Maryville University Nursing 615 Detailed Exam 2025

Dosing for low dose colchicine - -1.2 mg followed by 0.6 one hour later or 1.8 mg total *Dosing for high dose colchicine - -1.2 mg followed by 0.6 mg every 4 to 6 hours; or 4.8 mg total. What is the difference between low dosing and high dosing of colchicine - -low dose is as effective as high dose with lower side effect profile What medication is used for gout? - -Colchicine What does colchicine do? - -Used for gout and to treat and prevent gout attacks. Also Behcets syndrome. Sid effects of Cochicine - -Always Diarrhea. Upset Stomach, nausea, abdominal pain. Instructions for colchicine - -take with food to help decrease GI side effects What should be checked with colchicine? - -Renal Function before and during treatment. (BUN, Creatinine) Patient Education for Colchicine - -Always causes severe degree of diarrhea so make sure that people understand that. Mr. Holloway presents to your clinic with a significantly swollen, painful big toe and you diagnose him with gout. Of the following options which would be the best treatment for Mr. Holloway? a. Acetaminophen with codeine b. Low-dose colchicine c. High-dose colchicine d. High-dose aspirin - -Low-dose colchicine. Low-dose colchicine is 1.2 mg followed by 0.6 mg one hour later or 1.8 mg total. High-dose colchicine is 1.2 mg followed by 0.6 mg Q4 to Q6 hours or 4.8 mg total. The difference between the two is low-dose is as effective as high-dose with a lower side effect profile. Patient education when prescribing colchicine includes? a. Moderate amounts of alcohol are safe with colchicine b. Colchicine may be constipating c. Colchicine always causes some degree of diarrhea d. Mild muscle weakness is normal - -B. Colchicine always causes some degree of diarrhea Nursing 615 Nursing 615 What lab value should be monitored with gout? - -Check renal function test, BUN, Creatine Cholchesine - -for gout, think about alcohol Allopurinol is used for what? - -Gout MOA Allopurinol - -xanthine oxidase inhibitor. uric acid reducer, prevents flare ups and kidney stones SE of Allopurinol - -skin rash, flu like symptoms, painful or little urination, drowsi, dizzy Monitor what with Allopurinol - -BUN, Creatinine, Liver Function You have a patient who is taking allopurinol to prevent gout. What labs will you monitor for this patient on allopurinol? a. Blood glucose b. Complete blood count c. BUN, creatinine, and creatinine clearance d. C-reactive protein - -BUN, creatinine, and creatinine clearance Patient teaching for Uloric - -Gout may worsen with therapy initially Uloric other medication - -Febuxostat Febuxostat (Uloric) MOA - -xanthine oxidase inhibitor, uric acid reducer for its with gout and prevent flares. SE of Febuxostat (Uloric) - -gout flares, nausea, mild rash, liver problems, heart attack symptoms Febuxostat (Uloric) need to monitor what? - -liver and renal function Patient education for Uloric - -Got may worsen with therapy initially What medication can you take with Uloric? - -NSAID or colchicine for up to 6 months w/ beginning of treatment for gouty flare ups Mr. Thompson has just started taking febuxostat (Uloric) to treat his gout and he needs to be educated on what to expect. a. Feuxostat may cause severe diarrhea b. He will need frequent CBC monitoring c. He should consume a high-calcium diet d. Gout may worsen with therapy - -D. Gout may worsen with therapy Nursing 615 Nursing 615 ADV effects of corticosteroids if given longer than 6 months? - -The main thing you want to worry about is osteoporosis, it can also worsen diabetic control and patients should report any tarry black stools or abdominal pain. PEPTIC ULCER DISEASE. What should long term corticosteroids be used for? - -Exacerbation of autoimmune diseases, and in bursts for type 1 hypersensitivity reactions/sensitivities. Risk for long term corticosteroids? - -Decreased ability to fight infections, slow immune response, osteoporosis, increased blood glucose Recommendations for patients who are taking long term corticosteroids - -Getting vaccinations Corticosteroids medication ending - -"sone" Corticosteroids are used to treat what? - -RA, lupus, asthma, allergies SE of corticos - -High BP, weight gain, muscle weakness, insomnia ADV of corticos after 6 months - -osteoporosis, can also worsen diabetic control (raise BGL) What should be given with corticosteroids? - -vitamin supplements What should be reported with corticosteroids - -black tarry stool and abdominal pain What can happen with long term therapy of corticosteroids? - -Adrenal Suppression S/S of adrenal suppression - -malaise, myalgia, fever, hypotension. Don't do what with corticosteroids? - -Stop Abruptly, must taper off Why do you taper corticosteroids? - -necessary to prevent withdrawal symptoms What should you do with 1 gram of a corticosteroid? - -PPI (omeprazole) Ms. Jensen has been on prednisone for 6 months. Patients who have been on prednisone for some time should be assessed for what? a. Iron deficiency anemia b. Renal dysfunction c. Osteoporosis d. Gout - -Osteoporosis. Prednisone can also worsen diabetic control and you must educate