Pharmacology test 4

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