NUR 521 EXAM 3 QUESTIONS
WITH 100% COMPLETE
SOLUTIONS
Aspirin - Answer- NSAID that protects against MI, Stroke (others slightly increase the
risk for thrombotic events)
Aspirin - Answer- Non-selectively and irreversibly inhibits cyclooxygenase, reducing
prostaglandin and thromboxane A2 synthesis, producing analgesic, anti-inflammatory,
and antipyretic effects and reducing platelet aggregation
Aspirin - Answer- •Pregnancy: Poses risk for premature closure of the ductus arteriosus
and increased risk for anemia and postpartum hemorrhage. Do not give full dose in
pregnancy starting at 30 weeks gestation (low-dose is ok); Do give full dose to a
breastfeeding mom of infant with viral infection
•Monitor for salicylism
ringing in the ears - Answer- major sign of salicylism
ibuprofen (advil) - Answer- •Inhibits cyclooxygenase, reducing prostaglandin and
thromboxane synthesis (reversible)
Ibuprofen, Celebrex - Answer- •BBW: CV Thrombotic Event and GI Bleeding, Ulceration
and Perforation
Ibuprofen - Answer- NSAID that may delay ovulation, caution with females trying to
conceive
Ibuprofen - Answer- •Monitoring: Cr if severe renal dz; CBC, chemistry profile if long-
term tx; BP; s/sx hepatic impairment in peds pts if dose >30 mg/kg/day or abnormal
LFTs w/ prior NSAID tx
•Take with food or milk to lessen stomach upset.
•"can increase your risk of fatal heart attack or stroke. Do not use this medicine just
before or after heart bypass surgery (coronary artery bypass graft, or CABG). may also
cause stomach or intestinal bleeding, which can be fatal."
Ibuprofen - Answer- NSAID of choice while breastfeeding
Ibuprofen, Celebrex - Answer- NSAIDs to avoid at 30 weeks gestation, weigh
risk/benefits, may use while breastfeeding
,Celebrex - Answer- •Can increase the risk of fatal heart attack or stroke; Do not take
after or before a CABG; May cause stomach or intestinal bleeding; Do not take if you
have a sulfa allergy
•Monitoring: Cr at baseline, then if elderly, renal or hepatic impairment, CHF,
dehydration, or hypovolemia cont. periodically; BP during tx start, then periodically;
CBC, chemistry profile if long-term tx; coagulation tests if systemic onset JIA
Aspirin - Answer- do not take if CrCl is less than 10
Ibuprofen, Celebrex - Answer- do not take if CrCl is less than 30
Acetaminophen - Answer- •Analgesic mechanism of action unknown; antipyretic effect
via direct action on the hypothalamic heat-regulating center; decreases prostaglandin
synthesis in the CNS reducing fever and pain
Acetaminophen - Answer- Can use during pregnancy and breastfeeding for pain, fever
Acetaminophen - Answer- BBW: Hepatotoxicity and Medication Error Risk for IV use
Acetaminpophen - Answer- •Infant and children dosing: 10-15 mg/kg/dose PO q4-6h prn
(Be sure to use Infants' and Childrens')
Acetaminophen - Answer- •Antidote for overdose: Acetylcysteine
Acetaminophen - Answer- •Monitoring: Cr at baseline; LFTs if high-dose or long-term tx,
esp. if pre-existing hepatic disease
•Severe liver damage may occur if patient consumes 3 or more alcoholic drinks every
day
Acetaminophen - Answer- No antiinflammatory and antirheumatic actions, does not
suppress platelet aggregation, does not cause gastric ulceration, and does not
decrease renal blood flow or cause renal impairment. However, overdose can cause
severe liver injury.
Glucocorticoid - Answer- elevate blood glucose, elevate BP, decrease immune system,
reduce muscle mass, decrease protein matrix of bone, cause thinning of skin, potbelly,
moon face, buffalo hump,
Glucocorticoids, epinephrine - Answer- adrenal glands should secrete more of this in
times of stress
Glucocorticoids - Answer- •Insufficient release during stress: Hypotension and
hypoglycemia occur
•Very severe stress: insufficiency can result in circulatory failure and death
, Glucocorticoid - Answer- may need to increase dosage in stressful situations due to an
increase in demand (such as in hospitalized patients)
Glucocorticoid - Answer- can exert actions similar to aldosterone (fluid and sodium
retention, potassium excretion) causing edema, hypernatremia, hypokalemia (most
drugs utilized in this class have very low activity such as this)
Glucocorticoid Withdrawal/Weening - Answer- To allow time for recovery of adrenal
function, withdrawal should be done slowly, schedule determined by the degree of
adrenal suppression. Ex: (1) taper the dosage to a physiologic range over 7 days; (2)
switch from multiple daily doses to single doses administered each morning; (3) taper
the dosage to 50% of physiologic values over the next month; and (4) monitor for
production of endogenous cortisol and, when basal levels have returned to normal,
cease routine (but be prepared to give supplemental doses at times of stress).
