Anti-inflammatory, Antiarthritis, and Related Agents

1. A nurse has admitted a 10-year-old child to the short-stay unit. The child has complained of chronic headaches and his or her mother reports that he or she gives him or her acetaminophen (Tylenol) at least twice a day. What will the nurse evaluate? A) Renal function B) Hepatic function C) Respiratory function D) Cardiac function Ans: B Feedback: The nurse should evaluate the patient’s hepatic function. Severe hepatotoxicity can occur from overuse of acetaminophen. Significant interferences do not occur in the kidney, heart, or lung with acetaminophen. 2. The nurse is discussing ethnic differences in response to medication with your nursing students. What group of people would the nurse tell the students may have a decreased sensitivity to pain-relieving effects of anti-inflammatory drugs and should be educated concerning signs and symptoms of gastrointestinal bleeding from use of these drugs? A) African Americans B) White Americans C) Hispanics D) Asians Ans: A Feedback: African Americans have a documented decreased sensitivity to pain-relieving effects of many anti- inflammatory drugs. They also have an increased risk of developing GI adverse effects to these drugs. In general, White Americans, Hispanics, and Asians are at lower risk for these problems. 3. A patient, newly diagnosed with ulcerative colitis, has been admitted to the short-stay unit. What salicylates does the nurse anticipate will be ordered for this patient? A) Balsalazide (Colazal) B) Sodium thiosalicylate (generic) C) Choline magnesium trisalicylate (Tricosal) D) Salsalate (Argesic) Ans: A Feedback: Balsalazide is delivered intact to the colon, where it delivers a local anti-inflammatory effect that is most effective for patients with ulcerative colitis. Choline salicylate and salsalate are used to treat pain, fever, and inflammation. Sodium thiosalicylate is used mainly for episodes of acute gout, for muscular pain, and to treat rheumatic fever. 4. The nurse is caring for a 66-pound child with orders for choline magnesium trisalicylate (Tricosal). The orders read 50 mg/kg/d PO in two divided doses. How many milligram will the patient receive per dose? A) 250 mg B) 500 mg C) 750 mg D) 1,000 mg Ans: C Feedback: First, the nurse must determine the child’s weight in kilogram. One kg is equal to 2.2 pounds. Divide 2.2 into 66 to equal 30 kg. Multiply 50 mg times 30 kg to equal 1,500 mg. Divide 1,500 by 2 for the divided doses, which will equal 750 mg per dose. 5. A nurse is caring for a patient with severe rheumatoid arthritis who takes anti-inflammatory agents on a regular basis. What medication should the nurse question if ordered by the physician to be taken in addition to the anti-inflammatory agent? A) Oral antidiabetic agent B) Calcium channel blocker C) Beta-blocker D) Antibiotic Ans: C Feedback: Nonsteroidal anti-inflammatory drugs have the potential to decrease antihypertensive effects from beta blockers if these drugs are taken at the same time. Patients who receive these combinations should be monitored closely and appropriate dosage adjustments made if needed. Drug interactions do not usually occur with oral antidiabetic agents, calcium channel blocking medications, or antibiotics. 6. A nurse is assessing a patient who has been taking nonsteroidal anti-inflammatory drugs (NSAID). What statement by the patient indicates to the nurse that the patient has a good understanding of the use of this therapy? A) I drink a glass of wine just about every night. B) I asked my doctor to check for blood in my stool regularly. C) I do not like to swallow tablets so I crush them. D) I drink as little water as possible when I take my medication. Ans: B Feedback: Taking certain anti-inflammatory drugs can irritate the gastric mucosa and increase the risk of bleeding; therefore, by asking his or her doctor to check his or her stool for bleeding, the nurse knows that the patient is aware of this. Alcohol and crushing the tablets can interfere with anti-inflammatory metabolism. A full glass of water should be taken with this medication to increase absorption. 7. A salicylate has been prescribed for a 15-year-old patient who has been diagnosed with arthritis. The mother is concerned about giving her child a salicylate. What salicylates could the nurse tell this mother are recommended for use in children? A) Salsalate (Argesic) B) Olsalazine (Dipentum) C) Sodium thiosalicylate (generic) D) Choline magnesium trisalicylate (Tricosal) Ans: D Feedback: Aspirin and choline magnesium trisalicylate are the only salicylates recommended for use in children. They should not be used when any risk of Reye’s syndrome exists. Salsalate (Argesic), olsalazine (Dipentum), and sodium thiosalicylate (generic) have not been approved for pediatric use and do not provide pediatric dosing guidelines as a result. 8. A mother has brought her 6-year-old child to the clinic. The child has a fever of 102.8ºF and is diagnosed with the flu. What medication will the nurse suggest for this child? A) Etanercept (Enbrel) B) Penicillamine (Depen) C) Acetaminophen (Tylenol) D) Aspirin (Bayer) Ans: C Feedback: Acetaminophen would be the suggested medication. It is prescribed for relief of pain and fever for influenza in children. Aspirin would be contraindicated because it increases the risk for Reye’s syndrome. Etanercept and penicillamine are given for severe rheumatoid arthritis therapy. ....................................................................................................CONTINUE.