Week 4 Pain, Inflammation, fever Drug Therapy

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1

this is the sensation of discomfort, hurt, or distress

pain

2

pain occurs generally due to these 2 things:

tissue injury and inflammation

3

these sensitize pain receptors and increase pain associated with other chemical mediators of inflammation and immunity

prostaglandins

4

This is the elevation of body temp above normal range

fever

5

what controls the body temp?

hypothalamus

6

this occurs when set point of hypothalamus is raised in response to presence of pyrogens

fever

7

this is inflammation or fever causing agents inside of the body:

endogenous pyrogens

8

this is inflammation or fever causing agents outside of the body:

exogenous pyrogens

9

what is inflammation?

local reaction of the body to injury or invasion from a foreign substance

10

the activation of neutrophils and chemicals that lead to cell injury and destruction is called:

chemotaxis

11

clinical signs of inflammation include:

warmth, redness, swelling, pain

12

this inhibits prostaglandins produced in inflammation, acts on hypothalamus for antipyretic effects, and low doses block thromboxane A2 to inhibit PLT aggregation

salicylates [aspirin]

13

salicylates [such as aspirin] use:

analgesic agent [pain], antipyretic, anti-inflammatory, antiplatelet effects

14

salicylate adverse effects:

nausea, vomiting, heartburn, epigastric pain, occult blood loss, dizziness, tinnitus, acidosis

15

salicylates like aspirin is ______ in high doses

nephrotoxic

16

contraindications for salicylates like aspirin:

known sensitivity, high risk for bleeding, impaired renal function, children and adolescents may get Reye Syndrome

17

salicylates are some times a preventative for this condition[s]:

TIA or MI [transient ischemic attack] or heart attack] ex-aspirin

18

do not give salicylates to these people:

children

19

should salicylates be taken with food?

yes

20

bleeding, ringing in the ears, or diminished hearing is sometimes associated with this type of drug:

salicylates

21

avoid this drug for 2 weeks before and after major surgery including dental procedures:

salicylates

22

aspirin and other salicylates should be used with CAUTION with these people:

people on low sodium diet

23

what is the therapeutic serum level of salicylates for treatment of arthritis and rheumatic fever?

100 to 300 mcg/ ML

24

when does salicylate toxicity occur?

when therapeutic serum level is above 300 mcg/mL

25

how to treat MILD salicylate toxicity?

stop the drug or reduce the dose

26

how to treat SEVERE salicylate toxicity?

gastric lavage, activated charcoal, IV sodium bicarbonate, iv fluids and hemodialysis

27

This drug is a Non-narcotic analgesic antipyretic drug:

acetaminophen, aka tylenol

28

what does acetaminophen do?

reduces fever acting on hypothalamus,

increases vasodilation and sweating,

diminishes pain somehow,

has NO anti-inflammatory effects

29

What is the drug of choice [DOC] t ogive children with fever or pain?

acetaminophen

30

give this drug prior to DTAP in those at risk for a seizure:

acetaminophen

31

can you alternate ibuprofen and acetaminophen every 4 hours over 3 days to control a fever?

yes

32

name 3 contraindications for acetaminophen?

hypersensitivity, hepatic dysfunction, alcoholism

33

why shouldn't you give acetaminophen to an alcoholic?

it causes liver enlargement and liver failure

34

acetaminphen can have drug-drug interactions with these 2 :

alcohol ingestion and anticoagulants like rifampin

35

when does myocardial damage occur when taking tylenol?

ingesting 5-6 grams a day for several weeks

36

what should a nurse assess for when giving acetaminophen?

look for jaundice, decrease pain, checking temp every 2-4 hours for fever, rash, history of myocardial damage/ chest pain

37

this drug produces a toxic metabolite that is normally inactivated by combining with glutathione:

acetaminophen

38

it is important to obtain this in the blood work when acetaminophen overdose is known or suspected:

plasma acetaminophen levels

39

what is another drug you can give to help with acetaminophen toxicity that is a mucolytic agent given by inhalation in respiratory disorders?

acetylcysteine [mucomyst or acetadote] helps by synthesizing glutathione

40

this is what NSAIDs stands for:

Non- Steroidal Anti-inflammatory Drugs

41

How do NSAIDS work?

they block COX-1 and COX-2 enzymes

42

2nd generation NSAIDS only block this enzymes:

