Chapter 44: Antiinflamatory and Antigout Drugs

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Antiinflamatory and Antigout Drugs
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1

Chemotaxis

The chemical attraction of leukocytes to the site of inflammation, which worsens an inflammatory response.

2

Done Nomogram

A standard data graph, originally published in 1960 in the journal Pediatrics, for rating the severity of aspirin toxicity following overdose. Serum salicylate levels are plotted against time elapsed since ingestion.

3

Gout

Hyperuricemia (elevated blood uric acid level); the arthritis caused by tissue buildup of uric acid crystals.

4

Inflammation

A localized protective response stimulated by injury to tissues that serves to destory, dilute, or wall off (sequester) both the injurious agent and the injured tissue.

5

Nonsteroidal antiinflammatory drugs (NSAIDs)

A large and chemically diverse group of drugs that possess analgesic, antiinflammatory, and antipyretic (fever-reducing) activity.

6

Salicylism

The syndrome of salicylate toxicity, including symptoms such as tinnitus (ringing sound in the ears), nausea, and vomiting.

7

Allopurinol

Relief of gout is the inhibition of the enzyme xanthine oxidase, which thereby prevents uric acid production.

8

Aspirin

Known chemically as acetylsalicylic acid (ASA), most widely used drug in the world, effective after a myocardial infarction, often used to treat the pain associated with headache, neuralgia, myalgia, and arthralgia, as well as other pain syndromes resulting from inflammation.

9

Celecoxib

First COX-2 inhibitor and is the only one remaining on the market. It is indicated for the treatment of osteoarthritis, rheumatoid arthritis, acute pain symptoms, ankylosing spondylitis, and primary dysmenorrhea.

10

Colchicine

Oldest available therapy for acute gout and is considered second-line therapy, after the NSAIDs.

11

Ibuprofen

An NSAID is often used for its analgesic effects in the management of rheumatoid arthritis, osteoarthritis, primary dysmenorrhea, gout, dental pain, and musculoskeletal disorders; in addition, it is used for its antipyretic actions.

12

Indomethacin

An NSAID that has analgesic, antiinflammatory, antirheumatic, and antipyretic properties.

13

Ketorolac

Is somewhat unique in that, although it does have some antiinflammatory activity, it is used primarily for its powerful analgesic effects.

14

Probenecid

Inhibits the reabsorption of uric acid in the kidney and thus increases the excretion of uric acid.

15

What is the mechanism of action of nonsteroidal antiinflammatory drugs (NSAIDs)?

  1. Enhancing pain perception
  2. Inhibiting prostaglandin production
  3. Increasing blood flow to painful areas
  4. Increasing the supply of natural endorphins
  • Increasing blood flow to painful areas
16

When teaching a client about potential adverse effects of NSAID therapy, the nurse will teach the client to immediately notify the health care provider of which effect?

  1. Diarrhea
  2. Mild indigestion
  3. Black tarry stools
  4. Nonproductive cough
  • Black tarry stools
17

The nurse is administering probenecid (Benemid) to a client with recurrent strep throat. The nurse teaches the client that the MOST likely reason for taking this medication is for what drug effect?

  1. Increase uric acid excretion
  2. Prevent the occurrence of gout
  3. Inhibit bacterial growth and replication
  4. Prolong the effectiveness of penicillin therapy
  • Prolong the effectiveness of penicillin therapy
18

What is advantage of COX-2 inhibitors over other NSAIDs?

  1. Maintain GI mucosa
  2. Have a longer duration of action
  3. Have a more rapid onset of action
  4. Are less likely to cause hepatic toxicity
  • Maintain GI mucosa
19

The client asks the nurse about the use of herbal and dietary supplements to treat arthritis pain. What is the nurse’s best response?”

  1. “High doses of vitamins and minerals have been used for many years to help maintain joint health.”
  2. “There really are no safe herbal treatments for pain. Your best action would be to take your prescription medications.”
  3. “Ginkgo biloba has shown tremendous benefit as an antiinflammatory drug and is used to treat the symptoms of pain.”
  4. “There is evidence that glucosamine sulfate with chondroitin does decrease joint stiffness and pain. Discuss this with your health care provider.”
  • “There is evidence that glucosamine sulfate with chondroitin does decrease joint stiffness and pain. Discuss this with your health care provider.
20

The nurse knows colchicine (Colcrys) exerts its therapeutic effect by what action?

  1. Increases uric acid metabolism
  2. Decreases mobility of leukocytes
  3. Increases process of phagocytosis
  4. Increases production of lactic acid
  • Decreases mobility of leukocytes
21

Which nursing diagnosis is appropriate for a client prescribed colchicine (Colcrys)?

  1. Constipation related to adverse effect of the medication
  2. Risk for infection related to medication-induced leukocytosis
  3. Risk for injury related to adverse effect of life threatening seizures
  4. Risk for fluid volume deficient related to nausea, vomiting, and diarrhea
  • Risk for fluid volume deficient related to nausea, vomiting, and diarrhea
22

A nurse teaching a client receiving allopurinol (Zyloprim) should include which information?

