EXAM 2

ANTI-INFLAMMATORY

INFLAMMATION
1) Description
a) Protective response 2 injury 
i) By
(1) Destroys
(2) Dilute
(3) Walls off
b) Injurious agent & injured tissue
2) SIGNS & SYMPTOMS
a) Pain
b) Swelling
c) Fever
d) Loss of Function
e) Redness
NSAID
NSAIDSS
RX
1) Indomethacin  Indocin
2) Ketorolac  Toradol
3) Ibuprofen
THERAPEUTIC EFFECTS
1) Anti-inflammatory
2) Analgesic
3) Antipyretic
CONTRAINDICATION
1) Rx allergy
2) PT’S @ RISK 4 BLEED
A) Easily bruised
3) ↓ VITAMIN K
4) PEPTIC ULCERS DISEASE
5) Kids  Reye’s syndrome
ADVERSE EFFECT
1) GI
a) ❤️🔥
b) GI Bleeds
i) Dark/Bright stool
ii) Coffee ground vomit
c) Mucosal lesions
i) Erosions
ii) Ulcerations
 Rx
MISOPROSTOL  CYTOTEC

2) NEPHROTOXICITY
a) ❤️Failure
b) Dehydrated pts

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 c) Ace-Inhibitor
d) Diuretics
3) Hepatoxicity
a) Not as important she said
4) TINNITUS
INTERACTIONS
1) Anticoagulants
2) Aspirin
3) Corticosteroids
4) Ulcerogenic Rx
5) Diuretics
6) Ace-inhibitors

ASPIRIN

AKA
1) Salicylate
THERAPEUTIC EFFECT
1) PROPHYLACTIC THERAPY
a) Daily tablet 81mg or 325mg
2) ANTIPLATELET
a) 🚫 platelet aggregation
b) ↓❤️death after MI
3) ANTITHROMBOTIC EFFECTS
a) Tx
i) MI
ii) Thromboembolic Disorders
4) Lupus
5) Pain 4m inflammation
a) Arthritis
b) Pleurisy
c) Pericarditis
6) Antipyretic
7) Neuralgia
a) Nerve pain
8) Myalgia
a) Muscle pain
9) Arthralgia
a) Joint pain
ADVERSE EFFECTS
1) SALICYLATE TOXICITY
a) Dizziness
b) Mental confusion
c) ATI - Resp depression ↓
2) TINNITUS
a) Ringing in ears
3) GI
4) REYE’S SYNDROME
a) @ Risk population
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 i) Kids ↓ 12
ii) W/ viral infections
(1) Chickenpox
(2) Influenza
b) Symptoms
i) Rapid breathing
ii) Vomiting
iii) Fatigue
iv) Confusion
v) Seizures
vi) LOC
c) Causes
i) Confusion
ii) Liver Damage
iii) Brain swelling
5) Hepatoxicity
a) She said not as important

INDOMETHACIN  INDOCIN

USES
1) PDA
a) Patent Ductus Arteriosus
2) PRETERM LABOR

a) ↓ labor by 🚫 synthesis of prostaglandins.

TORADOL
KETOROLAC  TORADOL

AKA
1) Ketorolac
USES
1) Analgesic
a) Moderate 2 severe acute pain
b) Short term
I) 5 DAYS MAX
2) Anti-inflammatory
ADVERSE EFFECT
1) RENAL IMPAIRMENT
2) Edema
3) GI
4) Dyspepsia
a) Indigestion
5) Nausea
CONTRAINDICATED
1) PTs w/ Kidney Failure
2) 6+ days = kidney damage
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 Ibuprofen
IBUPROFEN

FACTS
1) #1 used NSAID
2) AKA
a) Motrin
b) Advil
USES
1) ARTHRITIS
A) RA
b) OA
2) Dysmenorrhea
a) Period cramps
3) Gout
4) Dental pain
5) Musculoskeletal disorders
6) Antipyretic
ADVERSE EFFECT
1) ATI 
2) ↓ ANTIPLATELET EFFECT OF ASPIRIN

