Podcast
Questions and Answers
What is the primary mechanism of action of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)?
What is the primary mechanism of action of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)?
Which of the following is a characteristic of selective NSAIDs?
Which of the following is a characteristic of selective NSAIDs?
What is one of the common side effects associated with NSAID use?
What is one of the common side effects associated with NSAID use?
Which of the following is NOT a contraindication for NSAID use?
Which of the following is NOT a contraindication for NSAID use?
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What should patients be advised about the anti-inflammatory effect of NSAIDs?
What should patients be advised about the anti-inflammatory effect of NSAIDs?
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Which of the following NSAIDs is classified as selective?
Which of the following NSAIDs is classified as selective?
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What is a serious adverse reaction associated with NSAID use?
What is a serious adverse reaction associated with NSAID use?
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How can patients reduce gastrointestinal upset when taking NSAIDs?
How can patients reduce gastrointestinal upset when taking NSAIDs?
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Which condition is NOT typically treated with NSAIDs?
Which condition is NOT typically treated with NSAIDs?
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What patient education should be emphasized regarding NSAID use in children?
What patient education should be emphasized regarding NSAID use in children?
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What is the primary mechanism of action of indirect thrombin inhibitors?
What is the primary mechanism of action of indirect thrombin inhibitors?
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Which of the following is a side effect associated with indirect thrombin inhibitors?
Which of the following is a side effect associated with indirect thrombin inhibitors?
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Which condition is NOT a use for indirect thrombin inhibitors?
Which condition is NOT a use for indirect thrombin inhibitors?
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Which lab test is used to determine the therapeutic range for heparin?
Which lab test is used to determine the therapeutic range for heparin?
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What should be monitored when administering cyclobenzaprine for the first time?
What should be monitored when administering cyclobenzaprine for the first time?
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What is a significant adverse reaction associated with indirect thrombin inhibitors?
What is a significant adverse reaction associated with indirect thrombin inhibitors?
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Which of the following side effects is commonly associated with colchicine?
Which of the following side effects is commonly associated with colchicine?
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Which of the following is a contraindication for heparin therapy?
Which of the following is a contraindication for heparin therapy?
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What is the primary mechanism of action of uricosurics like probenecid?
What is the primary mechanism of action of uricosurics like probenecid?
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Which action is recommended for patient education regarding heparin injections?
Which action is recommended for patient education regarding heparin injections?
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When administering allopurinol, which of the following patient instructions is correct?
When administering allopurinol, which of the following patient instructions is correct?
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What is the primary risk associated with heparin-induced thrombocytopenia (HIT)?
What is the primary risk associated with heparin-induced thrombocytopenia (HIT)?
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What is a significant drug interaction to avoid when taking uricosurics?
What is a significant drug interaction to avoid when taking uricosurics?
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Which medication should be avoided during heparin therapy?
Which medication should be avoided during heparin therapy?
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What is Protamine sulfate used for in relation to heparin?
What is Protamine sulfate used for in relation to heparin?
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Which instruction is critical for patients taking allopurinol to prevent potential complications?
Which instruction is critical for patients taking allopurinol to prevent potential complications?
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What is a possible adverse reaction to allopurinol?
What is a possible adverse reaction to allopurinol?
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What is an important consideration regarding the schedule of follow-up appointments for patients on allopurinol?
What is an important consideration regarding the schedule of follow-up appointments for patients on allopurinol?
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What should patients be educated to avoid while taking medications for gout, particularly purine-rich foods?
What should patients be educated to avoid while taking medications for gout, particularly purine-rich foods?
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Which is a common side effect of uric acid synthesis inhibitors like allopurinol?
Which is a common side effect of uric acid synthesis inhibitors like allopurinol?
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What is one of the short-term side effects of corticosteroid therapy?
What is one of the short-term side effects of corticosteroid therapy?
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Which condition is NOT typically treated with corticosteroids?
Which condition is NOT typically treated with corticosteroids?
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What is a major long-term side effect of corticosteroid use that indicates Cushing syndrome?
What is a major long-term side effect of corticosteroid use that indicates Cushing syndrome?
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How should oral corticosteroids be administered to coincide with natural cortisol levels?
How should oral corticosteroids be administered to coincide with natural cortisol levels?
