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What is the pathophysiology of anti-inflammatory drugs
Inflammation, reaction to tissue injury, caused by release of chemical mediators, leads to vascular response, fluid and WBCs migrate to injured site
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What are the chemical mediators
Histamines, kinins, prostaglandins
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What are the effects of histamines
First mediator in inflammatory process and cause dilation of arterioles and increase capillary perm.
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What are the effects of kinin (bradykinin)
Increase cap. Perm. And increase pain
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What are the effects of prostaglandins
Increase cap. Perm.; increase vasodilation; increase pain and fever; used for: histamine effects, platelet aggregation and fever
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What are the cardinal signs of inflammation
Redness, swelling, heat, pain, loss of function
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Cyclo-oxgenase (cox) enzyme
Converts arachidonic acid into prostaglandins; has two enzmyes forms: cox1 and cox2
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What are theanti-inflammatory drug groups
Nonstereiodaa anti-inflammatory drugs (NSAIDS), corticosteriods, disease-modifying antirhumatic drugs, antigout drugs,
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What are the effects of NSAIDS
Inhibit biosyn. Of prostaglandins, analegisic antipyretic (against fever) effect, inhibit platelet aggregation, mimic effects of corticosteriods
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What is the action of NSAIDS
Inhibit COX enzyme, inhibit prostaglandins synthesis
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What are the uses of NSAIDS
Reduce inflammation and pain, not recommended for fever or headaches, except asprin, ibuprofen
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What are the first generation NSAIDS
Salicylates (asprin), parachorobenzoic acid, pyrazolone derivatives, fenamates, oxicwns, pheyllacteic acid derivatives
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What are the 2nd gen. NSAIDS
Cox-2 inhibitors
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What are salicylates
Aspirin (acetylsalicylic acid) (ASA)
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What are the actions of salicylates
Anti-inflammatory, anti-,platelet, antipyretic effects
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What is the therpetic serum level for salicylates
10-30 mg/dl
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What is the toxic serum level salicylate level
Greater than 30 mg/dl
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What are the drug interaction of salicylates
Increase anticoagulants, hypoglycemia, increase gastric ulcer risk with glucocoticoids
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What are the lab interactions of salicylates
Increase PT, bleeding time, INTO, and uric acid; decreases K+, cholesterol, T3 and T4 levels
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What are the foods containing salicylates
Prunes, raisins, licorice, certain spices
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What are the cautions of aspirin (salicylates)
Do not take with other NSAIDS; avoid during third trimester of pregnancy; dont give to children with flu or virus symptoms (reye's syndrome)
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What are the SE of aspirin
Tinnitus, peptic ulcer, thrombocytopenia, leukopenia, agranulocytes, hepatotoxcity (they will affect liver)
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Hypersensitivity of aspirin
Tinnitus, dizziness, broncospasm
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Saalicylism (,mild)
Tinnitus, dizziness, HA, confusion, sweating, drowsy, thirst, N&V, diarrhea
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Severe salicylate poisoning
Convulsions, cardiovascular collapsex coma
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What are the peopionic acid derivatives
Ibuprofens andnon selective COX inhibitors
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What is the brand name for propionoc acid derivitives
Ibuprofen (motrin, advil)
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What are the drug interactions for propionic acid derivatives
Increase effects of warfarin and phenytoin
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What are the SE of ibuprofen
Gastric distress .( to be taken with food)
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What are the cox 2 inhibitors
Celecoxib (celebrex); rofecoxib ( vioxx); meloxicam (Monic;)
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What is to be remembered when INHIBITING COX 1
Stomach bleeding and ulcers may occur;
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What is the most common SeE of aspirin and NSAIDS
GASTRIC Irritation
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What tether actions of ibuprofen (advil)
Selctively inhibits COX 2 ENZYME without inhibition of a COX 1
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What are the uses for advil
Decrease inflammation and pain
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What are the SE of advil
Mild: HA, dizziness, nausea, diarrhea, sinusitis, peripheral edema
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What is seen with NSAIDS in older adults
Greater incidence of GO distress and ulcerationm; reduce dose to decrease SE
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Whatbarethe NI for NSAIDS
Assessing renal and GI status
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Rhematoid arthritis and NSAIDS
Cause a decrease in in function due to presence of pain or disformity
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What are the disease modifying antirhematic drugs
Gold drug therapy ( chrysotherapy), immunosupressive agents, immunomodulstors, antimslsrisls, aursnofin
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What are the actions of disease modifying antirheumtic drugs
Decrease leukocyte migration, suppresses prostglandin activity, stops progression of joint degeneration
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What is the use for disease modifying antirheumatic drugs
Rheumatoid arthritis
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What are the SE/adverse effects reactions
Stomatitis, photosynthesis, metallic taste, severe rash, corneal goldbdeposits, bradycardia, profound hypotension, hematuria, proteinuria, nephrotoxicity, agranulocytes, thrombocytopenia
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What are the contraindications of antirheumatic drugs
Severe female or hepatic disease; pregnancy, blood dyscrasias, colitis; systemic lupus erythromatosus
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What are the immunomodulstors
Tumor necrosis factor blockers; entanercept (enbrel), inflixlmab (remicade)
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What are the SE of immunomodulstors
HA, dizziness,chills, hot flashes, depression, N/V, diarrhea, urinary frequency
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What is the action of abalimumab (humira)
Disrupt inflammatory process, neutralize TNF, delay disease progression, used for Rhematoid arthritis
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Gout pathophysiology
Inflammatory disease of joints, tendons; usually occurs in great toe, defect in purine metabolism leads to uric acid accumulation in the joints; purine -containing foods: salmon, liver, sardines
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What are the antigout drugs
Colchicine; urix acid inhibitors; uricosurics
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What colchicine used for
Inhibit migration of leukocytes to inflamed site, very potent