ARTHRITIS

TYPES
1) Gout
a) Hyperuricemia
2) Rheumatoid Arthritis
a) Autoimmune disorder
3) Osteoarthritis
a) Age related

GOUT

DESCRIPTION
1) Type of arthritis
2) Due 2 hyperuricemia
A) ↓ URIC ACID EXCRETION
B) ↑ URIC ACID PRODUCTION
3) Causes PAIN due 2
A) URIC ACID DEPOSITS @
I) TISSUES
II) JOINTS
RX
1) Allopurinol
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2) Colchicine

ALLOPURINOL

AKA
1) Zyloprim
USES
1) 🚫 Uric Acid production
ADVERSE EFFECT
1) ↑ RISK FOR BLEEDS
a) ↓ Metabolism of WARFARIN
2) RHABDO
a) Rhabdomyolysis
b) Rare muscle injury
C) PT REPORT MUSCLE PAIN
3) KIDNEY FAILURE
4) N/V
5) ↑ GOUT PAIN
6) RASH
A) Exfoliative dermatitis
B) Epidermal necrosis

COLCHICINE

USES
1) ↓ inflammatory response
ADVERSE EFFECT
1) BLEED
a) GI
b) Urinary tract
2) Short-term Leukopenia
PT EDUCATION
1) Avoid GRAPEFRUIT JUICE

RHEUMATOID ARTHRITIS

DESCRIPTION
1) Autoimmune disorder
a) Chronic & Progressive
2) Causes
a) Inflammation
b) Tissue damage @ joints
RX
1) DMARDs
a) Slows joint degeneration
b) ↓ Progression of RA
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2) Glucocorticoids
a) ↓ Inflammation
b) ↓ Pain
c) ↓ Disease progress
3) Immunosuppressants
4) NSAIDs
a) Rapid
i) ↓ Inflammation
ii) ↓ Pain
b) ≠ ↓ Disease progress
C) IBUPROFEN
i) #1 Rx 4 new Dx PTs

DMARDs

DESCRIPTION
1) Slow onset of action
i) Few weeks
2) Slows ↓ joint degeneration
3) ↓ Progression of RA
3 LEVELS
1) DMARDs 1
A) METHOTREXATE
B) LEFLUNOMIDE
2) DMARDs 2
A) ETANERCEPT
B) ABATACEPT
3) DMARDs 3
A) CYCLOSPORINE
I) Immunosuppressant
CONTRAINDICATED
1) Active Herpes
2) TB
3) Hep B & C
PT EDUCATION
1) Report signs of infection
2) Sore throat
3) Diarrhea
4) Vomiting
5) Fever ↑ 100.5ºF

METHOTREXATE

DESCRIPTION
1) DMARDs 1
a) Nonbiological
2) #1  NEW DX
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ADMINISTRATION
1) Weekly
2) Sub-Q
a) Thigh
b) Abdomen
c) Upper arm
3) 🚫 w/ other solutions
4) ≠ w/out filter
CONTRAINDICATIONS
1) Liver failure
2) Kidney dysfunction
3) Suppressed bone marrow
4) Infection
5) Alcohol use

ETANERCEPT

DESCRIPTION
1) DMARDs 2
2) Onset  1 – 2 weeks
CONTRAINDICATIONS
1) Latex Allergy
2) Active infections
3) Reactivates
a) Hepatitis
b) TB

ABATACEPT

DESCRIPTION
1) DMARDs 2
CONTRAINDICATIONS
1) PTS W/ INFECTION
2) COPD
3) Live vaccines
a) ↑ risk of infections
b) ↓ response