COX-2

43

Both 1st and 2nd generation Nsaids have the ability to cause this serious event:

cardiovascular thrombotic events

44

if your patient has had coronary artery bypass graft surgery, DO NOT GIVE THIS or you will get FIRED [probably].

an NSAID

45

name 4 NSAIDS

ibuprofen, indomethacin, celecoxib, meloxicam

46

Ibuprofen is a ___ generation Nsaid:

1st

47

this is a propionic acid derivative:

ibuprofen

48

use this NSAID to relieve mild pain including dysmenorrhea, inflammation, rheumatoid arthritis and osteoarthritis , initial attacks of gout

ibuprofen

49

ibuprofen can be given to children older than __ _____.

6 months

50

some side effects of ibuprofen include:

dry mouth, sores, dyspepsia, heartburn, nausea, epigastric pain, constipation, GI ulcers w/ occult blood loss

51

on bloodwork, some bad effects of ibuprofen can be shown here:

elevated BUN, creatinine, edema, cbc and signs of anticoagulation

52

ibuprofen also goes by these 2 names:

motrin or Advil

53

allergic reactions occur more to patients with these pre-existing issues:

rhinitis, asthma, chronic urticaria, nasal polyps

54

naproxen [aleve] is similar to ibuprofen, but naproxen has this:

a longer half life

55

drug -drug interactions with ibuprofen include:

loop diuretics, beta blockers [lessens effect on HTN], and lithium

56

when taking this drug, take it with food or water and drink 2-3 quarts of fluid daily when taking regularly.

ibuprofen

57

indomethacin goes by these 2 names:

indocin and Tivorbex

58

this drug is an acetic acid derivative:

indomethacin

59

what action does indomethacin take on the body?

anti-inflammatory, analgesic, antipyretic by inhibiting prostaglandin synthesis. inhibits COX1 and COX2

60

rheumatoid arthritis, osteoarthritis, bursitis, gouty arthritis and acute gout attacks is when patients use this drug:

indomethacin

61

this drug can produce closure of patent ductus arteriosus in preterm infants:

indomethacin

62

GI bleeding/ ulcers, abdominal pain and distention, transient ileus, headaches, renal impairment, decrease clotting time and severe respiratory effects can be seen with this drug:

indomethacin

63

dont use indomethacin in patients with a history of:

salicylate hypersensitivity, past GI bleeding, severe renal impairment or patients who had coronary bypass

64

name an injectable NSAID:

ketorolac [toradol]

65

this is a selective COX2 inhibitor that is activated with inflammation and does not affect COX1 enzymes:

celecoxib [celebrex]

66

what sre some uses for celecoxib?

acute or long term tx of juvenile rheumatoid arthritis, osteoarthritis, acute pain and primary dysmenorrhea, and familial adenomatous polyposis

67

adverse effects of celecoxib include:

headaches, dizzy, insomnia, increase for MI and CVA, rash, pruritus, sweating, dry MM, stomatitis, GI bleeding

68

contraindications for celebrex include:

allergy to sulfonamides, NSAIDS/ aspirin, renal impairment, perioperative pain, post- coronary artery bypass sx, or pregnancy

69

to prevent gastric upset, give this med with food, try not to operate machinery, and report a sore throat, rash, itching, weight gain, swelling or vision changes:

celecoxib [ celebrex]

70

this is a disease- modifying antirheumatic drug that is given SQ:

etanercept [Enbrel]

71

what does etanercept do?

genetically engineered tumor necrosis factor TNF receptors react with and deactivate TNF, released by active leukocytes- decreasing inflammation.

72

etanercept is used in these patients:

patients with rheumatoid arthritis, polyarticular idiopathic arthritis, psoriatic arthritis, ankylosis spondylitis, plaque psoriasis [to decreased signs/ symptoms]

73

adverse reactions of etanercept:

fatal infections, lymphoma, demyelinating disorders like MS, MI, heart failure, injection site reactions.

