Pharmacology Made Easy 5.
0 Assigned Activities
1) ATI Tutorial: Pharmacology Made Easy 5.0
Module: Pain and Inflammation
2) Active Stack: Pharmacology Flash Cards
Module: Pain and Inflammation
3) Dosage calculation and safe Medication Administration 4.0
Module: Oral Medications
First-Generation NSAIDs (COX-1 and COX-2 Inhibitors)
The first generation of nonsteroidal anti-inflammatory drugs, or NSAIDs, suppress
inflammation, treat mild to moderate pain, reduce fever, and relieve dysmenorrhea, which
is painful menses. Aspirin also inhibits platelet aggregation, making it an effective option
as an anticoagulant when the stronger medication, warfarin, is not needed. For this
reason, you can often give aspirin when prophylactic or long-term treatment against the
development of thrombi is needed.
Prototype and Other Medications
Ibuprofen – Medication Classification: COX-1 and COX-2 inhibitors
The prototype medications for the first generation of NSAIDs, which are COX-1 and COX-2
inhibitors, are aspirin (ASA) and ibuprofen (Advil and Motrin). Other medications in this
category include naproxen, indomethacin, ketorolac, meloxicam, and diclofenac.
Expected Pharmacological Action
Organ/body Function Affected, Stimulate COX-1, Inhibit COX-1, Stimulate COX-2, Inhibit
COX-2
• G Expected Pharmacological Action
• Organ/body Function Affected, Stimulate COX-1, Inhibit COX-1, Stimulate COX-2,
Inhibit COX-2
• Gastric mucosa, Gastric mucosa protected – increased production of mucus,
decreased production of stomach acid, Gastric mucosa not protected – ulcer
development, ,
• Platelet aggregation, Enhances platelet aggregation, Decreases platelet aggregation
– anticoagulant effects (bleeding, bruising), ,
• Kidneys, Promote kidney perfusion, Impairs renal perfusion – decreased urine
output, increased BUN and creatinine, ,
• Tissue injury/inflammation, , , Promotes inflammation, Decreases inflammation
• Tissue injury/pain, , , Causes pain, Decreases pain
• Tissue injury/body temperature, , , Increases body temperature, Decreases body
temperature
• Adverse Drug Reactions
• The adverse drug reactions of non-selective NSAIDs (COX-1 and COX-2 inhibiting)
relate to the inhibition of the protective effects of COX-1. Gastric upset, heartburn,
nausea, and gastric ulceration can occur secondary to blocking the gastric mucosal
protective effects of COX-1. Bleeding tendencies occur for the same reason;
however, this occurs less with non-aspirin NSAIDs. Renal dysfunction is an adverse
drug reaction because NSAIDs block the protective effects of COX-1 on the kidneys.
In addition to these effects that relate to the inhibition of COX-1, there are other
adverse drug reactions. An increased risk for thromboembolic events exists when
clients take a non-aspirin NSAID. Salicylism, which is a buildup of aspirin in the
body to toxic levels, can occur if clients ingest more aspirin than they excrete.
Reye’s syndrome is a rare but serious disorder that occurs secondary to giving
aspirin to a child who has a viral infection; therefore, aspirin was removed from
most products intended for children under the age of 18.
• Safety Alert
• Reye’s syndrome manifests with vomiting, confusion, seizures, and loss of
consciousness. It may occur secondary to a metabolic condition or when you give
aspirin to an infant, child, or adolescent who has a viral infection, most frequently
influenza or chickenpox. It can cause liver and brain damage and even death. Early
diagnosis and treatment with diuretics and electrolytes can help prevent swelling of
the brain. Treatment for bleeding may also be necessary due to the liver damage
that interferes with coagulation. Make sure your clients, especially those who are
caring for children, know to avoid giving their children aspirin or an NSAID for fever
in children who have influenza or varicella. Acetaminophen is safe for
administration.