HEMATOPOIETIC DRUGS

DESCRIPTION
1) After Chemo
a) ↑ Neutrophils
b) ↑ Platelets
2) After transplant
a) ↑ Bone marrow functions
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3) ↑ RBC production
USES
1) Chemo
a) Enables ↑ doses 2 b given
b) ↓ duration of anemia
2) Neutropenia
3) Thrombocytopenia
RX
1) FILGRASTIM  Neupogen
A) GIVEN 24 HRS AFTER CHEMO
B) ↑WBC
i) ↑ Basophils
ii) ↑ Eosinophils
iii) ↑ Neutrophils
2) PEGFILGASTIM  Neulasta
a) Longer acting
3) OPRELVEKIN  Neumega
A) ↑ PLATELET PRODUCTION
b) 🚫 THROMBOCYTOPENIA 4 chemo PTs
ADVERSE EFFECT
1) Fever
2) Muscle aches
3) Bone Pain
4) Flushing
5) DIARRHEA
6) HEADACHES
7) EDEMA
8) N/V

IMMUNOSUPPRESSANTS THERAPY

DESCRIPTION
1) 🚫 NORMAL IMMUNE SYSTEM
A) ↑ Opportunistic infections
2) Transplant
a) 🛑 Organ Rejection
i) Kidney
ii) Liver
iii) ❤️❤️
B) LIFETIME THERAPY
LABS
1) CBC
a) Platelet count
b) Hemoglobin
c) Hematocrit
2) WBC
3) Kidneys
a) BUN
b) Creatine
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 c) I&O
4) Liver
5) ❤️
6) Respiratory assessment
CONTRAINDICATIONS
1) Crowds
2) Ppl w/ infection

CYCLOSPORINE

AKA
1) Sandimmune
USES
1) 🚫 Organ rejection
2) Arthritis
ADVERSE EFFECT
1) ↑ BP
2) RISK OF INFECTION
3) HEPATOXICITY
4) NEPHROTOXICITY
CONTRAINDICATED
1) GRAPEFRUIT JUICE
2) STYROFOAM CUP

CNS DEPRESSANTS

DESCRIPTION
1) Sedatives
a) ℞ @ ↓ Dose
b) ❌ Sleep 💤
c) Reducing
i) ↓ Nervousness
ii) ↓ Excitability
iii) ↓ Irritability
2) Hypnotic
a) ℞ @ ↑ Dose
b) Causes Sleep 💤
c) ↑ Potency > sedatives
CATEGORIES
1) Benzodiazepines
a) Classification
i) Sedative – Hypnotic
ii) Anxiolytic
2) Barbiturates
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3) Misc. ℞
a) Zolpidem  AMBIEN
i) Causes Sleepwalking

BENZODIAZEPINES
PURPOSE
1) Anxiety disorder
2) Seizure (status epilepticus)
A) DIAZEPAM  VALIUM
3) Insomnia
4) Muscle Spasms
5) Alcohol withdrawal
A) DIAZEPAM  VALIUM
B) LORAZEPAM  ATIVAN
6) Panic disorder
7) Anesthesia/Perioperative
A) MIDAZOLAM  VERSED
i) Causes AMNESIA
ADVERSE EFFECTS
1) FALL HAZARD
a) Vertigo
b) Dizziness
2) HANGOVER EFFECT
a) DAYTIME ☀︎SLEEPINESS 💤
B) DROWSINESS
3) Lethargy
4) Cognitive impaired
5) Headache
6) Toxicity
a) Somnolence
b) Coma
c) Confusion
D) ↓ REFLEXES
INTERACTIONS
1) GRAPEFRUIT JUICE
a) Prolongs ℞ effect
b) ↑ chance of Toxicity
2) CNS DEPRESSANTS
a) Alcohol
b) Opioids
c) Barbiturates
CONTRAINDICATED
1) 🚫 4 PTs w/
a) Sleep apnea
b) Respiratory depression
c) Breast feeding
d) Brain disease
2) History of
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 a) Liver dysfunctions
b) Kidney failure
c) Substance abuse
PT EDUCATION
1) ❌FDO 🚙🚗 NOT 🚕🚙🚗 DRIVE 🚕🚗
2) Take ℞ w/ food
3) FLUMAZENIL
a) Benzo antidote