2 to 3 weeks - Answer- As a rule, tapering is unnecessary when oral glucocorticoids
have been used for less than
low and slow - Answer- if there is no immediate threat, start glucocorticoids...
Start high and decrease as possible - Answer- If there is an immediate threat, start
glucocorticoids....
Prolonged, high dose glucocorticoids - Answer- is used only if disorder is life-
threatening or has potential to cause permanent disability
Glucocorticoids - Answer- have much greater anti-inflammatory effects than NSAIDS
Prednisone - Answer- •May use while breastfeeding, consider holding breastfeeding x4h
after dose if prolonged high-dose use
•Weigh risk/benefit during pregnancy; Possible risk of orofacial cleft based on conflicting
human data and animal data
Prednisone and Decadron - Answer- •Instruct patients to not take if they have a fungal
infection; DO NOT stop abruptly; Can weaken the immune system so notify provider of
any S/S of infection; May lead to bone loss so take Calcium and Vit D; Take with food
•Monitoring: electrolytes; BP; weight; 2h postprandial glucose, height (peds), chest x-ray
if prolonged tx; ophthalmic exam if tx >6wk; BMD if prolonged tx or in pts 65 yo and
older; consider upper GI x-ray if PUD hx or significant dyspepsia
Dexamethasone (Decadron) - Answer- •Lactation: No human data available, though
possible risk of suppressed infant growth and endogenous steroid production based on
drug's mechanism of action
•Pregnancy: Weigh risk/benefit during pregnancy, esp. in 1st trimester or w/ long-term
use; possible risk of orofacial cleft based on conflicting human data; possible risk of low
WITH 100% COMPLETE
SOLUTIONS
Aspirin - Answer- NSAID that protects against MI, Stroke (others slightly increase the
risk for thrombotic events)
Aspirin - Answer- Non-selectively and irreversibly inhibits cyclooxygenase, reducing
prostaglandin and thromboxane A2 synthesis, producing analgesic, anti-inflammatory,
and antipyretic effects and reducing platelet aggregation
Aspirin - Answer- •Pregnancy: Poses risk for premature closure of the ductus arteriosus
and increased risk for anemia and postpartum hemorrhage. Do not give full dose in
pregnancy starting at 30 weeks gestation (low-dose is ok); Do give full dose to a
breastfeeding mom of infant with viral infection
•Monitor for salicylism
ringing in the ears - Answer- major sign of salicylism
ibuprofen (advil) - Answer- •Inhibits cyclooxygenase, reducing prostaglandin and
thromboxane synthesis (reversible)
Ibuprofen, Celebrex - Answer- •BBW: CV Thrombotic Event and GI Bleeding, Ulceration
and Perforation
Ibuprofen - Answer- NSAID that may delay ovulation, caution with females trying to
conceive
Ibuprofen - Answer- •Monitoring: Cr if severe renal dz; CBC, chemistry profile if long-
term tx; BP; s/sx hepatic impairment in peds pts if dose >30 mg/kg/day or abnormal
LFTs w/ prior NSAID tx
•Take with food or milk to lessen stomach upset.
•"can increase your risk of fatal heart attack or stroke. Do not use this medicine just
before or after heart bypass surgery (coronary artery bypass graft, or CABG). may also
cause stomach or intestinal bleeding, which can be fatal."
