NURS 615 exam 3 - Maryville.
corticosteroid drugs - ANSWER prednisone, methylprednisolone, dexamethasone, topical such as
hydrocortisone, and then joint injections for pain
MOA of corticosteroids drugs - ANSWER drugs that suppress inflammation by mimicking glucocorticoid
hormones
Inhibit interleikin one, tumor necrosis factor and other cytokines, impairs phagocytosis, impairs
lymphocytes, and inhibits tissue repair
indications for cortocosteriod use - ANSWER Allergy or hypersensitivity, respiratory, shock,
rheumatology, neurology, hepatic, neoplastic... basicly every organ is covered if there is an issue.
withdrawal from corticorsteriod symptoms - ANSWER malaise, myalgia, headache, nausea, fevers,
hypotension and relapse of symptoms (pain, inflammation, ashtma)
what must you do with corticosteriods to prevent withdrawal - ANSWER Must taper them down, you
can have possible adrenal crisis if you do not.
corticosteriod considerations - ANSWER suppression patients response to infections- no live viral
vaccines, and have increased susceptibility to disease.
If used over 6 months: Increase blood glucose, impair immune function (get vaccines) , impair wound
healing, GI complaints (report black tarry stools) , osteoporosis (decreases calcium), anxiety/insomnia,
sodium & fluid retention 9monitor weight and fluid retention)
If on 1gram or more also prescribe PPI (omeprazole) to prevent PUD
,contraindicated with active infection and hypersensitivity
What are the adverse effects of corticosteroids if administered for six months or more? - ANSWER The
main thing you want to worry about is osteoporosis
It can also worsen diabetic control
Patients should report any tarry black stools or abdominal pain.
NSAIDS - ANSWER nonsteroidal anti-inflammatory drugs
Ibprofen, aspirin, torsdol, naproxin, Mobic
Arachidonic Acid Cascade - ANSWER Cell membrane ► Arachinidonic acid ► Cycloxygenerase (COX)►
prostaglandin's
Or
Cell membrane ► Arachinidonic acid ► Lipoxygenase► Leukotrines
NSAID mechanism of action - ANSWER • NSAIDs inhibit the enzymes COX I and II
• Results in reduction in formation of prostaglandin precursors and thromboxanes from arachidonic acid
COX1- ibuprofen, naproxen, aspirin, when this is inhibited you are also inhibiting the prostaglandins that
protect the stomach
,COX2 - celebrex more stomach proctective
Drug interactions with NSAIDS - ANSWER Pretty much anything that is highly protien bound. Do not give
together with
ACE inhibitors - counteracts antihypertensive effect
BetaBlockers - counteracts antihypertensive effect
lithium - increases lithium levels
Anticoagulants - increases bleeding
Antidiabetics- increases hypoglycemic effect
Black box warning for NSAIDS - ANSWER May cause an increased risk of serious cardiovascular
thrombotic events:
•Patients with cardiovascular disease or with risk factors for cardiovascular disease may be a greater
risk. **
•Myocardial-infarction
•Stroke which can be fatal.**
•This risk may increase with duration of use.
NSAIDs can also cause an increased risk of serious gastrointestinal adverse effects including
•Bleeding**
•Ulceration
•Perforation the stomach or intestines which can be fatal.
, •These events can occur at any time during use and without warning symptoms.
•Elderly patients are at greater risk for serious GI events.
Tylenol - ANSWER non opioid, non NSAID analgesic
treatment for mild pain and fever, has no anti- inflammatory properties
The main mechanism is performed a proposed is the inhibition of cox.
And recent findings suggest that it's highly selective cox-2.
Because of its selectivity for cox-2 it does not significantly inhibit the production of pro clotting
thromboxanes.
Tylenol warnings - ANSWER Acute overdoses of acetaminophen can cause potentially fatal liver damage.