BARBITURATES

PURPOSE
1) Uncontrollable Seizure
a) Phenobarbital Coma
2) Insomnia
3) Anxiety
4) Panic disorder
5) Pre – Anesthesia/Anesthesia
ADVERSE EFFECTS
1) Hypotension
2) CNS
a) Confusion
b) Abnormal Thoughts
3) Respiratory depression
a) Sleep  Coma  Death
4) ↑ Liver enzymes
a) Breaks↓ many ℞
b) ↓ Duration of action
5) Overdose Tx
A) ACTIVATED CHARCOAL
INTERACTIONS
1) ↓ Anticoagulant response
a) ↑ Blood 🩸clotting
2) Birth control effectiveness ↓
a)  Unwanted pregnancy
CONTRAINDICATED
1) Liver failure
PT EDUCATION
1) Avoid 🚫 CNS ⬇︎ 💊 🥃
2) Rebound Insomnia
a) 3 – 4 weeks after stopping ℞

CNS STIMULANTS

DESCRIPTION
1) Enhance performance
2) Increases
a) Mood
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 b) Euphoria
c) Energy
d) Alertness
3) Decreases
a) Appetite
b) Fatigue
c) Drowsiness
TYPES OF AMPHETAMINES
1) Ritalin
a) Methylphenidate
2) Adderall
a) Amphetamine aspartate
ADVERSE EFFECTS
1) Palpitations
2) Tachy
3) Hypertension
4) Angina
5) Dysrhythmias
6) Nervousness
7) Restlessness
8) Anxiety
9) Insomnia
10) N/V/D
11) Dry mouth
12) ↑ Urination
13) ↑ Respiration
PATIENT EDUCATION
1) Daily ℞ 💊 4 – 6 hrs b4 bedtime
a) ↓ Insomnia
2) Take 30 – 45min b4 meal
3) ℞ “Holidays”

MIGRAINE
DESCRIPTION
1) Recurring Unilateral headaches
2) Lasting 4 – 72 hr
TYPICAL FEATURE
1) Pulsating pain
2) Worsening with each pulse
ASSOCIATED SYMPTOMS
1) Nausea
2) Vomiting
3) Photophobia
a) Avoid light
4) Phonophobia
a) Avoid sound
AURA
1) Altered visual & other senses
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 RITALIN

AKA METHYLPHENIDATE

DESCRIPTION
1) #1 ℞ 4 ADHD
2) NARCOLEPSY
ADVERSE EFFECTS
1) WEIGHT LOSS
2) Insomnia
3) Nervousness
4) Agitation
INTERACTIONS
b) hhhh
CONTRAINDICATED
3) hhhhhh

ADDERALL

DESCRIPTION
1) ADHD
2) Narcolepsy
ADVERSE EFFECTS
5) Palpitations

℞
i)

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1. The nurse is administering medications. One patient has an order for aspirin 325 mg by mouth daily and
another patient has an order for aspirin 650 mg 4 to 6 times daily (maximum 4 g/day). The nurse understands
that the indication for the 325 mg of aspirin once daily is:
A. pain management.
B. fever reduction.
C. treatment of OA.
D. thromboprevention.

2. A hospitalized patient has an order for ketorolac (Toradol). The nurse notes that the order is only for 5 days.
What is the reason for this?
A. The patient’s pain should subside by that time.
B. There are concerns about addiction to the drug.
C. The drug can cause severe renal and GI effects.
D. The drug loses its effectiveness over time.