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What happens if corticosteroid therapy is abruptly stopped after long-term use?
What happens if corticosteroid therapy is abruptly stopped after long-term use?
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What precaution should be taken when using topical corticosteroids?
What precaution should be taken when using topical corticosteroids?
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Which of the following is a contraindication for corticosteroid therapy?
Which of the following is a contraindication for corticosteroid therapy?
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Which of the following drugs is classified as a Disease-Modifying Antirheumatic Drug (DMARD)?
Which of the following drugs is classified as a Disease-Modifying Antirheumatic Drug (DMARD)?
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What type of condition do DMARDs primarily target for treatment?
What type of condition do DMARDs primarily target for treatment?
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What is an effect of decreased white blood cell count due to corticosteroid use?
What is an effect of decreased white blood cell count due to corticosteroid use?
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Corticosteroids can be administered in all the following ways EXCEPT:
Corticosteroids can be administered in all the following ways EXCEPT:
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Which symptom indicates potential adrenal insufficiency when corticosteroid treatment is stopped?
Which symptom indicates potential adrenal insufficiency when corticosteroid treatment is stopped?
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Which dietary consideration is recommended for patients receiving corticosteroids?
Which dietary consideration is recommended for patients receiving corticosteroids?
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Which of the following conditions is NOT typically treated with DMARDs?
Which of the following conditions is NOT typically treated with DMARDs?
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What is a potential side effect of immunosuppressant therapy?
What is a potential side effect of immunosuppressant therapy?
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Which of the following is a common adverse reaction to the use of methotrexate?
Which of the following is a common adverse reaction to the use of methotrexate?
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What must be assessed before administering DMARD therapy to patients?
What must be assessed before administering DMARD therapy to patients?
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Which side effect might indicate liver problems during rheumatoid arthritis treatment?
Which side effect might indicate liver problems during rheumatoid arthritis treatment?
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How long may it take for the anti-inflammatory effects of hydroxychloroquine to become evident?
How long may it take for the anti-inflammatory effects of hydroxychloroquine to become evident?
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Which of the following is a possible side effect of gold salts used in rheumatoid arthritis treatment?
Which of the following is a possible side effect of gold salts used in rheumatoid arthritis treatment?
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In which scenario should the administration of DMARDs be closely monitored?
In which scenario should the administration of DMARDs be closely monitored?
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What is a nursing consideration when a patient is receiving their first dose of a DMARD?
What is a nursing consideration when a patient is receiving their first dose of a DMARD?
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What specific testing must be conducted prior to initiating therapy with a DMARD?
What specific testing must be conducted prior to initiating therapy with a DMARD?
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Which of the following is a common side effect of azathioprine?
Which of the following is a common side effect of azathioprine?
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What is a critical aspect of patient education regarding DMARD therapy?
What is a critical aspect of patient education regarding DMARD therapy?
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Which clinical manifestation should prompt immediate communication with a healthcare provider during DMARD therapy?
Which clinical manifestation should prompt immediate communication with a healthcare provider during DMARD therapy?
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What is the primary mechanism of action of bisphosphonates?
What is the primary mechanism of action of bisphosphonates?
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Which condition is NOT typically treated with bisphosphonates?
Which condition is NOT typically treated with bisphosphonates?
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Which of the following is a side effect of estrogen receptor modulators?
Which of the following is a side effect of estrogen receptor modulators?
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What nursing consideration is essential for a patient receiving parathyroid hormone therapy?
What nursing consideration is essential for a patient receiving parathyroid hormone therapy?
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Which side effect is associated with calcium and vitamin D supplements?
Which side effect is associated with calcium and vitamin D supplements?
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The use of bisphosphonates increases the risk of which serious condition?
The use of bisphosphonates increases the risk of which serious condition?
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What instruction should be given to patients taking bisphosphonates regarding administration?
What instruction should be given to patients taking bisphosphonates regarding administration?
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Which of the following actions is recommended for patients on estrogen receptor modulators?
Which of the following actions is recommended for patients on estrogen receptor modulators?
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What should patients receiving calcium and vitamin D be advised to do?
What should patients receiving calcium and vitamin D be advised to do?
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Which of the following is a side effect of calcitonin-salmon?
Which of the following is a side effect of calcitonin-salmon?