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What are the SE of colchicine
N, V, D, abdominal pain; take with food ti avoid GO distress
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What are the contraindications of.colchicine
Severe renamed, cardiac, or GI problems
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What is the drug used for uric acid inhibitors
Allopurinol (zyloprim)
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What is the action of allopurinol
Decrease uric acid levels; prophylactic to prevent gout attacks
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What are the NI of allopurinol
Monitor CBC, liver enzymes, renal function; yearly eye exams for visual changes; client to avoid alcohol, caffeine, and thiazide diuretics that increase fluid intake to increase uric acid excretion
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What are the uricosurics
Probenecid (benemid)
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What is pain
Unpleasant sensosory and emotional experience associated with tissue damage; pt pain is conerstone of pain assessment; pain is personal and individual experience; pain iswhatever the pt says it is! Don't be iudgemental and stingy with pain less
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What is acute pain
Last for the duration of tissue injury
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What is cancer pain
Pressure or blockage to tissue or cells
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What is chronic pain
Persistent, lasts longer than 6 weeks
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What is somatic pain
Bones, skeletal muscles and joints
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What is superficial pain
Skin or mucous membranes
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What is visceral pain
Body organ pain
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What are the assement parameters of pain
Onset of temporal pattern, location, quality, intensity, modulating factors, previous treatment (did it work previously), impact
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What are the non-drug therapy assessments of pain
Application of heat and cold, massage, exercise, acupuncture, relaxation, imagery, peer group support, neurolytic nerve block, and radiation therapy
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What are the non-opiods
Not an opium derivative, non-narcotic, a lot of times it isOTC
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What is the action of acetaminophen
Inhibits prostaglandin synthesis
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What are theuses of acetaminophen
Relieves pain, discomfort, fever; max dose is 4 g/day
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What are the SE of acetaminophen
Rash, low incidence of GI distress; toxic effects/overdose; hepatotoxicity, thrombocytopenia
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What are analgesic used for
Paraaminophenol derivative
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What is the other information about acetaminophen
Constitutes 25% of all OTC drugs sold, safe effective analegesic and antipyretic, can be hepatotoxic, used to be frequently to I'D
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What is the antidote for acetaminophen
Mucomyst
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What is an exaaple of non-opiods
Acetaminophen
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What are opoid analgesic
Prescription only, controlled substances, nurses must sign for them, count them daily & account for the number of narcotics in cabinet
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What are the opoid analgesicsused for
For moderate to severe pain, acute MI, cancer, dyspena from pulmonary edema, preop med for balanced anesthesia, cough center depressant, treatment of diarrhea, antidote is narcotic anatagonists naxolone (narcan) and naltrexone (revia)
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What are the opoid drugs
Morphine and codeine
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What are.the synthetic opioids
Meperidine (demerol) and hydromorphone (dilaudid)
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What are the uses of opioids
Pain relief; antitussives (except meperidine)
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What is the actions of opioids
Acts on the CNS to suppress pain impulses, cough centers and depresses respirations
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Codenine
1/15 to 1/20 we potent as morphine sulfate
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What do most opioids with exception of demerol have the effect of
Antitussive
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What are the two isomers of opioids
Levo and dextro; Levo causes physical dependence
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What are the SE/ adverse effects of opioids
Hypotension, sedation, confusion, blurred vision, constipation, urinary retention; ithing, respiratory depression (must be 12 or narcotics cannot be administered), tolerance and dependence, withdrawal symptoms
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What are.the contraindications for opioids
Known drug allergy, head injuries, increased intracranial pressure; severe asthma or other respiratory disorders; shock or hypotension and pregnancy
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What are the.NI for opioids
Obtain allergies history, obtain baseline vital signs and I & O, perform a through pain assessment, be sure to medicate pt before the pain becomes severe as to provide adequate analgesia and pain control, ensure saefty measures (side rails up and call light within reach, bed in lowest position)drugs can cause othostatic hypotension, sedation so we need to give them a safe environment
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What are the classic triads of opioids OD
Coma, respiratory depression, pinpoint pupils
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What is.the treatment for opioid OD
Ventilator support, opioids antagonist,nalmefene (,revex)
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What is the drug used for opioid agonist-antagonist
Nalbuphine HCL (nubain)-most commonal used
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What is the action of nalbuphine HCL (nubain)
Binds with opiate receptor and increases pain threshold
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What is the advantages of nalbuphine (nubain)
Decreases risk of narcotis abuse; safest to use during labor
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What are the SE/adverse effects of nalbuphine (nubain)
Confusion, restlessiness, abdominal cramps, urinary urgency, depression; respiratory depression
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What are the contraindications of nalbuphine (nubain)
Renal or hepatic dysfunction; head injuries, increased, intracranial pressure, impaired respiration; history of drug abuse or emotional instability
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What is the use for opioid antagonists
Antidote for opiate overdose; reverse effects of opiates, including respiratory depression, sedation, hypotension; respiratory distress
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What is the drug used for opioid antagonist
Naloxone (narcan)
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What are the SE of naloxone(narcan)
Tremors, sweating, hypertension, tachy, excitement, N/V, reversal of analgesic, dysrhytmia, elevated PTT
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What are the NI for opioid antagonist
Monitor vital signs and bleeding continuously
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What is the methadone treatment program
Weaning program, maintenance program, and hot life longer ( given once a day)
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