• Interventions
When caring for a client taking non-selective NSAIDs (COX-1 and COX-2 inhibiting),
monitor for manifestations of bleeding, including black or dark-colored stools,
abdominal pain, nausea, and hematemesis (vomiting blood). Test for and treat
Helicobacter pylori. For clients who are at high risk for gastric bleeding, it is
recommended that they receive a proton pump inhibitor concurrently during
therapy. Monitor for petechiae or easy bruising, which manifests as pinpoint
hemorrhages below the skin and excessive bleeding from minor injuries such as
cuts from shaving. Monitor for a decrease in renal function from totals of I&O and
decreasing levels of BUN and creatinine. In relation to the potential for salicylism in
clients taking aspirin, monitor for client reports of tinnitus, dizziness, and/or
headache, as well as diaphoresis (excessive sweating) and tachypnea, which can
result in respiratory alkalosis. If any of these manifestations develop, stop aspirin
therapy immediately so the serum level of aspirin does not continue to rise. To
prevent Reye’s syndrome in children and adolescents who have viral infections,
recommend the use of acetaminophen instead of aspirin or NSAIDs. When NSAID
therapy is necessary, recommend non-aspirin NSAIDs for short periods and in low
doses to help minimize adverse drug reactions. Monitor for manifestations of
embolic events. If a provider prescribes COX-1 and COX-2 inhibiting NSAIDs for
long-term therapy, make sure the provider also prescribes low-dose aspirin to
prevent embolic events.
• Administration
When administering non-selective NSAIDs (COX-1 and COX-2 inhibiting), make sure
clients swallow enteric-coated or sustained-release forms whole and do not crush
or chew them. Due to their effects on platelet aggregation and bleeding,
discontinue aspirin 1 week before scheduled surgery. Throughout therapy, continue
to monitor for the medication’s therapeutic effects. Expect the dose of aspirin to be
81 milligrams a day when given prophylactically to inhibit platelet aggregation. This
is different than a medication such as warfarin, which has more adverse drug
reactions and medication interactions.
• Client Instructions
When providing instructions about non-selective NSAIDs (COX-1 and COX-2
inhibiting), tell clients to take the medication with food, milk, or 8 ounces of water to
minimize gastrointestinal effects. Avoiding alcohol also minimizes adverse
gastrointestinal effects. Tell clients to report persistent gastric irritation and
manifestations of bleeding, such as easy bruising, petechiae, coffee-ground
emesis, and excessive bleeding from minor injuries. Also, tell clients to report any
unusual or prolonged bleeding, as well as changes in urine output, weight gain, or
manifestations of fluid retention such as edema or bloating. Tell caregivers not to
administer aspirin or NSAIDs to children or adolescents under the age of 18 who
have viral infections. Instruct them to administer acetaminophen instead. Due to
the risk of development of thrombi when taking a non-aspirin NSAID, tell clients to
immediately report to the provider manifestations of myocardial infarction (MI) such
as chest pain or heaviness and shortness of breath, as well as manifestations of
stroke such as sudden and severe headache, one-sided numbness, weakness,
visual disturbances, or confusion. If a daily low-dose aspirin is prescribed by the
provider to minimize the risk of MI and stroke, reinforce to the client the importance
of taking it. Instruct clients to report tinnitus immediately, as this is the first
manifestation of salicylism, as well as unwarranted sweating, headache, and
dizziness. They should stop taking aspirin if these manifestations develop.
• Safety Alert
Salicylism is the name for aspirin toxicity. It can happen accidentally to clients who
self-medicate with aspirin and to clients who take the medication regularly for a
chronic condition such as rheumatoid arthritis. It is important for clients to know
what manifestations indicate toxicity is beginning to develop before more serious
adverse drug reactions occur. The earliest manifestations are decreased hearing
and tinnitus, which is ringing or humming in the ears. Headache and dizziness are
additional manifestations of toxicity that can accompany the tinnitus. If clients quit
taking aspirin at the first manifestations of tinnitus, the blood level will gradually
drop as it is excreted by the kidneys. If clients continue to take aspirin, they will
begin to experience nausea and vomiting, diarrhea, and diaphoresis. With
continued ingestion, fever, confusion, seizures, and respiratory and/or renal failure
can develop. Be sure clients know the manifestations of salicylism and measures to
take if they begin experiencing them.