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What is the main use of teriparatide (Forteo)?
What is the main use of teriparatide (Forteo)?
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What should a patient taking bisphosphonates do before any dental procedure?
What should a patient taking bisphosphonates do before any dental procedure?
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What is a characteristic of osteonecrosis of the jawbone related to bisphosphonate therapy?
What is a characteristic of osteonecrosis of the jawbone related to bisphosphonate therapy?
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What is the primary mechanism of action for cyclobenzaprine and tizanidine?
What is the primary mechanism of action for cyclobenzaprine and tizanidine?
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Which of the following is NOT a common side effect of skeletal muscle relaxants?
Which of the following is NOT a common side effect of skeletal muscle relaxants?
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Which statement regarding tizanidine's mechanism of action is true?
Which statement regarding tizanidine's mechanism of action is true?
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What important assessment should a nurse perform prior to administering skeletal muscle relaxants?
What important assessment should a nurse perform prior to administering skeletal muscle relaxants?
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Which condition is NOT typically treated with skeletal muscle relaxants?
Which condition is NOT typically treated with skeletal muscle relaxants?
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What is a potential adverse reaction to taking skeletal muscle relaxants?
What is a potential adverse reaction to taking skeletal muscle relaxants?
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How long should a patient take an antidepressant like amitriptyline before expecting to feel pain relief?
How long should a patient take an antidepressant like amitriptyline before expecting to feel pain relief?
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Which medication is used primarily for neuropathic pain and fibromyalgia?
Which medication is used primarily for neuropathic pain and fibromyalgia?
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What lab values are important to monitor if a patient exceeds the maximum daily dose of acetaminophen?
What lab values are important to monitor if a patient exceeds the maximum daily dose of acetaminophen?
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Which of the following options is a use for antidepressants in pain management?
Which of the following options is a use for antidepressants in pain management?
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What is one nursing consideration when educating a patient about the use of skeletal muscle relaxants?
What is one nursing consideration when educating a patient about the use of skeletal muscle relaxants?
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What common misconception might a patient have about antidepressants prescribed for pain management?
What common misconception might a patient have about antidepressants prescribed for pain management?
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What is an important nursing consideration when advising a patient to use capsaicin cream?
What is an important nursing consideration when advising a patient to use capsaicin cream?
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Which of the following is a side effect associated with tramadol?
Which of the following is a side effect associated with tramadol?
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What effect does glucosamine have that is beneficial for patients with osteoarthritis?
What effect does glucosamine have that is beneficial for patients with osteoarthritis?
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What should a patient using acetaminophen be advised against?
What should a patient using acetaminophen be advised against?
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Which of the following statements about pregabalin is true?
Which of the following statements about pregabalin is true?
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What is a crucial teaching point for a patient beginning a DMARD regimen?
What is a crucial teaching point for a patient beginning a DMARD regimen?
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Which response is appropriate for a patient wishing to discontinue prednisone abruptly?
Which response is appropriate for a patient wishing to discontinue prednisone abruptly?
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What is the primary mechanism of action of nonopioid centrally acting analgesics like tramadol?
What is the primary mechanism of action of nonopioid centrally acting analgesics like tramadol?
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Which statement about the use of capsaicin cream is accurate?
Which statement about the use of capsaicin cream is accurate?
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What type of patient history would contraindicate the use of tramadol?
What type of patient history would contraindicate the use of tramadol?
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What should be monitored in patients taking acetaminophen to avoid adverse reactions?
What should be monitored in patients taking acetaminophen to avoid adverse reactions?
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Why should a patient on DMARD therapy be cautious regarding chickenpox exposure?
Why should a patient on DMARD therapy be cautious regarding chickenpox exposure?
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How does the mechanism of action of acetaminophen differ from that of NSAIDs?
How does the mechanism of action of acetaminophen differ from that of NSAIDs?
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What should a patient taking NSAIDs be properly educated about?
What should a patient taking NSAIDs be properly educated about?
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What is a common side effect associated with the use of topical analgesics?
What is a common side effect associated with the use of topical analgesics?
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Which of the following indicates a potential allergy when taking NSAIDs?
Which of the following indicates a potential allergy when taking NSAIDs?
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What is the main action of warfarin in the body?
What is the main action of warfarin in the body?