3. An 82-year-old woman is taking ibuprofen (Motrin) 3200 mg divided three times daily as treatment for
arthritis. She has had no other health problems. What is the most important assessment for the nurse to
monitor while the patient is on this therapy?
A. Blood sugar
B. Liver function studies
C. Assessment of hearing
D. Renal function studies

4. A patient is admitted with salicylate toxicity. When assessing the patient, the nurse anticipates which
manifestation associated with salicylate toxicity?
A. Bradycardia
B. Hypoventilation
C. Constipation
D. Hyperglycemia

5. Which drug does the nurse associate with the development of potentially life-threatening skin adverse
effects of exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis?
A. probenecid
B. colchicine
C. febuxostat (Uloric)
D. allopurinol (Zyloprim)

6. A patient is taking ibuprofen 800 mg three times a day by mouth as treatment for OA. While taking a health
history, the nurse finds out that the patient has a few beers on weekends. What concern would there be with
the interaction of the alcohol and ibuprofen?
A. Increased bleeding tendencies
B. Increased chance for GI bleeding
C. Increased nephrotoxic effects
D. Reduced antiinflammatory effects of the NSAID

7. A 40-year-old female patient is seen in the clinic. She has been newly diagnosed with RA. Which
medication does the nurse anticipate being ordered for the patient?
A. methotrexate
B. adalimumab
C. infliximab
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 D. etanercept

8. Before administering methotrexate, it is most important for the nurse to assess the patient for:
A. allergy to eggs.
B. congestive heart failure.
C. latent tuberculosis.
D. hypothyroidism.

9. The patient is scheduled for discharge. Which information does the nurse include when teaching the patient
about methotrexate therapy?
A. You can expect to develop mouth sores that will improve with time when taking this medication.
B. Administer the methotrexate injection daily in the early morning.
C. Mix the methotrexate with sterile saline before administration.
D. Administer the methotrexate subcutaneously into the thigh, abdomen, or upper arm, rotating injection
sites.

10. The nurse should question the prescriber regarding use of cyclosporine for the treatment of which disease?
A. Arthritis
B. Psoriasis
C. Irritable bowel disease
D. MS

11. A patient who had a kidney transplant is receiving cyclosporine orally in maintenance doses. What action
would decrease the potency of this drug?
A. Taking it with orange juice
B. Taking it with milk
C. Using a Styrofoam container to administer the drug
D. Mixing it with chocolate milk

12. Which potential problem is of most concern for a patient receiving immunosuppressant drugs?
A. Orthostatic hypotension
B. Increased susceptibility to infections
C. Neurotoxicity
D. Peripheral edema

13. A patient is being discharged on cyclosporine therapy. Which statement by the patient indicates that more
teaching is needed? “I will take the cyclosporine tablet with:
A. water.”
B. milk.”
C. grapefruit juice.”
D. apple juice.”

14. When providing education to the patient on the use of a benzodiazepine medication, the nurse will include
which information?
A. These medications have little effect on the normal sleep cycle.
B. Using this medication may cause drowsiness the next day.
C. It is safe to drive while taking this medication.
D. These drugs are safe to use with alcohol.

15
15. A client presents at the clinic with symptoms of hyperexcitability and agitation. Which medication would
the nurse expect the physician to prescribe?
A. Hypnotic
B. Benzodiazepine
C. Barbiturate
D. Other Anxiolytic and Hypnotic Drugs

16. Barbiturates have a low therapeutic index. This means

A. low doses are not therapeutic.
B. the toxic range is narrow.
C. they are habit forming.
D. the effective, safe dosage range is narrow.

17. A patient is prescribed an anorexiant. Which statement will the nurse include in patient teaching?
A. “Take the medication with your evening meal.”
B. “You will need to take this drug for at least 2 years.”
C. “If you develop a dry mouth, stop taking the drug immediately.”
D. “Avoid intake of caffeine.”

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1. Correct answer: D
Rationale: “Low-dose” aspirin, such as 81 or 325 mg once daily, is given for thromboprevention. Dosages for
pain, fever, or arthritis are much higher usually.