• Contraindications and Precautions
There are many contraindications to using aspirin, which is a non-selective NSAID
(COX-1 and COX-2 inhibiting). First, it is a pregnancy-risk teratogenic medication, so
women who are pregnant should not take it. Clients who are hypersensitive to
aspirin or other NSAIDs should avoid taking aspirin. Clients who have peptic ulcer
disease or a bleeding disorder, such as hemophilia or vitamin K deficiency, and
children or adolescents with chickenpox or influenza should avoid taking aspirin.
Clients who are perioperative before coronary artery bypass surgery should avoid
taking non-aspirin NSAIDs, and aspirin itself needs to be discontinued within 1 week
of any elective surgery due to the risk of bleeding. Use aspirin with caution in clients
who are older adults, smoke, have alcohol use disorder, a Helicobacter pylori
infection, heart failure, and/or advanced kidney dysfunction. Non-aspirin NSAIDs
are a contraindication in clients who have hypertension. Try relating each of these
disorders back to the effects that the COX inhibitor NSAID causes in the body and
see if you can identify the relationship.
• Interactions
The use of aspirin, along with anticoagulants, glucocorticoids, and alcohol,
increases the client’s risk of bleeding. Ibuprofen decreases the anti-platelet effects
of low-dose aspirin. The use of aspirin along with angiotensin-converting enzyme
(ACE) inhibitors and angiotensin receptor blockers (ARBs) increases the risk of renal
failure, as well as decreasing the anti-hypertensive effects of ACE inhibitors. The
risk of toxicity of lithium carbonate and methotrexate increases when clients take
them concurrently with aspirin or other NSAIDs.
• he use of aspirin along with angiotensin-converting enzyme (ACE) inhibitors and
angiotensin receptor blockers (ARBs) increases the risk of renal failure, as well as
decreasing the anti-hypertensive effects of ACE inhibitors. The risk of toxicity of
lithium carbonate and methotrexate increases when clients take them concurrently
with aspirin or other NSAIDs.
Second Generation NSAIDs (COX-2 Inhibitors)
Another type of NSAID that treats pain is COX-2. In addition to treating mild to moderate
pain, COX-2 inhibitors also suppresses inflammation, reduces fever, and treat the pain of
dysmenorrhea.
Prototype and Other Medications
Celecoxib – Medication Classification: COX-2 Inhibitors
The only prototype COX-2 inhibitor NSAID is celecoxib.
Safety Alert
There is continuing research on the safety of celecoxib. Increased risk of
gastrointestinal complications can relate to the length of time clients take the
medication or the client’s age, as well as concurrent ingestion of alcohol or
smoking. Increased risk of thromboembolic events can relate to the length of time
clients take celecoxib, as well as a previous history of heart disease. In the
meantime, clients taking a COX-2 inhibitor should be aware of the early
manifestations of gastrointestinal bleeding such as coffee-ground emesis or black,
tarry-looking stools; myocardial infarction such as heaviness in the chest and/or
shortness of breath; and stroke such as one-sided numbness or weakness and
confusion. These manifestations indicate the need for immediate medical care.
celecoxib
Acetaminophen
The nonopioid analgesic acetaminophen treats mild to moderate pain and reduces fever.
Prototype and Other Medications
Acetaminophen – Medication Classification: Nonopioid Analgesic
Acetaminophen is its own prototype medication. Acetaminophen provides many of the same benefits as
COX-1 and COX-2 inhibitors, but without serious adverse drug reactions when taken in therapeutic doses.
Acetaminophen is particularly toxic to the liver when clients ingest more than 4
g/day.
If a client takes two extra-strength acetaminophen tablets, which equals 1000 mg, four times/day, they
will receive their maximum dose. If they concurrently take a combination cold medication that also
contains acetaminophen, they will be ingesting a potentially toxic amount of acetaminophen in a day’s
time. Ingestion of toxic doses can cause toxic hepatitis with liver damage and scarring th
Dual-Mechanism Analgesic Agent
The last group of nonopioid medications to help relieve pain is the dual-mechanism analgesic
agents. These treat moderate to moderately severe pain.
