Podcast
Questions and Answers
What is the purpose of a Purified Protein Derivative (PPD) injection?
What is the purpose of a Purified Protein Derivative (PPD) injection?
- To treat Tuberculosis (TB)
- To detect exposure to the TB organism (correct)
- To vaccinate against TB
- To diagnose other respiratory diseases
What is a positive result indicated by in a PPD test?
What is a positive result indicated by in a PPD test?
- Induration at the site of injection (correct)
- Erythema at the site of injection
- Swollen lymph nodes
- Fever and chills
What is the major effect of anti-Tubercular drug therapy?
What is the major effect of anti-Tubercular drug therapy?
- Reduction of cough and reduction of infectiousness (correct)
- Prevention of further transmission
- Complete elimination of the TB bacteria
- Improvement of nutritional intake
What is a common adverse effect of INH therapy?
What is a common adverse effect of INH therapy?
What should patients be instructed to do while taking Rifampin?
What should patients be instructed to do while taking Rifampin?
What should patients be monitored for during TB therapy?
What should patients be monitored for during TB therapy?
What should patients be informed about regarding their bodily fluids while taking certain TB medications?
What should patients be informed about regarding their bodily fluids while taking certain TB medications?
What is Isoniazid primarily used for?
What is Isoniazid primarily used for?
What laboratory tests should be monitored when administering Isoniazid?
What laboratory tests should be monitored when administering Isoniazid?
What is a common adverse effect of Rifabutin?
What is a common adverse effect of Rifabutin?
What is the main concern regarding multidrug-resistant TB?
What is the main concern regarding multidrug-resistant TB?
What is the primary reason for the resurgence of TB in the United States in 1992?
What is the primary reason for the resurgence of TB in the United States in 1992?
What is the definition of multidrug-resistant TB?
What is the definition of multidrug-resistant TB?
Why is Ethambutol not recommended for pediatric patients younger than 13?
Why is Ethambutol not recommended for pediatric patients younger than 13?
What is the primary mechanism of NSAIDs' action in the body?
What is the primary mechanism of NSAIDs' action in the body?
Which of the following NSAIDs is NOT contraindicated in patients with a sulfa allergy?
Which of the following NSAIDs is NOT contraindicated in patients with a sulfa allergy?
What is the primary indication for the use of allopurinol?
What is the primary indication for the use of allopurinol?
What is the primary risk associated with the use of NSAIDs in patients with dehydration?
What is the primary risk associated with the use of NSAIDs in patients with dehydration?
Which of the following is a potential interaction between NSAIDs and other medications?
Which of the following is a potential interaction between NSAIDs and other medications?
What is the primary indication for the use of aspirin?
What is the primary indication for the use of aspirin?
What is the primary mechanism of action of probenecid?
What is the primary mechanism of action of probenecid?
What is a crucial requirement for patients taking Lesinurad?
What is a crucial requirement for patients taking Lesinurad?
What should patients be educated about when taking medications for gout?
What should patients be educated about when taking medications for gout?
Why should salicylates not be given to children and teenagers?
Why should salicylates not be given to children and teenagers?
What laboratory studies should be performed before beginning therapy with NSAIDS?
What laboratory studies should be performed before beginning therapy with NSAIDS?
Why should NSAIDS be taken with food, milk, or an antacid?
Why should NSAIDS be taken with food, milk, or an antacid?
What is a condition that requires cautious use of NSAIDS?
What is a condition that requires cautious use of NSAIDS?
What is a therapeutic effect of NSAIDS in gout?
What is a therapeutic effect of NSAIDS in gout?
How long may it take to see therapeutic effects of NSAIDS?
How long may it take to see therapeutic effects of NSAIDS?
What is an important aspect of nursing implications for NSAIDS?
What is an important aspect of nursing implications for NSAIDS?
Patients with bleeding disorders are contraindicated to NSAIDS therapy.
Patients with bleeding disorders are contraindicated to NSAIDS therapy.
Sulfinpyrazone is a medication that requires good renal function.
Sulfinpyrazone is a medication that requires good renal function.
Lesinurad is a medication that can be used for long-term treatment of gout.
Lesinurad is a medication that can be used for long-term treatment of gout.
Drinking at least 2 liters of fluid a day is recommended for patients taking NSAIDS.
Drinking at least 2 liters of fluid a day is recommended for patients taking NSAIDS.
GI lesions or peptic ulcer disease are conditions that require cautious use of NSAIDS.
GI lesions or peptic ulcer disease are conditions that require cautious use of NSAIDS.
Reye's Syndrome is a common adverse effect of NSAIDS in adults.