**The maximum recommended dose is 3 grams in 24 hours.
DMARDs (disease modifying anti-rheumatic drugs) - ANSWER Methotrexate
Folic acid antagonist- slows the disease process by inhibiting DNA synthesis and cell reproduction
causes hepatotoxicity leukopenia, anemia
has tons of drug interations
Drugs for Gout - ANSWER allopurinol (Zyloprim), colchicine, and febuxostat (Uloric)
corticosteroid drugs - ANSWER prednisone, methylprednisolone, dexamethasone, topical such as
hydrocortisone, and then joint injections for pain
MOA of corticosteroids drugs - ANSWER drugs that suppress inflammation by mimicking glucocorticoid
hormones
Inhibit interleikin one, tumor necrosis factor and other cytokines, impairs phagocytosis, impairs
lymphocytes, and inhibits tissue repair
indications for cortocosteriod use - ANSWER Allergy or hypersensitivity, respiratory, shock,
rheumatology, neurology, hepatic, neoplastic... basicly every organ is covered if there is an issue.
withdrawal from corticorsteriod symptoms - ANSWER malaise, myalgia, headache, nausea, fevers,
hypotension and relapse of symptoms (pain, inflammation, ashtma)
what must you do with corticosteriods to prevent withdrawal - ANSWER Must taper them down, you
can have possible adrenal crisis if you do not.
corticosteriod considerations - ANSWER suppression patients response to infections- no live viral
vaccines, and have increased susceptibility to disease.
If used over 6 months: Increase blood glucose, impair immune function (get vaccines) , impair wound
healing, GI complaints (report black tarry stools) , osteoporosis (decreases calcium), anxiety/insomnia,
sodium & fluid retention 9monitor weight and fluid retention)
If on 1gram or more also prescribe PPI (omeprazole) to prevent PUD
,contraindicated with active infection and hypersensitivity
What are the adverse effects of corticosteroids if administered for six months or more? - ANSWER The
main thing you want to worry about is osteoporosis
It can also worsen diabetic control
Patients should report any tarry black stools or abdominal pain.
NSAIDS - ANSWER nonsteroidal anti-inflammatory drugs
Ibprofen, aspirin, torsdol, naproxin, Mobic
Arachidonic Acid Cascade - ANSWER Cell membrane ► Arachinidonic acid ► Cycloxygenerase (COX)►
prostaglandin's
Or
Cell membrane ► Arachinidonic acid ► Lipoxygenase► Leukotrines
NSAID mechanism of action - ANSWER • NSAIDs inhibit the enzymes COX I and II
• Results in reduction in formation of prostaglandin precursors and thromboxanes from arachidonic acid
COX1- ibuprofen, naproxen, aspirin, when this is inhibited you are also inhibiting the prostaglandins that
protect the stomach
,COX2 - celebrex more stomach proctective
Drug interactions with NSAIDS - ANSWER Pretty much anything that is highly protien bound. Do not give
together with
ACE inhibitors - counteracts antihypertensive effect
BetaBlockers - counteracts antihypertensive effect
lithium - increases lithium levels
Anticoagulants - increases bleeding
Antidiabetics- increases hypoglycemic effect
Black box warning for NSAIDS - ANSWER May cause an increased risk of serious cardiovascular
thrombotic events:
•Patients with cardiovascular disease or with risk factors for cardiovascular disease may be a greater
risk. **
•Myocardial-infarction
•Stroke which can be fatal.**
•This risk may increase with duration of use.
NSAIDs can also cause an increased risk of serious gastrointestinal adverse effects including
•Bleeding**
•Ulceration
•Perforation the stomach or intestines which can be fatal.
, •These events can occur at any time during use and without warning symptoms.
•Elderly patients are at greater risk for serious GI events.
Tylenol - ANSWER non opioid, non NSAID analgesic
treatment for mild pain and fever, has no anti- inflammatory properties
The main mechanism is performed a proposed is the inhibition of cox.
And recent findings suggest that it's highly selective cox-2.
Because of its selectivity for cox-2 it does not significantly inhibit the production of pro clotting
thromboxanes.
Tylenol warnings - ANSWER Acute overdoses of acetaminophen can cause potentially fatal liver damage.
**The maximum recommended dose is 3 grams in 24 hours.
DMARDs (disease modifying anti-rheumatic drugs) - ANSWER Methotrexate
Folic acid antagonist- slows the disease process by inhibiting DNA synthesis and cell reproduction
causes hepatotoxicity leukopenia, anemia
has tons of drug interations
Drugs for Gout - ANSWER allopurinol (Zyloprim), colchicine, and febuxostat (Uloric)
