Assignment: Pharmacotherapy of Inflammation & Fever

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Assignment: Pharmacotherapy of Inflammation & Fever ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Pharmacotherapy of Inflammation & Fever Scenario #A: Joyce Layne is a 17-year old high school student in her senior year. She is an honors student, works hard to get good grades, and hates to miss school. For the past 3 days, she has not been feeling well. This morning her temperature is 39 C (102.2 F), and she has chills and a headache. Several of her friends at school have the flu. She has taken ibuprofen for fevers and menstrual cramps in the past, but Joyce cannot find any in the house as she prepares to leave for school. Her parents have already left for work, and they trust her to check with you, the nurse who lives next door, before taking any medications. Joyce calls you to ask “Is it okay to take the aspirin that my mom uses for her arthritis so I can go to school?” As a nurse, this presents an opportunity for you to teach Joyce about aspirin and her fever. Assignment: Pharmacotherapy of Inflammation & Fever This activity contains 5 questions: Describe the pathophysiology of fever and inflammation. Why is aspirin administered for fever? Should Joyce take the aspirin? Why or why not? What will you teach Joyce about aspirin and the flulike symptoms she is having? What additional patient teaching will she need? What would be the treatment for overdosing on aspirin? attachment_1 attachment_2 attachment_3 NUR120 Chapter 41 Pharmacotherapy of Inflammation and Fever Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Learning Outcomes 1. Explain the pathophysiology of inflammation and fever. 2. Identify drug classes used to treat inflammation and fever. 3. For each of the classes shown in the chapter outline, identify the prototype and representative drugs and explain the mechanism(s) of drug action, primary indications, contraindications, significant drug interactions, pregnancy category, and important adverse effects. 4. Apply the nursing process to care for patients receiving pharmacotherapy for fever or inflammation. Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Pathophysiology of Inflammation and Fever • Inflammation is the response to agents that could damage tissue. – Acute = immediate onset ? Result of influx of neutrophils ? Pain and edema result ? Lasts 1 to 2 weeks – Chronic = slow onset ? Caused by lymphocytes and macrophages ? Scar tissue can result ? May last years Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Pathophysiology of Inflammation and Fever • Both types of inflammation may have febrile response. – Body temperature over 102°F – Pulse over 90 beats/minute – Respirations greater than 20 breaths/min – WBC count over 12,000/mm3 Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Pharmacotherapy of Inflammation • General principles – Inflammation is a symptom. ? Treat underlying cause – Inflammation is usually self-limiting. ? Nonpharmacologic treatments whenever possible – Topical drugs cause few adverse effects ? Used when applicable Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Pharmacotherapy of Inflammation • Goal of pharmacotherapy – Prevent or decrease intensity of inflammation response – Reduce fever • Nonspecific inflammations treated with: – NSAIDs – Corticosteroids • Fever treated with antipyretics Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Three major classes of NSAIDs – Salicylates – Ibuprofen and ibuprofen-like agents – Cyclooxygenase-2 (COX-2) inhibitors Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Salicylates – Aspirin first-generation salicylate ? Originally derived from willow bark ? Indications –Analgesic –Anti-inflammatory –Antipyretic –Suppression of platelet aggregation Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Salicylates – Mechanisms of actions ? Prostaglandins are local hormones found in every tissue ? Aspirin blocks synthesis of prostaglandins by inhibiting enzyme cyclooxygenase (COX) Figure 41.1 Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Aspirin (Acetylsalicylic Acid) – Therapeutic classification ? Nonnarcotic analgesic ? Antipyretic ? Antiplatelet – Pharmacologic classification ? Salicylate ? NSAID Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Aspirin (Acetylsalicylic Acid) – Therapeutic effects and uses ? Mild to moderate intensity pain, inflammation, fever ? Assignment: Pharmacotherapy of Inflammation & Fever Prevention of thromboembolic event ? Stroke prophylaxis in patients with history of TIAs or persistent or paroxysmal atrial