your patients to report any tarry black stools or abdominal pain. When you place a patient on prednisone and the total dose exceeds 1 gram, what additional drug should you prescribe? Nursing 615 Nursing 615 a. Naproxen, an NSAID for joint pain b. Omeprazole, a proton-pump inhibitor to prevent PUD c. Metformin, a biguanide to prevent diabetes d. Furosemide, a diuretic to treat fluid retention - -Omeprazole Patients who are currently on or will start chronic corticosteroid therapy should be monitored for what? a. Stool culture b. Vitamin B12 c. Serum glucose d. Folate levels - -Serum glucose. FYI: remember steroid therapy will raise glucose levels even in your nondiabetic patients. Patients with rheumatoid arthritis who are on a chronic low-dose prednisone will need co-treatment with which medications to prevent further adverse effects? a. Vitamin D b. Calcium supplementation c. A bisphosphonate d. All of the above - -D. All of the above. FYI: long term steroid therapy can contribute to weakened bones. Why do you taper corticosteroids? - -Tapering must be done carefully to avoid both recurrent activity of the underlying disease process and possible cortisol deficiency resulting from the hypothalamic-pituitary adrenal cis of HPA suppression during the period of steroid therapy. Margaret has been on 60 mg of prednisone for 10 days for her severe asthma exacerbation. Since she is breathing much better it is time to discontinue the medication. What should you know when discontinuing this drug? a. Prednisone can be abruptly discontinued with no adverse effects b. Substitute the prednisone with another anti-inflammatory such as ibuprofen c. Develop a tapering schedule to slowly wean Margaret off the prednisone d. Transition patient onto an inhaled corticosteroid - -Develop a tapering schedule because tapering helps to avoid both recurrent activity of the underlying disease process and possible cortisol deficiency resulting from the hypothalamic-pituitary adrenal axis (HPA) suppression during the period of steroid therapy. What are the black box warnings on NSAIDs? - -May cause an increased risk of serious cardiovascular thrombotic events, myocardial-infarction and stroke which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or with risk factors for cardiovascular disease may be a greater risk. NSAIDs can also cause an increased risk of serious gastrointestinal adverse effects including: bleeding, ulceration, and perforation the stomach or intestines which can be fatal. These events can can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious GI events. Nursing 615 Nursing 615 NSAIDS warning - -BB warning for GI bleeds and CV events MOA inhibits what? - -Cyclooxynase thus reducing prostaglandin synthetase. What is the FDA Black Box Warning for ALL nonsteroidal anti-inflammatory drugs (NSAIDS)? a. Increased risk of developing systemic arthritis with prolonged use b. Risk of life-threatening rashes, including Stevens-Johnson c. Potential for causing life-threatening gastrointestinal bleeds d. Potential for transient changes in serum glucose levels - -Potential for causing life threatening gastrointestinal bleeds (and ulceration and perforation of the stomach or intestines). NSAIDs can also increase the risk of cardiovascular thrombotic events, MI, and stroke, especially with extended use. Elderly patients are at greater risk and can happen without any warning symptoms. If you are getting ready to prescribe an NSAID, a complete drug history should be conducted as NSAIDs interact with which drug? a. Diphenhydramine (an antihistamine) b. Combined oral contraceptives c. Warfarin (anticoagulant) d. Omeprazole (proton-pump inhibitor) - -Warfarin. NSAIDs work by inhibiting the cox enzymes. Strathman says to get familiar with the "cox pathway" and how blocking one part of the cox pathway can lead to build up of other different products. NSAIDs stimulate platelet aggregation by the formation of thromboxane-A2 leading to the formation of blood clots. See attachment. What are the recommendations in the treatment of pain? - -You want to start with NSAIDs first and then work your way up from there. NSAIDS - -Ibuprofen, naproxen, celecoxib, ketorolac 1st line for mild or moderate pain, inflammation - -NSAIDS Ibuprofen MOA - -non selective cox 2 inhibitor, decrease PG, antipyretic, inhibiting cox 1 gives GI side effects Black Box Warning for NSAIDS - -CV issues/events such as stroke, MI, thrombus, CV disease; GI issues such as bleed, ulcer, perforation, increased risk for elderly and with increased dose Celecoxib other name - -Celebrex Celecoxib (Celebrex) MOA - -selective cox-2 inhibitors, less GI symptoms (does not inhibit cox1) Drug interactions with Warfarin - -can increased bleeding Nursing 615 Nursing 615 NSAIDS are excreted how? - -Kidneys Teaching with NSAIDS - -stay hydrated If on long term aspirin check what? - -CBC annually and salicylate level and urine PH if high dose aspirin When should you give an H2 blocker? - -If pt is taking aspirin and is feeling heartburn symptoms What is an early sign of aspirin toxicity? - -tinnitus What would you use to treat low back