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Which of the following is a common side effect of warfarin?
Which of the following is a common side effect of warfarin?
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Patients taking warfarin should specifically avoid which of the following dietary items?
Patients taking warfarin should specifically avoid which of the following dietary items?
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What should a patient taking warfarin be advised regarding supplements?
What should a patient taking warfarin be advised regarding supplements?
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What is the therapeutic INR range for a patient on warfarin?
What is the therapeutic INR range for a patient on warfarin?
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Which adverse reaction is directly associated with warfarin therapy?
Which adverse reaction is directly associated with warfarin therapy?
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What is the antidote for warfarin overdose?
What is the antidote for warfarin overdose?
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Which condition is a contraindication for starting warfarin therapy?
Which condition is a contraindication for starting warfarin therapy?
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When transitioning from heparin to warfarin, what should be monitored?
When transitioning from heparin to warfarin, what should be monitored?
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Which of the following should patients on warfarin be cautious of while performing daily activities?
Which of the following should patients on warfarin be cautious of while performing daily activities?
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How should a patient taking warfarin manage bleeding from accidental cuts?
How should a patient taking warfarin manage bleeding from accidental cuts?
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In which situation should a patient be cautious before taking warfarin?
In which situation should a patient be cautious before taking warfarin?
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What should a patient wear while on anticoagulant therapy like warfarin?
What should a patient wear while on anticoagulant therapy like warfarin?
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Why is it important to educate patients about green leafy vegetables while on warfarin?
Why is it important to educate patients about green leafy vegetables while on warfarin?
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Study Notes
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
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Mechanism of Action: Slows prostaglandin, kinin, histamine, TNF, and other inflammatory mediator production from arachidonic acid. Provides analgesic, anti-inflammatory, and antipyretic effects. Prevents tissue and blood vessel response to injury. Categorized as selective or nonselective.
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Nonselective NSAIDs: Block both COX-1 and COX-2 enzymes, often causing more side effects. COX-1 produces protective prostaglandins, COX-2 produces inflammatory prostaglandins. Examples: aspirin, ibuprofen, naproxen, nabumetone, indomethacin.
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Selective NSAIDs: Primarily block COX-2 enzymes. Examples: celecoxib, meloxicam, diclofenac.
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Inhibits Platelet Aggregation: Stops blood platelets from clumping together.
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Uses: Myalgia, neuralgia, arthralgia, headache, dysmenorrhea, arthritis (rheumatoid, osteoarthritis, ankylosing spondylitis, gout), pain from procedures/injuries (dislocations, herniated disks), clot prevention.
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Side Effects: GI irritation (heartburn, nausea, vomiting), dizziness, headache, increased bleeding risk, fluid retention, edema, increased blood pressure, reduced effectiveness of antihypertensives, increased hypoglycemia risk in diabetic patients.
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Adverse Reactions & Contraindications: Allergic reactions, renal failure, GI bleeding/ulceration/perforation, blood disorders, increased cardiovascular risk (stroke, MI), Reye syndrome (children), toxicity (tinnitus, hyperventilation, diaphoresis, thirst, headache, drowsiness, skin eruptions, electrolyte imbalance, CNS depression, stupor, convulsions, coma, tachycardia, respiratory insufficiency).
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Nursing Considerations & Patient Education: Assess for contraindications (allergies, asthma, blood disorders, GI/liver/kidney/heart problems, pregnancy). Administer with food, milk, antacids, or water. Anti-inflammatory effect may take 1-2 weeks. Assess for bleeding/bruising (mucous membranes, petechiae, black/tarry stool, blood in stool/urine/vomit). Advise patient to report abnormal bleeding, tinnitus, heart attack signs, weight gain/edema, and upcoming procedures. Avoid aspirin, aspirin products, other NSAIDs, blood thinners, tobacco, and alcohol. Caution use in children with illness, older adults and during pregnancy.
Corticosteroids
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Examples: Prednisone, methylprednisolone, dexamethasone, hydrocortisone.
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Mechanism of Action: Decrease inflammatory cytokine production (including COX-1 and COX-2) and white blood cells. Mimic natural cortisol hormones.