  1. “Increase your fluid intake to 3 L per day.”
  2. “This medication may cause your urine to turn orange.”
  3. “Include salmon and organ meats in your diet on a weekly basis.”
  4. “Take the medication with an antacid to minimize GI distress.”
  • “Increase your fluid intake to 3 L per day.”
23

The nurse would question a prescription to administer misoprostol (Cytotec) to a client with which condition?

  1. Pregnancy
  2. Peptic ulcer
  3. Gastroesophageal reflux disease
  4. Chronic obstructive pulmonary disease
  • Pregnancy
24

The nurse should question a prescription to administer acetylsalicylic acid (aspirin) to which client?

  1. A 62-year-old patient with a history of stroke
  2. A 45-year-old patient with a history of heart attack
  3. A 28-year-old patient with a history of sports injury
  4. A 14-year-old patient with a history of flulike symptoms
  • A 14-year-old patient with a history of flulike symptoms
25

Which NSAID would the nurse anticipate administering parenterally for the treatment of acute postoperative pain?

  1. Ketorolac (Toradol)
  2. Diclofenac (Cataflam)
  3. Allopurinol (Zyloprim)
  4. Indomethacin (Indocin)
  • Ketorolac (Toradol)
26

The acetic acid derivative indomethacin (Indocin) has which properties? (Select all that apply.)

  1. Antinausea
  2. Antipyretic
  3. Anticonvulsant
  4. Antirheumatic
  5. Antiinflammatory
  • Antipyretic
  • Antirheumatic
  • Antiinflammatory
27

When a patient is receiving long-term NSAID therapy, which drug may be given to prevent the serious gastrointestinal adverse effects of NSAIDs?]

  1. Misoprostol (Cytotec)
  2. Metoprolol (Lopressor)
  3. Metoclopramide (Reglan)
  4. Magnesium sulfate
  • Misoprostol (Cytotec)
28

The nurse recognizes that manifestations of NSAID toxicity include

  1. Constipation
  2. Nausea and vomiting
  3. Tremors
  4. Urinary retention
  • Nausea and vomiting.
29

During a teaching session about antigout drugs, the nurse tells the patient that antigout drugs work by which mechanism?

  1. Increasing blood oxygen levels
  2. Decreasing leukocytes and platelets
  3. Increasing protein and rheumatoid factors
  4. Decreasing serum uric acid levels
  • Decreasing serum uric acid levels
30

When the nurse is teaching about antigout drugs, which statement by the nurse is accurate?

  1. “Drink only limited amounts of fluids with the drug.”
  2. “This drug may cause limited movements of your joints.”
  3. “There are very few drug interactions with these medications.”
  4. “Colchicine is best taken on an empty stomach.”
  • “Colchicine is best taken on an empty stomach.”
31

A mother calls the clinic to ask what medication to give her 5-year-old child for a fever during a bout of chickenpox. The nurse's best response would be:

  1. “Your child is 5 years old, so it would be okay to use children's aspirin to treat his fever.”
  2. “Start with acetaminophen or ibuprofen, but if these do not work, then you can try aspirin.”
  3. “You can use children's dosages of acetaminophen or ibuprofen, but aspirin is not recommended.”
  4. “It is best to wait to let the fever break on its own without medication.”
  • “You can use children's dosages of acetaminophen or ibuprofen, but aspirin is not recommended.”
32

A 49-year-old patient has been admitted with possible chronic salicylate intoxication after self-treatment for arthritis pain. The nurse will assess for which symptoms of salicylate intoxication? (Select all that apply).

  1. Tinnitus
  2. Headache
  3. Constipation
  4. Nausea
  5. Bradycardia
  • Tinnitus
  • Headache
  • Nausea
33

An order for a child reads: “Give ibuprofen suspension 30 mg/kg/day, divided into four doses, for pain.” The child weighs 33 pounds. How many milligrams will this child receive per dose?

  • 112.5 mg per dose
34

The nurse is reviewing a patient's medication list during a preoperative visit. The patient is scheduled for diagnostic laparoscopy in 2 weeks. He asks the nurse, “I hope I can continue the Motrin, because I really ache if I don't take it. It's just minor surgery, right?” What is the nurse's best response?

  1. “You can continue to take it as the laparoscopy is considered minor surgery.”
  2. “You will need to take a lower dosage during the preoperative period.
  3. “I'll check with your prescriber, but this drug is usually stopped a week before the surgery because it can cause increased bleeding tendencies.”
  4. “You can switch to aspirin before the surgery; both aspirin and Motrin are over-the-counter pain relievers.”
  • “I'll check with your prescriber, but this drug is usually stopped a week before the surgery because it can cause increased bleeding tendencies.”