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78 Cards in this Set
- Front
- Back
(def)
a protective process of the tissues in response to irritation, infection or injury |
Inflammation
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True/False:
It is possible to have inflammation without infection or injury |
True
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What 3 processes make up the inflammatory response?
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1. vasodilation
2. increased vascular permeability 3. migration of WBCs to the inflamed area |
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What are the 5 cardinal signs of inflammation?
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1. redness
2. increased warmth 3. swelling 4. pain 5. varying degrees of loss of function in that area |
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The cardinal signs of inflammation are initiated by what type of cells? What do these cells specifically release in the body to produce such an effect?
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Mast cells- these cells release biochemical mediators such as histamines, leukotrienes and prostaglandins
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What are the 3 types of drugs used to treat inflammation?
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1. anti-inflammatories
2. immunosuppressants 3. immunomodulators |
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What are 3 common drug categories that are frequently used to treat inflammation caused by osteoarthritis, rheumatoid arthritis, musculoskeletal disorder, minor surgeries, dental procedures, and GYN disorders (dysmenorrhea / endometriosis)?
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1. anti-inflammatories
2. immunosuppressants 3. immunomodulators |
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True/False:
Certain drugs that treat inflammatory conditions have antipyretic effects. |
True
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True/False:
Acetaminophen is considered an anti-inflammatory drug. |
False- it is a prostaglandin synthesis inhibitor (thus decreases pain) but it's anti-inflammatory response is so weak that it is not considered an anti-inflammatory drug.
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What are the 2 primary uses for acetaminophen?
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antipyretic
analgesic |
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Salicylates and NSAIDS are classifications of ___________ drugs.
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anti-inflammatory
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How do salicylates and NSAIDS exert their action?
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they inhibit prostaglandin
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Prostaglandins are converted from arachidonic acid by the enzyme __________.
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cyclooxygenase (COX)
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What are the 2 forms of COX.
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COX-1 and COX-2
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Which enzyme, COX-1 or COX-2, is most actively involved in prostaglandin formation at the site of inflammation?
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COX-2
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What is the goal of the pharmacological therapy with agents such as salicylates and NSAIDS (anti-inflammatory)?
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to inhibit COX
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Salicylates and most NSAIDS inhibit COX-1, COX-2, or both?
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both
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True/False:
There is one NSAID that selectively inhibis COX-2. |
true
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What is the problem with the inhibition of COX-1?
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can leads to bleeding disorders through anti-platelet aggregation
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_______ (COX-1 or COX-2) is protective of the stomach lining.
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COX-1
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Drugs that inhibit _________ are more likely to cause gastric irritation with bleeding; especially in the elderly.
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COX-1
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What is the advantage of selective COX-2 inhibitors?
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they decrease the incidence of bleeding disorders
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COX-2 selective inhibitors have been implicated in what negative disorders?
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increased incidence of cardiac disorders and strokes due to edema and hypertension
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Why were rofecoxib and valdecoxib, COX-2 selective inhibitors, taken off the market by the FDA?
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because there was an increase in cardiac disorders and strokes associated with these drugs
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What is the primary use for aspirin?
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used for anti-platelet aggregation in heart disease
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What specific consideration should be known about ketorolac, a potent NSAID?
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- it is extremely potent, can only be used short term (5 days or less) due to a high potential for nephrotoxicity
- only NSAID that can be given parenterally |
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What can be caused by both NSAIDS and salicylates due to the inhibition of COX-1?
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Peptic Ulcers
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What should be done to avoid stomach irritation with NSAIDS and salicylates?
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give with food
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Many clients must take what with NSAIDS and salicylates to counter the stomach irritation?
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antacids and/or histamine blockers
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True/False:
You still should take antacids or histamine blockers to avoid stomach irritation even with the IV form of an NSAID. |
True
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Both NSAIDS and salicylates can cause what due to their anti-platelet aggregation abilities?
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bleeding disorders
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What effect can NSAIDS and salicylates have on the kidneys?
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- both can cause vasoconstriction of the kidneys which can lead to renal damage
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What can occur when a client takes salicylates in high doses?
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tinnitus (ringing in the ears)
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What is a nursing consideration for a client with asthma and on salicylates?
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- they can cause bronchospasm with wheezing, especially in clients with asthma
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Why should children who have viral infections avoid the use of salicylates?
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it can lead to the potentially fatal Reye Syndrome
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Edema may be caused by the use of NSAIDS. What might this lead to?
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hypertension
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True/False:
NSAIDS and Salicylates work on inflammation relatively quickly, decreasing inflammation in a few hours. |
False- normally it takes days or weeks to reduce inflammation
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The use of herbs (dong quai, feverfew, garlic, ginger, and ginkgo biloba) along with NSAIDS and Salicylates, can increase the risk for what?