Reye's Syndrome is a common adverse effect of NSAIDS in adults.
NSAIDS are generally well-tolerated medications.
NSAIDS are generally well-tolerated medications.
Therapeutic effects of NSAIDS may be seen immediately after taking the medication.
Therapeutic effects of NSAIDS may be seen immediately after taking the medication.
Monitor for a decrease in swelling, pain, stiffness, and tenderness of a joint or muscle area as a therapeutic effect of NSAIDS.
Monitor for a decrease in swelling, pain, stiffness, and tenderness of a joint or muscle area as a therapeutic effect of NSAIDS.
Performing a medication history is not necessary before beginning NSAIDS therapy.
Performing a medication history is not necessary before beginning NSAIDS therapy.
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Study Notes
Antitubercular Drugs
- First-line drugs:
- Isoniazid (INH): primary drug used, metabolized through the liver, contraindicated for patients with liver disease
- Rifapentine
- Ethambutol: first bacteriostatic drug used to treat TB, causes optic neuritis in pediatric patients
- Rifabutin: used to treat infections caused by non-TB mycobacterial species
- Pyrazinamide
- Rifampin
- Streptomycin
- Second-line drugs:
- Bedaquiline: used for multidrug-resistant TB
- Pretomanid: new drug used for only pulmonary multidrug-resistant TB
- Capreomycin
- Cycloserine
- Levofloxacin
- Ethionamide
- Oflaxacin
- Kanamycin
- Para-aminosalicycle (PAS)
TB Infection and Incidence
- Primary TB infection: first infectious episode
- Reinfection: can occur due to dormancy process
- Chronic form of the disease: may test positive for exposure but are not necessarily infectious
- Incidence:
- 1950s: TB incidence decreased in most years until about 1985
- 1985: TB incidence began to rise due to development of TB in patients coinfected with HIV
- 1992: Resurgence peak in the United States, but has decreased since then
- Current concern: increasing number of multidrug-resistant TB cases and nonadherence to prolonged treatment
PPD (Purified Protein Derivatives)
- Intradermal injection given in doses of 5 tuberculin units (0.1 ml) to detect exposure to TB organism
- Positive result indicated by induration (not erythema) at the site of injection
Anti-Tubercular Drug Therapy Considerations
- Patient cannot be sent home until medication regimen is determined to be working
- Major effects of drug therapy: reduction of cough and infectiousness of the patient
- Successful treatment: sometimes lasts for up to 12-24 months due to noncompliance and environmental factors
Adverse Effects and Nursing Implications
- INH: peripheral neuropathy, hepatotoxicity
- Ethambutol: retrobulbar neuritis, blindness
- Rifampin: hepatitis, discoloration of urine, stools, and other body fluids
- Patient education is critical: therapy may last up to 12-24 months, take medications exactly as ordered, and emphasize strict adherence to regimen
NSAIDs and Gout
Common Uses for NSAIDs
- Pain relief for mild or moderate headaches, myalgia, neuralgia, and arthralgia
- Treatment of gout and hyperuricemia
Adverse Effects of NSAIDs
- GI: heartburn to severe GI bleeding
- Acute renal failure
- Noncardiogenic pulmonary edema
- Increased risk of MI and stroke
- Altered hemostasis
- Hepatotoxicity
- Skin eruption, sensitivity reaction
- Tinnitus, hearing loss
- Interactions: serious interactions can occur with anticoagulants, aspirin, corticosteroids, and other ulcerogenic drugs
Renal Function and Black-Box Warning
- Renal function depends partly on prostaglandins
- Disruption of prostaglandin function by NSAIDs can precipitate acute or chronic renal disease
- Black-box warning: all NSAIDs (except aspirin) share an increased risk of adverse cardiovascular thrombotic events, including fatal MI and stroke
Specific NSAIDs
- Acetic acid derivatives:
- Diclofenac sodium (Voltaren)
- Indomethacin
- Sulindac
- Tolmetin
- Etodolac
- Ketorolac
- Cyclooxygenase-2 (COX-2) inhibitors:
- Celecoxib (Celebrex): first and only remaining COX-2 inhibitor
- Enolic acid derivatives:
- Nabumetone (Relafen)
- Meloxicam (Mobic)
- Piroxicam (Feldene)
- Propionic acid derivatives:
- Fenoprofen (Nalfon)
- Flurbiprofen (Ansaid)
- Ibuprofen (Motrin, Advil)
- Ketoprofen (Orudis KT)
- Naproxen (Naprosyn, Aleve)