2. Correct answer: C
Rationale: The main adverse effects of ketorolac include renal impairment, edema, GI pain, dyspepsia, and
nausea. It is important to note that the drug can only be used for 5 days because of its potential adverse effects
on the kidney and GI tract.

3. Correct answer: D
Rationale: NSAIDs disrupt the prostaglandins, which stimulate vasodilation and increase renal blood flow. This
disruption may precipitate chronic or acute renal failure in some patients, and older patients are at greater risk
for this adverse drug reaction.

4. Correct answer: D
Rationale: Manifestations of salicylate toxicity include increased heart rate, tinnitus, hearing loss, dimness of
vision, headache, dizziness, mental confusion, lassitude, drowsiness, nausea, vomiting, diarrhea, sweating,
thirst, hyperventilation, and hypoglycemia or hyperglycemia.

5. Correct answer: D
Rationale: If the patient is taking allopurinol, assess the integrity of the skin because of potentially life-
threatening skin adverse effects of exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal
necrolysis.

6. Correct answer: B
Rationale: NSAIDs taken with alcohol may result in increased risk of GI bleeding.

7. Correct answer: A
Rationale: For the treatment of RA, the recommend therapy with nonbiologic DMARDs usually begins with
methotrexate or leflunomide for most patients. Biologic DMARDs are generally reserved for patients whose
disease does not respond to methotrexate or leflunomide. The biologic DMARDs include etanercept, infliximab,
adalimumab, abatacept, and rituximab.

8. Correct answer: C
Rationale: Before administering DMARDs, it is important for the nurse to assess the patient for
contraindications to the use of DMARDs such as active bacterial infections, active herpes, active or latent
tuberculosis, and acute or chronic hepatitis B or C.

9. Correct answer: D
Rationale: Methotrexate should be administered subcutaneously into the thigh, abdomen, or upper arm, rotating
injection sites. Methotrexate should not be administered with other solutions and without use of a filter.
Methotrexate is taken weekly. The development of stomatitis should be reported to the prescriber immediately.

10. Correct answer: D

Rationale: Cyclosporine (Sandimmune, Neoral, Gengraf) is an immunosuppressant drug that is indicated for the
prevention of organ rejection as well as the treatment of other immunologic disorders, such as various forms of
arthritis, psoriasis, and irritable bowel disease.

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11. Correct answer: C
Rationale: Cyclosporine should not be mixed in a Styrofoam container because the medication has been found
to adhere to the inside wall of the cup or container.

12. Correct answer: B

Rationale: Neurotoxicity and edema may be a problem with some immunosuppressants (not orthostatic
hypotension), but a heightened susceptibility to opportunistic infections is a major risk factor in
immunosuppressed patients.

13. Correct answer: C

Rationale: Common drug interactions to assess for when patients take cyclosporin include estrogens, protease
inhibitors, HMG-CoA reductase inhibitors, clarithromycin, phenytoin, phenobarbital, St. John’s wort,
nonsteroidal antiinflammatory drugs, and grapefruit juice.

14. Correct answer: B

Rationale: Benzodiazepines interfere with REM sleep and may cause a “hangover” effect or next-day
drowsiness. They should not be used with alcohol, and persons taking these drugs should not drive.

15. Correct answer: B

16. Correct answer: D

Rationale: Drugs with a low therapeutic index have only a narrow dosage range within which the drug is
effective; above that range, they are rapidly toxic. Barbiturates are habit forming, but this is not related to the
therapeutic index.

17. Correct answer: D

Rationale: Caffeine in any form must be avoided by patients taking anorexiants. These medications should be
taken in the morning to prevent interference with sleep. The drugs are taken on a short-term basis. Dry mouth
frequently develops and can be managed by sucking ice chips and keeping a bottle of water nearby at all times.
These drugs should not be abruptly stopped because a rebound increase in appetite may develop.

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