Ibuprofen - Answer- NSAID of choice while breastfeeding
Ibuprofen, Celebrex - Answer- NSAIDs to avoid at 30 weeks gestation, weigh
risk/benefits, may use while breastfeeding
,Celebrex - Answer- •Can increase the risk of fatal heart attack or stroke; Do not take
after or before a CABG; May cause stomach or intestinal bleeding; Do not take if you
have a sulfa allergy
•Monitoring: Cr at baseline, then if elderly, renal or hepatic impairment, CHF,
dehydration, or hypovolemia cont. periodically; BP during tx start, then periodically;
CBC, chemistry profile if long-term tx; coagulation tests if systemic onset JIA
Aspirin - Answer- do not take if CrCl is less than 10
Ibuprofen, Celebrex - Answer- do not take if CrCl is less than 30
Acetaminophen - Answer- •Analgesic mechanism of action unknown; antipyretic effect
via direct action on the hypothalamic heat-regulating center; decreases prostaglandin
synthesis in the CNS reducing fever and pain
Acetaminophen - Answer- Can use during pregnancy and breastfeeding for pain, fever
Acetaminophen - Answer- BBW: Hepatotoxicity and Medication Error Risk for IV use
Acetaminpophen - Answer- •Infant and children dosing: 10-15 mg/kg/dose PO q4-6h prn
(Be sure to use Infants' and Childrens')
Acetaminophen - Answer- •Antidote for overdose: Acetylcysteine
Acetaminophen - Answer- •Monitoring: Cr at baseline; LFTs if high-dose or long-term tx,
esp. if pre-existing hepatic disease
•Severe liver damage may occur if patient consumes 3 or more alcoholic drinks every
day
Acetaminophen - Answer- No antiinflammatory and antirheumatic actions, does not
suppress platelet aggregation, does not cause gastric ulceration, and does not
decrease renal blood flow or cause renal impairment. However, overdose can cause
severe liver injury.
Glucocorticoid - Answer- elevate blood glucose, elevate BP, decrease immune system,
reduce muscle mass, decrease protein matrix of bone, cause thinning of skin, potbelly,
moon face, buffalo hump,
Glucocorticoids, epinephrine - Answer- adrenal glands should secrete more of this in
times of stress
Glucocorticoids - Answer- •Insufficient release during stress: Hypotension and
hypoglycemia occur
•Very severe stress: insufficiency can result in circulatory failure and death
, Glucocorticoid - Answer- may need to increase dosage in stressful situations due to an
increase in demand (such as in hospitalized patients)
Glucocorticoid - Answer- can exert actions similar to aldosterone (fluid and sodium
retention, potassium excretion) causing edema, hypernatremia, hypokalemia (most
drugs utilized in this class have very low activity such as this)
Glucocorticoid Withdrawal/Weening - Answer- To allow time for recovery of adrenal
function, withdrawal should be done slowly, schedule determined by the degree of
adrenal suppression. Ex: (1) taper the dosage to a physiologic range over 7 days; (2)
switch from multiple daily doses to single doses administered each morning; (3) taper
the dosage to 50% of physiologic values over the next month; and (4) monitor for
production of endogenous cortisol and, when basal levels have returned to normal,
cease routine (but be prepared to give supplemental doses at times of stress).
2 to 3 weeks - Answer- As a rule, tapering is unnecessary when oral glucocorticoids
have been used for less than
low and slow - Answer- if there is no immediate threat, start glucocorticoids...
Start high and decrease as possible - Answer- If there is an immediate threat, start
glucocorticoids....
Prolonged, high dose glucocorticoids - Answer- is used only if disorder is life-
threatening or has potential to cause permanent disability
Glucocorticoids - Answer- have much greater anti-inflammatory effects than NSAIDS
Prednisone - Answer- •May use while breastfeeding, consider holding breastfeeding x4h
after dose if prolonged high-dose use
•Weigh risk/benefit during pregnancy; Possible risk of orofacial cleft based on conflicting
human data and animal data
Prednisone and Decadron - Answer- •Instruct patients to not take if they have a fungal
infection; DO NOT stop abruptly; Can weaken the immune system so notify provider of
any S/S of infection; May lead to bone loss so take Calcium and Vit D; Take with food
•Monitoring: electrolytes; BP; weight; 2h postprandial glucose, height (peds), chest x-ray
if prolonged tx; ophthalmic exam if tx >6wk; BMD if prolonged tx or in pts 65 yo and
older; consider upper GI x-ray if PUD hx or significant dyspepsia
Dexamethasone (Decadron) - Answer- •Lactation: No human data available, though
possible risk of suppressed infant growth and endogenous steroid production based on
drug's mechanism of action
•Pregnancy: Weigh risk/benefit during pregnancy, esp. in 1st trimester or w/ long-term
use; possible risk of orofacial cleft based on conflicting human data; possible risk of low