fibrillation ? MI prophylaxis ? Suspected coronary thrombosis ? Off-label use to prevent colorectal cancer Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Aspirin (Acetylsalicylic Acid) – Mechanism of action ? Reduces prostaglandin synthesis ? Lowers body temperature ? Causes centrally mediated peripheral vasodilation and sweating Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs Prototype drug: Aspirin (Acetylsalicylic Acid) – Serious adverse effects ? Hypersensitivity reaction ? GI bleeding ? Thrombocytopenia ? Hemolytic anemia ? Occult bleeding ? Nephrotoxic effects ? Hepatotoxicity ? Tinnitus and hearing loss with high doses – Adverse effects ? Stomach irritation ? Heartburn ? Nausea ? Vomiting ? Diarrhea ? Stomach pain Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Aspirin (Acetylsalicylic Acid) – Contraindications/precautions ? Hypersensitivity to any salicylate (including in foods) ? “Aspirin triad” ? Agranulocytosis ? Head trauma or increased intracranial pressure ? History of GI bleeding ? Hypoprothrombinemia ? Vitamin K deficiency ? Heart failure (HF) ? Flu or flulike illness in children or teens ? Pregnancy, especially in the third trimester Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Aspirin (Acetylsalicylic Acid) – Contraindications/precautions ? Precautions –Hypothyroidism –Immunosuppression –Asthma, gout, or anemia –Chronic kidney disease (CKD) –Hepatic impairment –G6PD deficiency Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Aspirin (Acetylsalicylic Acid) – Drug interactions ? Other salicylates (additive effect) ? Ammonium chloride and other acidifying agents ? Anticoagulants, thrombolytics, or antiplatelet agents ? Oral antidiabetic agents ? Three or more alcoholic drinks per day ? Corticosteroids ? Methotrexate ? Probenecid and sulfinpyrazone ? Beta blockers Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Aspirin (Acetylsalicylic Acid) – Drug interactions ? Herbal/food –Feverfew, garlic, ginger, horse chestnut, red clover –Caffeine –St. John’s wort Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Aspirin (Acetylsalicylic Acid) – Pregnancy categories C (first and second trimester) and D (third trimester) – Treatment of overdose ? Emesis, gastric lavage, and alkalinization of urine ? Hemodialysis Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Ibuprofen-like drugs – Most common drugs for mild to moderate pain and inflammation – All have same mechanism of action = inhibit COX – All have analgesic, anti-inflammatory, and antipyretic properties – Most are weak acids = easily absorbed in GI tract – Most are bound to albumin in blood and are metabolized by liver. – All have ability to damage the GI mucosa – Many pose increased risk of cardiac events – Many nephrotoxic at high doses Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Ibuprofen (Advil, Motrin, others) – Assignment: Pharmacotherapy of Inflammation & Fever Therapeutic classification ? Analgesic ? Anti-inflammatory drug ? Antipyretic – Pharmacologic classification ? NSAID Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Ibuprofen (Advil, Motrin, others) – Therapeutic effects and uses ? Relief of fever and mild to moderate pain associated with chronic symptomatic rheumatoid arthritis (RA )and osteoarthritis ? Myalgia, headache, dental pain, and dysmenorrhea Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Ibuprofen (Advil, Motrin, others) – Mechanism of action ? Inhibits COX-1 and COX-2, which block prostaglandin synthesis and modulate T-cell function ? Inhibits inflammatory cell chemotaxis ? Decreases release of superoxide radicals ? Increases scavenging of superoxide radicals at inflammatory sites Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Ibuprofen (Advil, Motrin, others) – Adverse effects ? Most common: GI related –Bleeding, anorexia, heartburn, N/V, Constipation or diarrhea ? CNS effects: –Dizziness, headache, drowsiness, tinnitus ? Rare but serious: –Peripheral edema, aplastic anemia, leukopenia and anaphylaxis ? Chronic use may lead to: –Polyuria, azotemia, cystitis, hematuria, & increased creatinine and blood urea nitrogen (BUN) levels Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Ibuprofen (Advil, Motrin, others) ? Black box warnings ? Risk of serious and potentially fatal cardiovascular thrombotic events, MI, and stroke ? Risk of serious GI adverse effects (bleeding, ulcer, and stomach or intestine perforation) Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Ibuprofen (Advil, Motrin, others) – Contraindications/precautions ? Allergy to aspirin or other NSAIDs ? Peptic Ulcer Disease (PUD) ? Bleeding