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Uses: Reduce inflammatory, allergic, or immunologic response (acute adrenal emergencies, allergic states, acute brain injury, severe asthma). Herniated intervertebral disk, carpal tunnel syndrome, arthritis (rheumatoid, osteoarthritis, ankylosing spondylitis, gout), inflammatory bowel diseases, systemic lupus erythematosus, fat embolism. Local injection for joint, soft tissue, bursae, or skin issues. Topical use for integumentary, rectal, ophthalmic, or otic problems. Inhaled for asthma.
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Short-Term Side Effects: Sodium/fluid retention, potassium depletion, increased blood pressure, acne, insomnia, nervousness, mood changes, hyperglycemia.
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Long-Term Side Effects (Cushing Syndrome): Weight gain, fat redistribution (moon face, buffalo hump), muscle loss/weakness, hair thinning, hirsutism , stretch marks, immunosuppression, increased bleeding risk, ulcers/bleeding.
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Adverse Reactions & Contraindications: Adrenal gland suppression (sudden stop of use can cause adrenal insufficiency, potential for death). Immunosuppression (decreased WBCs, less noticeable infection signs). Osteoporosis, cataracts, corneal fungal infections. Hypertension, ocular hemorrhage, delirium/behavior changes.
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Nursing Considerations & Patient Education: Assess for contraindications (infection). Administer with food. Administer oral corticosteroids in the morning. Do not apply topicals to infected areas. Caution with thin skin. Effect may take several days/weeks (injected) vs 24 hours (oral). Monitor for adrenal insufficiency up to a year after stopping. Never stop abruptly (taper). Avoid tobacco, alcohol, NSAIDs. Monitor blood glucose in diabetics. Report infection signs, adrenal insufficiency, hypokalemia, unusual bleeding/bruising, rapid weight gain, and upcoming procedures.
Disease-Modifying Antirheumatic Drugs (DMARDs)
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Examples: Etanercept, adalimumab, infliximab, rituximab.
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Mechanism of Action: Reduce inflammatory disease progression by inhibiting TNF produced by white blood cells. DMARDs bind to TNF, blocking its interaction with inflammatory cells preventing tissue destruction. Alleviates pain, improves physical function, reduces tissue damage.
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Uses: Chronic inflammatory disorders with severe tissue destruction. Rheumatoid arthritis, ankylosing spondylitis, psoriasis, psoriatic arthritis, Crohn's disease, ulcerative colitis.
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Side Effects: Injection site reaction (pain, swelling, itching, redness), headache, nausea, bone marrow suppression (anemia, increased bleeding risk).
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Adverse Reactions & Contraindications: Immunosuppression (increased infection risk), heart failure, anaphylaxis.
Antimalarials
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Example: Hydroxychloroquine.
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Mechanism of Action: Anti-inflammatory, unknown mechanism.
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Uses: Rheumatoid arthritis.
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Side Effects: GI disturbances, retinal edema, blindness.
Gold Salts
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Examples: Gold sodium thiomalate (IM), auranofin (PO).
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Mechanism of Action: Anti-inflammatory (IM), antirheumatic (PO).
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Uses: Rheumatoid arthritis.
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Side Effects: Renal damage, hepatic damage, corneal deposits, dermatitis, stomatitis, hematologic changes (thrombocytopenia, leukopenia).
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Nursing Considerations & Patient Education: IM anti-inflammatory effect may not be evident for 3-6 months. Monitor urinalysis and CBC before each injection. Report dermatitis, metallic taste, or mouth lesions. Minimize sun exposure, meticulous oral care.
Antineoplastics
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Example: Methotrexate.
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Mechanism of Action: Alters folic acid use, necessary for cell growth. Anti-inflammatory.
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Uses: Rheumatoid arthritis.
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Side Effects: GI irritation (nausea, vomiting, anorexia, diarrhea, sore mouth), headache, blurred vision, dizziness.
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Nursing Considerations & Patient Education: Assess for pregnancy contraindication. Monitor vital signs, WBCs, platelets, intake/output, appetite. Adequate hydration. Avoid vaccinations.
Immunosuppressants
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Examples: Azathioprine, cyclophosphamide.
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Mechanism of Action: Inhibits DNA, RNA, and protein synthesis.
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Uses: Rheumatoid arthritis.
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Side Effects: GI irritation (nausea, vomiting, anorexia), rash.