Prototype and Other Medications
Tramadol – Medication Classification: Dual-mechanism Analgesic Agent
The prototype medication for dual-mechanism analgesic agents is tramadol. There are other types of
medications that treat pain by acting on the central nervous system, but this module focuses only on
tramadol
Opioid Agonists
• There are two types of opioid analgesics that support the treatment of pain. They are opioid
agonists and opioid agonist-antagonists. Opioid agonists bind primarily to mu-type opioid
receptors to produce their analgesic effects. Opioid agonist-antagonists bind to mu and
kappa receptors, simultaneously stimulating and blocking their analgesic effects. Obviously,
opioid agonist-antagonists are not as effective at reducing pain as opioid agonists are, but
they do serve as an alternative to opioids for clients addicted to opioids or women in labor.
Opioid Agonists
Opioid agonists serve as an analgesic for moderate to severe pain. The medications are also used to
induce sedation and lessen anxiety in preoperative clients.
Prototype and Other Medications
• Morphine – Medication Classification: Opioid Agonists
The prototype medication for opioid agonists is morphine. Other medications in this category include
fentanyl, meperidine, hydromorphone, and methadone. You might remember fentanyl from the
Neurological System 1 module, under general anesthesia. A medication information table for fentanyl
is available in that module. Meperidine is a synthetic opioid once given on a regular basis for
postoperative pain, but since it reacts with many other medications and is not well tolerated by older
adults, it’s usually only an option for clients who can’t tolerate other opioids. Methadone is another
synthetic opioid that’s chemically similar to morphine, but you use it primarily as a substitute for
opioids in substance use disorder programs. It blocks the euphoric effects of opioids and reduces
cravings in people addicted to a medication in this group. Other common opioid agonists include
codeine, oxycodone, hydrocodone, and tapentadol
morphine
Opioid Agonists-Antagonists
Opioid agonist-antagonists help relieve moderate to severe pain, and act as an adjunct to
anesthesia.
Prototype and Other Medications
Butorphanol and pentazocine — Medication Classification: Opioid Agonists-Antagonists
The prototype medications for opioid agonist-antagonists are butorphanol and
pentazocine. Butorphanol is only available as an injectable or nasal spray, whereas
pentazocine, in combination with naloxone, is available in an oral form. Another
medication in this category is buprenorphine.
Expected Pharmacologic Action
Opioid agonist-antagonists have mixed actions; they are mu receptor antagonists and
kappa receptor agonists. These medications result in fewer mu-related adverse drug
reactions, such as respiratory depression, euphoria, and dependence, but also produce
milder analgesic effects.
butorphanol
• pentazocine
• Opioid Antagonists
There are several types of opioid antagonists you can give to reverse various effects of
opioids. Some reverse most effects, including respiratory depression, while others
counteract selected effects such as constipation or euphoria. You can also give opioid
antagonists to reverse opioid overdose.
• Opioid Antagonists
Opioid antagonists reverse the effects of opioids and treat opioid overdose. They also
reverse the neonatal respiratory depression that can occur secondary to the mother
receiving an opioid during labor.
Prototype and Other Medications
• Naloxone – Medication Classification: Opioid Antagonists
• The prototype medication for opioid antagonists is naloxone. Other medications in this
category include methylnaltrexone, nalmefene, naloxegol, and naldemedine which
relieve opioid-related constipation; and naltrexone, which prevents the euphoric effects
of opioids for clients addicted to opioid agonists. You can give it to treat opioid use
disorder in much the same way you give disulfiram for alcohol use disorder. Alvimopan is
an opioid antagonist used to accelerate the recovery time of clients who have upper and
lower GI surgeries with a bowel resection and anastomosis (reconnecting the intestine).
• Expected Pharmacologic Action
Opioid antagonists are an antagonist in the purest sense of the word. They produce their
effects by blocking opioid receptors, effectively reversing, or antagonizing the effects of
opioids.
naloxone
Antihyperuricemics (Uricosurics and Urate Lowering Therapy)
• Gout is an inflammatory disorder that occurs secondary to hyperuricemia, which is a condition of
elevated levels of uric acid in the blood. Hyperuricemia leads to the development of urate acid
crystals, which deposit into the small joints of the body, particularly the big toe. If left untreated,
over time, the urate crystals can begin to deposit in the skin and other organs of the body.
