Nabumetone
What are the side effects of celecoxib?
Sinusitis, hypertension, peripheral edema, renal dysfunction
What drugs fall under corticosteroids?
Prednisone, prednisolone, dexamethasone
How do corticosteroids control inflammation?
Suppress/prevent the components of the inflammatory process
How do you discontinue corticosteroids?
Taper off over 5-10 days
What drug falls under disease modifying anti-rheumatics?
Infliximab
What ending does disease modifying anti-rheumatic drugs have?
“MAB”
What are the types of disease modifying anti-rheumatic drugs?
Immunosuppressive agents, immunomodulators, antimalarial
What are the side effects of infliximab?
fever, infection, elevated hepatic enzymes, leukopenia, neutropenia, thrombocytopenia
What is gout?
Inflammatory disease of joints, tendons, and other tissues
Where does gout usually occur?
Big toe
Purine metabolism leads to what kind of acid accumulation in gout?
Uric acid
What foods contain purine?
Organ meats, sardines, gravy, liver, alcohol (beer)
What drug falls under non-opioid analgesics?
Acetaminophen
What yearly exam should the nurse advise the patient to receive on allopurinol?
Eye exam
What is the action of probenecid?
Uricosurics, blocks reabsorption of uric acid which promotes its excretion
What are the side effects of probenecid?
Flushed skin, headache, sore gums, GI distress, kidney stones, severe blood dyscrasias
What is the action of allopurinol?
Uric acid inhibitor, decrease uric acid synthesis, not anti-inflammatory
What are the side effects of allopurinol?
Dizziness, headache, dry mouth , GI distress, arthralagia, bradycardia, hyperglycemia, blood dyscrasia, Steven-Johnson syndrome
Where do opioid analgesics work in the body?
Central nervous system
What are common side effects of all opioid analgesics?
Drowsiness, headache, dizziness
What drugs fall under opioid analgesics?
Codeine and morphine
What drug can probenecid be given with?
Colchicinet
Can codeine be mixed with other drugs?
Yes
Is acetaminophen a NSAID?
No
What is the maximum dose of acetaminophen a day?
4 g/day; 2 g/day for frequent use
What are the side effects of acetaminophen?
Rash, headache, insomnia, rare GI distress
What is the antidote for acetaminophen?
IV acetylcystine
Where do non-opioid analgesics work in the body?
Peripheral nervous system
Where do opioid analgesics work in the body?
Central nervous system
What are common side effects of all opioid analgesics?
Drowsiness, headache, dizziness
What drugs fall under opioid analgesics?
Codeine and morphine
What is codeine used for?
Mild to moderate pain; antitussive
Can codeine be mixed with other drugs?
Yes
What are the side effects of codeine?
Anxiety, euphoria, insomnia, fatigue, constipation
What is the use for morphine?
Acute pain (MI’s, cancer pain, severe pain)
What are the side effects of morphine?
Respiratory depression, constipation, GI distress, orthostatic hypotension, psychological dependence, miosis, blurred vision
What is the antidote for opioids?
Naloxone
Why are PCA pumps liked by patients?
Patient controlled and near-constant analgesic level
What kind of pain control do transdermal routes provide?
Continuous pain control
What can adjuvant therapies be used along with?
Nonopioid and opioid drugs
What are the different types of adjuvant analgesics?
Anticonvulsants, antidepressants, corticosteroids, antidysrhythmics, local aesthetics
What drug falls under opioid agonist- antagonists?
Nalbuphine
What is hydromorphone used for?
Pain; 6 times more potent than morphine
What are the side effects of hydromorphone?
Miosis, respiratory depression, urinary retention, constipation; fewer hypnotic effects and less GI distress than morphine
What is the use for morphine?
Acute pain (MI’s, cancer pain, severe pain)
What are the side effects of morphine?
Respiratory depression, constipation, GI distress, orthostatic hypotension, psychological dependence, miosis, blurred vision
What drugs are used in patient-controlled analgesia pumps?
Morphine, fentanyl, hydromorphone
Why are PCA pumps liked by patients?
Patient controlled and near-constant analgesic level
What kind of pain control do transdermal routes provide?
Continuous pain control
What can adjuvant therapies be used along with?
Nonopioid and opioid drugs
What are the different types of adjuvant analgesics?
Anticonvulsants, antidepressants, corticosteroids, antidysrhythmics, local aesthetics
What are withdrawal symptoms of benzos?
Tremors, agitation, nervousness, sweating, insomnia, anorexia, muscle cramps
What is nalbuphine used for?
Decreased opioid abuse
What are characteristics of migraine headaches?
Unilateral throbbing pain, nausea, vomiting, photophobia
What are characteristics of cluster headaches?
Unilateral non-throbbing pain around the eye, does not cause nausea
What drug is a opioid antagonist?
Naloxone
What is naloxone used for?
Antidote for opiate overdoses
Is a patient advised to drive while taking lorazepam?
No! Sedation is a side effect
What is the action of buspirone?
Binds to serotonin and dopamine receptors
Is buspirone effective right away?
No! Takes 1-2 weeks of continuous use
What is more common in males: migraine or cluster?
Cluster
What drug falls under selective serotonin receptor agonists?
Sumatriptain
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