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Nursing Considerations & Patient Education: Assess for pregnancy contraindication. Report unusual bleeding/bruising. Effect may not be evident for 12 weeks.
Topical Analgesics (e.g., Capsaicin)
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Mechanism of Action: Depletes substance P from nerve endings, interrupting pain signals.
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Uses: Rheumatoid arthritis.
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Side Effects: Rash, urticaria, localized burning, erythema.
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Nursing Considerations & Patient Education: Regular use for maximal effect. Aloe vera might help with burning. Avoid external heat sources. Wash hands, wear gloves. Avoid touching damaged skin, eyes, nose, mouth.
Nonopioid Centrally Acting Analgesics (e.g., Tramadol)
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Mechanism of Action: Inhibits neurotransmitter (norepinephrine, serotonin) action/reuptake in spinal cord/brain, reducing pain signal transmission. Binds opioid receptors. Often used with acetaminophen.
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Uses: Moderate to severe acute pain (osteoarthritis, fibromyalgia).
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Side Effects: Sedation, dizziness, dry mouth, constipation.
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Adverse Reactions & Contraindications: Seizures (avoid in patients with epilepsy/neurologic disorders).
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Nursing Considerations & Patient Education: Assess for contraindications (other sedatives/CNS depressants, seizure history).
Acetaminophen
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Mechanism of Action: Reduces prostaglandin production in the brain, reducing pain perception. Does not directly act at injury site, no anti-inflammatory properties.
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Uses: Mild to moderate pain (osteoarthritis, dislocations), fever, combines with opioids for severe pain.
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Side Effects: Nausea, skin rash.
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Adverse Reactions & Contraindications: Allergic reactions, hepatotoxicity at high/prolonged doses.
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Nursing Considerations & Patient Education: Assess for contraindications (other acetaminophen containing medications, liver disease). Avoid alcohol. Maximum daily dose of 4g. Variable dosage for children.
Skeletal Muscle Relaxants (e.g., Cyclobenzaprine, Tizanidine)
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Mechanism of Action: Depresses CNS, reduces signal transmission along motor nerves, fewer muscle spasms/pain, decreasing tender areas. Tizanidine lowers substance P, reducing pain.
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Uses: Pain, insomnia related to musculoskeletal spasms, fibromyalgia, fractures, whiplash, herniated disks, strains.
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Side Effects: Dizziness, headache, dry mouth, blurred vision, urinary retention.
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Adverse Reactions & Contraindications: Cardiac dysrhythmias, prolonged cardiac conduction, increased seizure risk, MAOI interactions.
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Nursing Considerations & Patient Education: Assess for contraindications (arrhythmias, recent heart attack, seizure disorders, other CNS depressants, MAOIs). Assess consciousness, cognition, skeletal muscle, blood pressure, and pulses. Initiate fall precautions. Assess for urinary retention. Avoid operating equipment/driving/critical decisions. Avoid alcohol. Check pulse daily.
Antidepressants (e.g., Amitriptyline, Duloxetine)
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Mechanism of Action: Increase natural opioids (endorphins, enkephalins) in the brain. Reduce depression related to chronic pain. Diminishes local pain/stiffness. Improves sleep.
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Uses: Chronic pain (fibromyalgia), cancer pain, neuropathic pain.
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Nursing Considerations & Patient Education: Assess for contraindications. May take 1-2 weeks for pain relief.
Anticonvulsants (e.g., Pregabalin)
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Mechanism of Action: Reduces pain signal transmission along sensory nerves. Reduces pain perception, improves fatigue/sleep/function.
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Uses: Fibromyalgia, neuropathic pain, migraines.
Other Medications/Supplements
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Clonazepam (Klonopin): Decreases leg movements, especially at night. Used for fibromyalgia.
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Sodium Oxybate (Xyrem): Improves deep sleep, growth hormone levels, reduces pain/fatigue. Used for fibromyalgia.
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Glucosamine Supplements: Enables collagen/proteoglycan production. Resupplies joint lubricant in synovial fluid. Used for osteoarthritis.
Antigout Medications
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Colchicine: Used for acute gout attacks. Side effects include GI upset (diarrhea, nausea, vomiting). Discontinue if symptoms persist or pain unrelieved. Avoid purine-rich foods. Drink plenty of water (at least 2000mL).