abnormalities ? Perioperative pain related to coronary artery bypass graft (CABG) ? Severe hepatic impairment ? Hypertension (HTN) ? History of GI bleeding Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Ibuprofen (Advil, Motrin, others) – Contraindications/precautions ? Diabetes mellitus ? Impaired renal or hepatic function ? Heart failure, serious HTN, or history of stroke or MI ? Diminished respiratory function in children with asthma Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Ibuprofen (Advil, Motrin, others) – Drug interactions ? Oral anticoagulants and antiplatelet drugs can increase risk of bleeding ? May increase toxicity of digoxin, lithium, or methotrexate ? Other NSAIDs, alcohol, or corticosteroids may cause serious adverse GI events ? Reduced antihypertensive action of diuretics, beta blockers, and angiotensin-converting enzyme (ACE) inhibitors ? Herbal/food –Feverfew, garlic, ginger, ginkgo may increase risk of bleeding. Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Ibuprofen (Advil, Motrin, others) – Pregnancy categories B (first and second trimesters) and D (third trimester) – Treatment of overdose ? Administration of activated charcoal and nasogastric suction Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Cyclooxygenase-2 inhibitors – Assignment: Pharmacotherapy of Inflammation & Fever Celecoxib (Celebrex) is a second-generation NSAID – Blocks COX-2 without inhibiting COX-1 – Less GI bleeding and ulcer formation than with ibuprofen or aspirin – Limited use due to risk of MI and stroke – Therapeutic classification = Anti-inflammatory – Pharmacologic classification ? COX-2 inhibitor ? NSAID Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Celecoxib (Celebrex) – Therapeutic effects and uses ? Mild to moderate pain and inflammation associated with RA, osteoarthritis, dysmenorrhea, dental procedures, headache, and ankylosing spondylitis ? Prophylaxis of adenomas or colorectal polyps – Mechanism of action ? Selectively inhibits the enzyme COX-2 ? Inhibits prostaglandin synthesis Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs Prototype drug: Celecoxib (Celebrex) • Adverse effects – Common: ? Headache, HTN, fever, dyspepsia, upper respiratory tract infection, arthralgia, cough, vomiting, diarrhea – CNS adverse effects: ? HA, dizziness, insomnia – Integumentary adverse effects: ? Erythema multiforme, exfoliative dermatitis, rash, Stevens–Johnson syndrome, toxic epidermal necrolysis – Long-term Use may cause: ? Chronic Kidney Disease (CKD) and hepatic impairment Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Celecoxib (Celebrex) – Black box warnings ? Risk of serious and potentially fatal cardiovascular thrombotic events, MI, and stroke ? Risk of serious GI adverse effects (bleeding, ulcer, and stomach or intestine perforation) Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Celecoxib (Celebrex) – Contraindications/precautions ? Hepatic insufficiency ? Chronic Kidney Disease (CKD) ? Anemia ? In postoperative phase of CABG ? History of GI bleeding or Peptic Ulcer Disease (PUD) ? Poor CYP2C9 metabolizers ? Taking anticoagulants ? History of asthma, bone marrow suppression, stroke, peripheral vascular disease, elevated liver function tests, heart failure, kidney disease, or fluid retention Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Celecoxib (Celebrex) – Drug interactions ? Increased risk of bleeding with oral coagulation modifiers ? May increase toxicity of lithium ? Serious adverse GI events with alcohol, corticosteroids, aspirin, or other NSAIDs ? Reduced antihypertensive action of diuretics or ACE inhibitors ? Increased serum celecoxib levels when used concurrently with fluconazole Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nonsteroidal Anti-Inflammatory Drugs • Prototype drug: Celecoxib (Celebrex) – Drug interactions ? Herbal/food –Feverfew, garlic, ginger, ginkgo, horse chestnut, red clover may increase risk of bleeding. – Pregnancy category C; category D in third trimester – Treatment of overdose ? Supportive ? Administer activated charcoal and nasogastric suction Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Antipyretic and Analgesic Drugs • Acetaminophen – Used to relieve pain and to reduce fever – Has no anti-inflammatory properties = Not an NSAID – Does not cause GI bleeding or ulcers – Often combined with opioid analgesics – Assignment: Pharmacotherapy of Inflammation & Fever Therapeutic classification ? Nonopioid analgesic ? Antipyretic – Pharmacologic classification ? Para-aminophenol derivative Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Antipyretic and