74

dont use etanercept in these patients:

acute infection, cancer, tuberculosis, sepsis, hepatitis, myelosuppression or demyelinating disorders, and pregnancy

75

do not use these drugs when using etanercept:

immunosuppressant drugs, or live vaccines

76

is blurred vision, tingling, numbness, and extreme fatigue side effects of etanercept?

yes

77

this narcotic/ opioid agonist binds to receptors in brain, spinal cord, and peripheral tissue to produce analgesia, euphoria, and sedation:

morphine [roxanol, astramorph]

78

what is the unlabeled use of morphine?

relief of dyspnea, acute left ventricular failure and pulmonary edema

79

side effects of morphine:

pupil constriction, CNS & respiratory depression, slow GI, decrease mental activity, constipation, nausea and vomiting

80

don't use morphine under these circumstances:

patient has respiratory depression, lung, liver, kidney disease, prostatic hypertrophy, pregnant, ICP, seizure disorder, addison's disease, toxic psychosis

81

morphine can interact poorly with these drugs:

antihistamines, alcohols, antidepressants, antipsychotics, barbiturates, sedatives, MAOIs, benzodiazepines, kava, valerian, st johns wort.

82

reversal for morphine is:

naloxone [narcan]

83

codeine, fentanyl, hydrocodone, hydromorphone, meperidine, methadone, oxycodone, oxymorphine, tramadol are all from this group of drugs:

opiods

84

duragesic, sublimaze is the trade name for this:

fentanyl

85

Hysingla is the trade name for this drug:

hydrocodone

86

Dilaudid and Exalgo is the trade name for this drug:

hydromorphone

87

Demerol is the trade name for this drug:

meperidine

88

Dolophine is the trade name for this drug:

methadone

89

OxyContin is the trade name for this drug:

oxycodone

90

Opana or Opana ER is the trade name for this drug:

oxymorphone

91

Ultram or ConZip is the trade name for this drug:

Tramadol

92

how is PCA, or patient controlled Analgesia, defined?

any method that allows a person in pain admin their own pain relief

93

a kappa agonist drug does this:

causes dysphoria and hallucinations

94

Talwin is AKA :

pentazocine

95

why would one use Talwin?

moderate to severe pain - generally perioperative or for labor pains.

96

side effects of pentazocine [talwin]:

headache, dizzy, drowsy, vertigo, euphoria, nausea vomiting and constipation.

97

contraindication for pentazocine:

acute asthma who are unmonitored or if resuscitative equipment is not available

98

Nubain is also called this:

nalbuphine- most often seen in labor and delivery

99

after stopping opiods after continuous use, you will see this happen in patients:

withdrawal symptoms

100

name the opioid Antagonist:

naloxone

101

patients may need more than one dose of naloxone due to this:

it has a short half-life

102

side effects of naloxone:

tremors, drowsiness, sweating, HTN, nausea vomiting d/t, narcotic abstinence syndrome, decreased respirations

103

dont use naloxone in these people:

known hypersensitivity, narcotic abuse, pregnancy

104

name another drug in the opioid antagonist group other than narcon:

Naltrexone [ Vivitrol]

105

A seizure is defined as:

not a disease but a symptom of underlying CNS dysfunction characterized by spontaneous nerve firing

106

these things can provoke seizures:

fever, electrolyte imbalance, hypoglycemia, CNS infection or damage

107

the cause for unprovoked seizures is:

unknown

108

there are over __ different things that can cause seizures

10

109

these are generalized seizure:

tonic- clonic, absence, myoclonic, febrile, status epilepticus

110

these are partial seizures:

simple [one part of the brain] and complex [ multiple parts of the brain]

111

there are 5 drug CLASSES for treating generalized seizures:

hydantoins,

barbiturates,

benzodiazepines,

succinimides,

inhibitory neurotransmitter gamma-amino-butyric acid

112

name 5 drugs that treat generalized seizures:

Dilantin, Solfoton, Valium, Zarontin, Depakene

113

this drug treats generalized seizures by stabilizing neuronal membrane, control tonic- clonic seizures, psychomotor seizures, non-epileptic seizures:

Dilantin- or phenytoin

114

ataxia, nause, vomiting, lethargy, gingival hyperplasia, steven johnson syndrome are adverse effects for:

phenytoin

115

do not use phenytoin [dilantin] if:

there is known hypersensitivity, sinus bradycardia, pregnant, hypoglycemia

116

alcohol, chloramphenicol, omeprazole, ticlopidine, amiodarone can cause drug-drug interactions with:

Dilantin [phenytoin]