pain? - -Opioid pure agonist MOA of Opioid pure agonist - -binds to opioid receptors tip efficacy achieved. What is an opioid antagonist - -Naloxone (Narcan) Side effect of Opioids - -Nausea What causes nausea - -CTZ (Chemotherapy trigger zone) MOA of ibuprofen? - -non-selective cox-2 inhibitor. it decreases prostaglandin synthesis Cox 1 Pathway - -systemic, present in all tissues, blocking these cause GI adverse reaction Cox 2 Pathway - -inducible enzyme produced in response to pain and inflammation NSAIDS such a ibuprofen work by inhibiting (Long Explanation of MOA) - -the cox enzyme cox which is cyclooxyrgenase is officially knows as the prostaglandin endoperoxide synthase (PTGS), which converts arachidonic acid to prostaglandin h2 of PGH2. PGH2 in turn is converted by other enzymes to several other prostaglandin which are mediators of pain, inflammation, and fever, and to thromboxane-A2 which stimulated platelet aggregation leading to the formation of blood clots. Exact MOA of Ibuprofen - -is unknown Ibuprofen MOA - -non-selective inhibitor of cycloxyenase Ibuprofen pharmacological effects - -are believed to be due to inhibition of cox-2 which decreases the synthesis of PGs in mediating the inflammation pain, fever, and swelling. Antipyretic effects - -may be due to action on the hypothalamus resulting in an increase of peripheral blood flow, basil dilation, and subsequent heat dissipation. Nursing 615 Nursing 615 Inhibition of cox-1 is thought to cause some side effects of ibuprofen such as? and like what other medications? - -GI ulcerations like aspirin and indomethacin ibuprofen is a... - -non-selective cox-2 inhibitor in that it inhibits two isoforms of psychologic oxygenase cox-1 and cox-2. What activities are mainly through inhibiting of cox-2 - -The analgesic and antipyretic and anti-inflammatory activity of NSAIDs Inhibition of cox-1 is responsible for what side effects? - -GI tract What is uncertain with cox isoforms - -the role of individual cox isoforms in the analgesic and anti-inflammatory and gastric damage effects of NSAIDs is uncertain and different compounds cause different degrees of analgesia and gastric damage. What is the difference between ibuprofen and aspirin - -ibuprofen=reversible inhibitor of the cox pathway. Aspirin= non-reversible inhibitor of the cox pathway Gabriella is a 3-year old diagnosed with otitis media and an upper respiratory infection. You prescribe her an antibiotic (probably amoxicillin) and ibuprofen. What education should the parents receive? a. The ibuprofen dose can be doubled if the pain is severe b. Need to keep Gabriella well hydrated while she is taking ibuprofen c. Ibuprofen is complete safe in children with no known adverse effects as the elderly are more prone to GI events d. The parents can cut the Ibuprofen in half to give to Gabriella - -B. Gabriella needs to stay well hydrated while taking ibuprofen. NSAIDs are excreted by the kidneys so it is a good idea to keep them flushed. William is a 78-year old who takes two aspirin every morning while he reads his newspaper to treat arthritis pain in his back. He states the aspirin helps him to "get moving" each day. Lately he has had some heartburn from the aspirin. After you rule out an acute GI bleed, what would be an appropriate course of treatment for William? a. Discontinue the aspirin and switch him to hydrocodone for pain b. Decrease the aspirin dose to one tablet daily c. Add an H2 blocker such as ranitidine to his therapy d. Have William take an antacid 15 minutes before taking the aspirin each day - -C. Add an H2 blocker such as ranitidine. Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is? a. Vomiting b. Tremors c. Black tarry stools d. Tinnitus - -D. Tinnitus Nursing 615 Nursing 615 You have a patient that is on long-tern aspirin therapy and what lab should be conducted annually? a. Amylase b. Complete blood count c. Salicylate level d. Urine analysis - -B. CBC Monitoring a patient on a high-dose aspirin level includes: a. Salicylate level b. Complete blood count c. Urine pH d. All of the above - -All the Above MOA of acetaminophen - -not completely understood, main mechanism is proposed is the inhibition of cox., recent findings suggest that its highly selective cox-2. Acteaminophen being cox 2 does not inhibit - -production of pro clotting thromboxjnes. Similarities with acetaminophen and NSAIDS - -analgesic and antipyretic properties What is limited in acetaminophen - -its peripheral anti-inflammatory activity is usually still limited by several factors. peripheral anti-inflammatory activity with acetaminophen is - -high levels of peroxides present and inflammatory lesions and, in some circumstances, even the peripheral anti inflammatory activity comparable to NSAIDs can be observed. Acute overdose of acetaminophen can cause what? - -Potentially fatal liver damage. Max recommended dose of acetaminophen - -4 grams in 24 hours If go over recommended dose to acetaminophen, risk for - -hepatocellular necrosis, 4000 mg max Janet has fractured her ankle and you give her a prescription for Vicodin (acetaminophen +hydrocodone). What education should you pro