Analgesic Drugs • Prototype drug: Acetaminophen (Tylenol) – Therapeutic effects and uses ? Mild to moderate pain ? Osteoarthritis of the hip or knee ? Dysmenorrhea ? Dental procedures ? Headache and myalgia ? Fevers Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Antipyretic and Analgesic Drugs • Prototype drug: Acetaminophen (Tylenol) – Mechanism of action ? Inhibits COX ? May inhibit chemical mediators of pain ? Direct action on heat-regulating center of hypothalamus Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Antipyretic and Analgesic Drugs • Prototype drug: Acetaminophen (Tylenol) – Adverse effects ? At recommended doses, acetaminophen well tolerated – Serious adverse effects ? Acute acetaminophen poisoning –Symptoms: anorexia, nausea, vomiting, dizziness, lethargy, diaphoresis, chills, epigastric or abdominal pain, diarrhea Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Antipyretic and Analgesic Drugs • Prototype drug: Acetaminophen (Tylenol) – Adverse effects ? Acute hepatic failure – Serious adverse effects ? Chronic use can lead to: –Neutropenia –Pancytopenia –Leukopenia –Thrombocytopenic purpura –Hepatotoxicity in alcoholics –Chronic Kidney Disease (CKD) –Stevens–Johnson syndrome Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Antipyretic and Analgesic Drugs • Prototype drug: Acetaminophen (Tylenol) – Black box warning ? Potential to cause severe liver injury ? Serious allergic reactions –Symptoms: angioedema, difficulty breathing, itching, or rash Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Antipyretic and Analgesic Drugs • Prototype drug: Acetaminophen (Tylenol) – Contraindications/precautions ? Allergy to acetaminophen ? Anemia ? G6PD deficiency ? Hepatic disease ? Rheumatoid or osteoarthritis ? Malnutrition ? Bone marrow depression ? Immunosuppression ? CKD Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Antipyretic and Analgesic Drugs • Prototype drug: Acetaminophen (Tylenol) – Drug interactions ? Alcohol increases risk of hepatotoxicity ? Increase anticoagulant actions with warfarin ? Can increase the risk of bone marrow suppression with zidovudine ? Herbal/food –Caffeine enhances analgesic effects –Hepatotoxicity reported with echinacea Copyright © 2019, 2016, 2013 Pearson Education, Inc. Assignment: Pharmacotherapy of Inflammation & Fever All Rights Reserved Antipyretic and Analgesic Drugs • Prototype drug: Acetaminophen (Tylenol) – Pregnancy category B – Treatment of overdose ? Within 8 hours of ingestion ? Three-bag method of acetylsteine (Acetadote) Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Nursing Practice Application • Assessment (prior to) • Obtain a complete health history including hepatic, renal, respiratory, cardiovascular or neurologic disease • Obtain pregnancy or breastfeeding history • Obtain drug history including allergies • Obtain VS, especially BP & temperature • Review baseline laboratory findings • Assess patient’s ability to receive and understand instructions • Assessment (during) • Assess for desired therapeutic effect • Continue to monitor lab results • Assess for & immediately report adverse effects Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Reference 1.Adams, M., Urban, C, & Sutter, R. (2019). Pharmacology: Connections to Nursing Practice (4th ed.). Pearson Publishing. Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved NUR120 Chapter 43 Immunizing Agents Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Learning Outcomes 1.Compare and contrast active and passive immunity. 2.Prepare a table listing the types of vaccines, their indications, and potential adverse effects. 3.Explain why it is important to administer childhood vaccines at specific ages. 4.Describe the pathogenesis and immunization of bacterial infections, including diphtheria, pertussis, tetanus, pneumococcus, and meningococcus. Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Learning Outcomes 5.Describe the pathogenesis and immunization of viral infections, including hepatitis A and B, influenza, rabies, measles, mumps, rubella, polio, varicella zoster, human papillomavirus, and rotavirus. 6.Apply the nursing process to care for patients receiving immunizing agents. Copyright © 2019, 2016, 2013 Pearson Education, Inc. All Rights Reserved Vaccines and the Immune System • Immune response – Antigen (a foreign substance) are recognized by B or T lymphocytes • During incubation period following exposure, symptoms of infection and tissue injury develop. • Vaccination – Introduction of foreign cells or proteins to trigger immune … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10