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bleeding disorders
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Corticosteriods are examples of what drug class?
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immunosuppressant drugs
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Corticosteroids are hormonal substances produced by what?
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the adrenal cortex
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The levels of corticosteroids naturally in the body will rise in response to what?
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physical or psychological stress
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What 3 things can exogenous corticosteroids decrease?
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1. decrease inflammation
2. decrease the allergic response 3. decrease the symptoms caused by an auto-immune disease |
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How do corticosteroids decrease inflammation?
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they suppress the immune system
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Corticosteroids penetrate cell membranes and bind to what?
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intracellular corticosteroid receptors
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The # of what is reduced in the blood when there is a higher # of corticosteroids?
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The number of circulating lymphocytes, basophils, and monocytes
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True/False:
Phagocytosis is enhanced with the use of corticosteroids. |
False- it is inhibited
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What is the largest concern with the use of corticosteroids?
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- the suppression of the immune system
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What drug class has a mechanism of action that can predispose the body to infection, decrease the ability to fight infection, and mask the signs and symptoms of infection?
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corticosteroids
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In addition to inhibiting phagocytosis, corticosteroids also inhibit the release of what 3 things?
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- histamines
- leukotrienes - prostaglandins |
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True/False:
Corticosteroids work quickly and are very effective. |
True
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Why are corticosteroids generally only for short term use?
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because they have many potentially serious adverse effects
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Corticosteroids can cause what due to the inhibition of COX-1?
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peptic ulcers
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What are some negative effects of long-term corticosteroid treatments?
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- impaired immune response
- hypernatremia - edema - hypertension - hyperglycemia - hypokalemia - hypocalcemia - osteoporosis - mood swings - weight gain - changes in fat distribution |
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Why must corticosteroids be discontinued in tapering doses (5-10 days)?
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to prevent adrenal insufficiency (unless they were used for a very short time or a very low does)
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DMARDs (disease-modifying antirheumatic drugs) are used to treat what?
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rheumatoid arthritis
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True/False:
DMARDs are prescription only |
True
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At what point would you use a DMARD in the treatment of rheumatoid arthritis?
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when less toxic remedies have not reduced the inflammatory response adequately
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What 4 classifications of drugs fall under the DMARD category?
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- anti-inflammatories
- immunosuppressants - immunomodulators - anti-malarial drugs |
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Which category of DMARD are gold compounds that decrease rheumatoid factor by inhibiting phagocytosis and lysosomal activity?
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anti-inflammatories
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Which category of DMARD is reserved for the most extreme cases of rheumatoid arthritis due to extreme adverse reactions (ex. damage to normal cells while stopping the division of abnormal cells)?
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immunosuppressants
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Which category of DMARD are tumor necrosis factor antagonists and typically safer for long term use?
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immunomodulators
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Which category of DMARD is primarily used for malaria but used off label in the treatment of rheumatoid arthritis?
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anti-malarial drugs
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What are some of the side effects of the anti-inflammatory class of DMARDs?
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- GI disturbances
- allergic reactions - respiratory distress - blood dyscrasia |
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Which category of DMARD is considered gold therapy?
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anti-inflammatory class (these are gold compounds)
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What 2 categories of DMARDs should not be used during an active infection and why?
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- immunosuppressants and immunomodulators because they decrease the immune system response
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_______ and _______ damage can occur with the long-term use of hydroxychloroquine, an anti-malarial drug.
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retinal and corneal damage
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What are 2 recommended exams for someone on long-term anti-malarial drug therapy?
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baseline eye exam
periodic exams thereafter |
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Glucosamine and Chondroitin are OTC herbs used for the treatment of what? How do they work?
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treatment of osteoarthritis, they inhibit cartilage degeneration
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What does SAM-e, an OTC herb, claim to do?
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improve mood and flexibility of joints
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What should be monitored for clients with diabetes and taking glucosamine/chondroitin (OTC herbs)?
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- blood glucose levels
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It is not advisable to take SAM-e along with what?
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St. John's wort or antidepressants
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Gout is a condition caused by increased levels of what?
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serum uric acid
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What are the 2 causes of increased serum uric acid?
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- increased production of uric acid
- decreased renal excretion of uric acid |
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How does gout develop from hyperuricemia?
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deposits of crystal are made in the joints and surrounding tissue
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What part of the anatomy is most greatly affected by gout?
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the large toe
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What is the goal of the pharmacological therapy in the treatment of gout? (4)
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- decrease uric acid synthesis
- decrease inflammation - decrease crystal deposit - eliminate uric acid in urine |
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What is recommended with the use of all anti-gout drugs?
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increased fluid intake
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Colchicine, an anti-gout drug, can cause what negative side effect?
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diarrhea (GI disturbances)
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