117

phenobarbitol is a

barbiturate

118

this drug depresses CNS by inhibiting conduction of impulses in ascending reticular activating system:

phenobarbital

119

this is a sedative and anti-epileptic agent in the treatment of generalized tonic- clonic and partial seizures

phenobarbital

120

some adverse side effects of phenobarbital include:

somnolence, agitation, confusion, vertigo, NightMares, steven-johnson syndrome, suicidal thoughts

121

sudden withdrawal from phenobarbital places patient at risk for:

status epilepticus

122

this drug has interactions with this list of drugs:

opioids, corticosteroids, doxycycline, estrogens, contraceptives, anticoagulants, antidepressants, vitamin D, alcohol, chloramphenicol, diazepam, monoamine oxidase inhibitors

Phenobarbital

123

Diazepam is also called:

valium

124

valium or diazepam is this class of drug:

benzodiazepine

125

this drug primarily works on the limbic system and reticular formation and potentiates GABA by increasing attraction of medication to receptor sites:

diazepam

126

adverse effects of diazepam include:

CNS depression, confusion, restlessness, paradoxical excitatory reaction, CVS collapse w/ bradycardia and hypotension, BBS [combining this w/ opioid]

127

the benzodiazepine Klonopin is aka:

clonazepam

128

alcohol, omeprazole, cimetidine, disulfiram, hormonal contraceptives, herbs and food like grapefruit juice increase the effect of this drug group:

benzodiazepines

129

theophylline, ranitidine are drugs that _____[increase or decrease]?] effects of benzodiazepines

decrease

130

Depakene is the trade name for this drug:

valproic acid

131

what does valproic acid do?

increase GABA in the brain

132

adverse effects of valproic acid [ depakene]:

hepatotoxicity, birth defects, pancreatitis, GI effects, tinnitus, blurred vision, ataxia, infection

133

what is depakene [valproic acid] used to treat?

to treat absence or partial seizures

134

dont use depakene [valproic acid] if:

hypersensitivity, acute narrow angle glaucoma, shock, coma, alcohol intoxication, pregnant

135

valproic acid [depakene] can have drug interactions with these4:

phenobarbital, diazepam, primidone, zidovudine

136

important things to teach patients when taking depakene [valproic acid]?

take with food, dont stop abruptly taking, dont take with OTC sleep agents, medical alert bracelet, report bruising or bleeding, and use contraceptives is sexually active

137

Gabapentin is also called this:

neurontin

138

action of gabapentin is to?

antiepileptic action; ability to inhibit postsynaptic neuralgia

139

why would you use gabapentin [neurontin]?

adjunctive therapy for partial seizures and postherpetic neuralgia

140

adverse effects of gabapentin [neurontin]?

CNS depression, dizzy, insomnia, ataxia, pruritus, dry mouth, dyspepsia, suicidal ideation

141

gabapentin interacts with these other drugs:

antacids and ginkgo biloba [decrease effects]

142

when teaching patients about taking gabapentin, it is important to note these things:

take with food, do not stop abruptly, report any mal-effects , do not crush or cut pills, do not drive if cns depression occurs

143

name another drug in the same class as gabapentin/ neurontin:

Lyrica [pregabalin]

144

Keppra is aslo known as:

levetiracetam

145

levetiracetam is used for:

adjunctive therapy for partial onset and generalize tonic- clonic seizures

146

true or false- levetiracetam inhibits normal firing and does not affect normal neuronal excitability or function?

true

147

Adverse effect of levetiracetam [keppra] are:

fatigue, double vision, amnesia, hostility, rhinitis, anxiety, pharyngitis, decrease in RBS, WBC

148

contraindications for keppra[ levetiracetam] are:

pregnant, lactating, hypersensitivity, suicidal ideation

149

Topamax is the trade name for the drug:

topiramate

150

increased GABA activity, antiepileptic action and blockage of sodium channels in neurons are associated with this drug:

topiramate

151

adverse effects of topiramate [topamax] include:

increase intraocular pressure, CNS, GI, metabolic issues such as weight gain and glucose, oligohydrosis, fatigue

152

do not take topiramate if:

hypersensitive, ,metabolic acidosis, or taking anticholinergic medications

153

in teaching patients about topiramate, it is important to tell them to:

take 2 forms of contraceptive, drink 6-8 8oz glasses of H2O a day to decrease renal stone development. dont stop taking abruptly.