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Questions and Answers
Which of the following are symptoms of inflammation?
What is a common action of white blood cells (WBC) during the inflammatory response?
Which statement about long-term inflammation is correct?
What is a potential adverse effect of nonsteroidal anti-inflammatory drugs (NSAIDs)?
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What teaching should be emphasized regarding corticosteroid-based anti-inflammatory drugs?
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Which enzyme is known as the 'good COX' and has protective functions in the body?
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Which class of drugs is primarily used for managing chronic inflammation and preventing tissue damage?
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What is a common adverse reaction to nonsteroidal anti-inflammatory drugs (NSAIDs)?
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What is a significant risk associated with the use of COX-2 inhibitors?
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Which statement is true regarding corticosteroids?
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What lifestyle change is recommended for managing gout?
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What serious condition can develop with prolonged use of disease-modifying antirheumatic drugs (DMARDs)?
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Which instruction is critical for patients taking allopurinol for gout?
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Which adverse effect is commonly associated with the long-term use of corticosteroids?
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What is the main action of uric acid synthesis inhibitors like allopurinol?
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Which of the following NSAIDs requires patients to stop taking it a week before dental procedures?
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Which substance is NOT a common drug interaction for corticosteroids?
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What indicates that a patient taking NSAIDs should seek medical attention?
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Which of the following statements regarding DMARDs is incorrect?
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Study Notes
Inflammation
- Inflammation is a normal body response to tissue injury or infection.
- It involves white blood cells (leukocytes) and their products.
- Long-term inflammation can damage tissues.
- Symptoms include: pain, redness, warmth, swelling, and loss of function.
Inflammatory Response
- White blood cells release mediators, including: kinins, prostaglandins (PGs), histamine, and tumor necrosis factor (TNF).
- These mediators act on blood vessels, causing dilation and fluid leakage.
- Increased blood flow brings more white blood cells to the site.
- The COX enzyme plays a role in inflammation:
- COX1: Found in all cells, helps protect the body (good COX).
- COX2: Present at inflammation sites, contributes to ongoing inflammation (bad COX).
Inflammation Management
- Anti-inflammatory drugs are used to reduce pain and prevent tissue and blood vessel responses.
- Long-term therapy is used to prevent tissue damage.
- The goal is short-term therapy.
- Types of anti-inflammatory drugs include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Corticosteroids
- Disease-modifying antirheumatic drugs (DMARDs)
- Antigout drugs
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
- Action: NSAIDs slow the production of inflammatory mediators.
- Uses: Treat rheumatic disease, degenerative joint disease, osteoarthritis, and acute musculoskeletal problems.
- Adverse reactions: Allergies, gastrointestinal (GI) bleeding, hypoglycemia, increased risk of myocardial infarction (MI), and Reye syndrome (ASA).
- Toxicity: Tinnitus, hyperventilation, diaphoresis, electrolyte imbalances, depression, stupor, convulsions, tachycardia, respiratory depression.
- Drug interactions: Alcohol, vaccinations, and warfarin.
NSAID Examples
- Cyclooxygenase 1 and 2 inhibitors:
- Aspirin (ASA): Stop taking one week before dental procedures.
- Ibuprofen (Motrin):
- Ketorolac (Toradol):
- Naproxen (Aleve):
- Cyclooxygenase 2 inhibitors:
- Celecoxib (Celebrex): Watch for sulfa allergy.
- Meloxicam (Mobic):
- Diclofenac (Voltaren):
NSAID Nursing Implications and Patient Teaching
- Allergies: Assess for allergies.
- GI problems: Assess for GI bleeding, monitor for signs of bleeding.
- Patient teaching:
- Take with a full glass of water.
- Take with food to reduce GI upset.
- Report ringing in the ears, bleeding, increased bruising.
- Drink 8-10 glasses of water a day.
- To reduce inflammation, take on a regular schedule for 1-2 weeks.
- Call the doctor if fever does not decrease in 24 hours.
Corticosteroids
- Action: Corticosteroids reduce inflammation by suppressing the immune system.
- Uses: Acute adrenal emergencies, allergic states, acute brain injury, severe asthma, and any condition where chronic inflammation could lead to tissue damage.
- Expected side effects/adverse reactions: Sodium retention, increased blood pressure, weight gain, bruising, reduced immunity, adrenal gland suppression.
- Drug interactions: Barbiturates, sedatives, narcotics, anticoagulants, oral contraceptives.
Corticosteroid Nursing Implications and Patient Teaching
- Advise patients to follow the doctor's instructions for medication dosage and timing.
- Monitor patients for side effects, including those related to sodium and fluid retention.
- Educate patients about the importance of taking the medication as prescribed and following up with their healthcare provider.
Disease-Modifying Antirheumatic Drugs (DMARDs)
- Action: DMARDs decrease or suppress the inflammatory response, slowing down disease progression and preserving joint function in cases of rheumatoid arthritis.
- Uses: Management of arthritis and other inflammatory disorders.
- Expected side effects/adverse reactions: Injection-site reactions, reduced immunity.
- Drug interactions: Drugs that reduce immunity.
- Example: Adalimumab (Humira).
DMARD Nursing Implications and Patient Teaching
- First dose administered by a healthcare professional, significant risk of allergic reaction.
- Monitor vital signs closely, have a crash cart readily available.
- Teach self-injection techniques.
- Assess for signs of infection, educate patients on infection signs.
- Report signs of liver failure.
- Encourage increased fluid intake.
Gout
- A metabolic disorder causing accumulation of uric acid crystals.
- Crystals deposit in joints, tendons, and tissue, causing pain, redness, swelling, and progressive joint damage.
- Laboratory tests: Sedimentation rate, uric acid level, CBC.
- Treatment and prevention: Lifestyle changes, reducing intake of shellfish, salmon, red meat, pork, beer/wine, high-fructose corn syrup.
- Weight management, avoiding alcohol, low dairy, low carb diet.
Antigout Drugs
- Uric acid synthesis inhibitors (treat symptoms, not the cause):
- Allopurinol (Aloprim).
- Febuxostat (Uloric).
- Action: Reduce the amount of an enzyme that converts purines in protein to uric acid, reducing gout attacks.
- Expected side effects/adverse reactions: Headache, rash, minor nausea, kidney stones, liver failure, heart failure, stroke.
- Drug interactions: Aluminum-based antacids, warfarin, chemotherapy drugs.
Antigout Drug Nursing Implications
- Take allopurinol after a full meal.
- Drink 8-16 glasses of water daily.
- Wait 3 hours after taking allopurinol to take an antacid.
- Do not breastfeed while taking allopurinol.
- Avoid foods high in purines.
- Keep all follow-up appointments.
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