- Oxaprozin (Daypro)
- Aspirin:
- Good for heart health
- Used for headache, neuralgia, myalgia, and arthralgia
Gout and Hyperuricemia
- Gout: condition that results from inappropriate uric acid metabolism
- Hyperuricemia: underexcretion or overproduction of uric acid
- Antigout medications:
- Allopurinol
- Febuxostat
- Colchine
- Probenecid
- Lesinurad
- Sulfinpyrazone
Antitubercular Drugs
- First-line drugs:
- Isoniazid (INH): primary drug used, metabolized through the liver, contraindicated for patients with liver disease
- Rifapentine
- Ethambutol: first bacteriostatic drug used to treat TB, causes optic neuritis in pediatric patients
- Rifabutin: used to treat infections caused by non-TB mycobacterial species
- Pyrazinamide
- Rifampin
- Streptomycin
- Second-line drugs:
- Bedaquiline: used for multidrug-resistant TB
- Pretomanid: new drug used for only pulmonary multidrug-resistant TB
- Capreomycin
- Cycloserine
- Levofloxacin
- Ethionamide
- Oflaxacin
- Kanamycin
- Para-aminosalicycle (PAS)
TB Infection and Incidence
- Primary TB infection: first infectious episode
- Reinfection: can occur due to dormancy process
- Chronic form of the disease: may test positive for exposure but are not necessarily infectious
- Incidence:
- 1950s: TB incidence decreased in most years until about 1985
- 1985: TB incidence began to rise due to development of TB in patients coinfected with HIV
- 1992: Resurgence peak in the United States, but has decreased since then
- Current concern: increasing number of multidrug-resistant TB cases and nonadherence to prolonged treatment
PPD (Purified Protein Derivatives)
- Intradermal injection given in doses of 5 tuberculin units (0.1 ml) to detect exposure to TB organism
- Positive result indicated by induration (not erythema) at the site of injection
Anti-Tubercular Drug Therapy Considerations
- Patient cannot be sent home until medication regimen is determined to be working
- Major effects of drug therapy: reduction of cough and infectiousness of the patient
- Successful treatment: sometimes lasts for up to 12-24 months due to noncompliance and environmental factors
Adverse Effects and Nursing Implications
- INH: peripheral neuropathy, hepatotoxicity
- Ethambutol: retrobulbar neuritis, blindness
- Rifampin: hepatitis, discoloration of urine, stools, and other body fluids
- Patient education is critical: therapy may last up to 12-24 months, take medications exactly as ordered, and emphasize strict adherence to regimen
NSAIDs and Gout
Common Uses for NSAIDs
- Pain relief for mild or moderate headaches, myalgia, neuralgia, and arthralgia
- Treatment of gout and hyperuricemia
Adverse Effects of NSAIDs
- GI: heartburn to severe GI bleeding
- Acute renal failure
- Noncardiogenic pulmonary edema
- Increased risk of MI and stroke
- Altered hemostasis
- Hepatotoxicity
- Skin eruption, sensitivity reaction
- Tinnitus, hearing loss
- Interactions: serious interactions can occur with anticoagulants, aspirin, corticosteroids, and other ulcerogenic drugs
Renal Function and Black-Box Warning
- Renal function depends partly on prostaglandins
- Disruption of prostaglandin function by NSAIDs can precipitate acute or chronic renal disease
- Black-box warning: all NSAIDs (except aspirin) share an increased risk of adverse cardiovascular thrombotic events, including fatal MI and stroke
Specific NSAIDs
- Acetic acid derivatives:
- Diclofenac sodium (Voltaren)
- Indomethacin
- Sulindac
- Tolmetin
- Etodolac
- Ketorolac
- Cyclooxygenase-2 (COX-2) inhibitors:
- Celecoxib (Celebrex): first and only remaining COX-2 inhibitor
- Enolic acid derivatives:
- Nabumetone (Relafen)
- Meloxicam (Mobic)
- Piroxicam (Feldene)
- Propionic acid derivatives:
- Fenoprofen (Nalfon)
- Flurbiprofen (Ansaid)
- Ibuprofen (Motrin, Advil)
- Ketoprofen (Orudis KT)
- Naproxen (Naprosyn, Aleve)
- Oxaprozin (Daypro)
- Aspirin:
- Good for heart health
- Used for headache, neuralgia, myalgia, and arthralgia
Gout and Hyperuricemia
- Gout: condition that results from inappropriate uric acid metabolism
- Hyperuricemia: underexcretion or overproduction of uric acid
- Antigout medications:
- Allopurinol
- Febuxostat
- Colchine
- Probenecid
- Lesinurad
- Sulfinpyrazone
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