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Uricosurics (e.g., Probenecid): Inhibit renal uric acid reabsorption, increasing uric acid secretion. Used for gout. Aspirin interferes, avoid during therapy.
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Uric Acid Synthesis Inhibitors (e.g., Allopurinol, Febuxostat): Reduce purine conversion into uric acid. Used to prevent/shorten gout attacks. May be used with chemotherapy. Side effects include headache, rash, nausea; rare effects like breast development and erectile dysfunction in males. Potential complications: kidney stone formation, liver failure, heart failure, stroke, depression, cardiac dysrhythmias. Allopurinol guidelines: take after meals, avoid aluminum-based antacids, be aware of warfarin interactions (monitor INR closely), when IV, utilize a separate port/tubing. Febuxostat can be taken without regard for meals or antacids. Avoid purine-rich foods. Drink plenty of water.
Osteoporosis Medications
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Bisphosphonates (e.g., Alendronate, Zoledronic acid): Move blood calcium into bone, prevent osteoclast destruction of bone cells. Increases bone density, slows bone loss. Reduce fracture risk. Indications include osteoporosis, bone metastases, multiple myeloma, Paget's disease, cancer-induced hypercalcemia. Side effects/problems include severe esophageal reflux, chest pain, nausea, osteonecrosis (jawbone).
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Estrogen Receptor Modulators (e.g., Raloxifene): Activates estrogen receptors, blocks in breast/uterus. Increases bone density, prevents excessive reproductive tissue growth. Side effects include hot flashes, increased blood pressure, joint/muscle pain, nausea, indigestion, lower extremity edema, sleep problems, weight gain. Adverse reactions/problems are increased thrombotic risk (deep vein thrombosis, stroke, MI, pulmonary embolism.)
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Parathyroid Hormone (e.g., Teriparatide): Anabolic drug that increases osteoblast formation, slows osteoblast apoptosis. Results in new bone formation. Indications include postmenopausal osteoporosis in women, osteoporosis due to hypogonadism in men. Side effects include bone pain, nausea, dizziness, leg cramps, hypercalcemia, increased heart rate, injection site reactions, orthostatic hypotension. Adverse reactions/problems include osteosarcoma, angioedema, serious allergic reactions
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Calcitonin-Salmon: Increases bone mass, especially in the spine. Side effects include injection site reactions and nasal irritation.
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Calcium and Vitamin D Supplements: Calcium builds and maintains bone, vitamin D helps absorb calcium. Slows bone loss, reduces fracture risk. Side effects include nausea, vomiting, constipation, bone pain, muscle weakness, increased thirst. Recommended dosages vary. Administer with food. Encourage calcium-rich diet. Vitamin D.
Anticoagulants
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Indirect Thrombin Inhibitors (e.g., Heparin): Increase antithrombin III activity, inhibits thrombin. LMWHs bind antithrombin and inhibit factor Xa. Prevent venous thromboembolism in high-risk patients (surgery, heart valve disease, dysrhythmias, hemodialysis, bedrest, clotting history, pulmonary embolism). Stops clot growth. Side effects/problems include bleeding, bruising, injection site irritation, pruritus, skin changes, hemorrhage, thrombocytopenia (HIT/HITT). Assess for contraindications (allergies, liver/kidney disease, hypertension, pregnancy/postpartum) and drug interactions. Heparin administration involves a two-nurse check, avoids shaking, must be in separate tubing/syringes. Monitor aPTT (1.5-2.5 times control). Monitor platelets. Protamine sulfate is the antidote.
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Vitamin K Antagonists (e.g., Warfarin): Inhibit vitamin K-dependent enzymes, reduce clot formation. Used for long-term therapy in chronic clot conditions (coronary artery disease, atrial fibrillation, knee/hip replacement, immobility). Side effects/problems include bleeding, bruising, GI upset, headache, rash, hemorrhage, skin necrosis. Assess for contraindications (drug interactions, alcohol, blood/bleeding disorders, uncontrolled hypertension, pregnancy/breastfeeding, elderly). Monitor INR (2.0-3.0). Limit green leafy vegetables and maintain consistent consumption. Vitamin K is the antidote. Warfarin and Heparin are often administered together until warfarin's effects are noticeable.
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