Uricosurics treat hyperuricemia that causes gout or occurs secondary to cancer chemotherapy
and some blood dyscrasias.
Prototype and Other Medications
• Allopurinol – Medication Classification: Antigout/Antihyperuricemic
The prototype medication for antihyperuricemics is allopurinol. Other medications that treat
hyperuricemia are febuxostat and probenecid. Colchicine was used to treat hyperuricemia for
many years, but newer medications with fewer adverse drug reactions eventually replaced the
use of this medication as a first-line treatment. Pegloticase is used to treat chronic gout that does
not respond to standard therapies of allopurinol and probenecid. Rasburicase is used to treat
hyperuricemia in clients who are receiving anticancer therapy. Chemotherapy causes the
breakdown of tumors, which leads to elevated levels of uric acid.
Expected Pharmacologic Action
• The uricosurics work in one of two different ways. Allopurinol and febuxostat inhibit the enzyme,
xanthin oxidase (XO), from converting hypoxanthine and xanthine into uric acid. Probenecid
inhibits tubular reabsorption of uric acid in the kidneys, thus promoting its excretion.
allopurinol
Glucocorticoids
Glucocorticoids are another type of medication used for the relief of pain and inflammation in relation to
a wide variety of inflammatory and autoimmune disorders. They are also used in the management of
many skin disorders and allergic reactions to delay progression of some disorders, such as rheumatoid
arthritis, and to prevent organ rejection after an organ transplant, as well as provide adjunctive therapy
for some cancers. For detailed information about glucocorticoids that treat asthma, see the Respiratory
System module.
Prototype and Other Medications
Prednisone – Medication Classification: Glucocorticoids
The prototype medication for glucocorticoids is prednisone. Other medications in this category include
prednisolone, hydrocortisone, methylprednisolone, betamethasone, cortisone, dexamethasone, and
triamcinolone.
Expected Pharmacologic Action
Corticosteroids are hormonal steroids produced by the adrenal cortex, the outside covering of the
adrenal glands that sit on top of the kidneys. There are two types of corticosteroids, glucocorticoids, and
mineralocorticoids. Glucocorticoids, of which the hormone cortisol is a member, help regulate
carbohydrate, fat, and protein metabolism. They are also produced in response to stress in an effort to
restore emotional stability. The most important effects of cortisol, which forms the basis for its use as a
pharmacotherapeutic agent, is its ability to produce anti-inflammatory effects in the body, as well as
suppress the immune system. Mineralocorticoids, of which the hormone aldosterone is a member,
promote the retention of sodium by the kidneys and, secondarily, fluid and electrolyte levels in the body.
For more information on medications used for their mineralocorticoid effects, review the Endocrine
System module. The medications used for their inflammatory properties are glucocorticoids. They mimic
cortisol by suppressing inflammation and the immune response.
Prednisone
ExaM 3 DATA PAIN WEEK 4
Pharmacology Made Easy 5.0
Pain and Inflammation
Summary
• Three categories of medications support the treatment of pain: nonopioid analgesics, opioid
analgesics, and opioid antagonists.
• Nonopioid analgesics treat pain, suppress inflammation, or reduce fever.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) interfere with the production of prostaglandins by
inhibiting the action of the cyclooxygenase enzymes, called COX-1 or COX-2. First-generation are
non-selective COX inhibitors. Second-generation is a COX-2 specific inhibitor NSAID.
• Acetaminophen is a COX inhibitor that treats mild to moderate pain and reduces fever, however,
does not treat inflammation.
• Dual-mechanism analgesic agents treat moderate to moderately severe pain by binding to
selected opioid receptors and blocking reuptake of norepinephrine and serotonin in the CNS.
• Opioid analgesics support the treatment of moderate to severe pain.
• Opioid agonists bind primarily to mu-type opioid receptors to produce analgesic effects, sedation,
euphoria, and respiratory depression.
• Opioid agonist-antagonists have mixed actions – both mu receptor antagonists and kappa
receptor agonists action; simultaneously stimulating and blocking their analgesic effects.
• Opioid antagonists block opioid receptors, reverse various effects of opioids like respiratory
depression, opioid-related constipation, and opioid use disorder.
• Two categories of medications support the treatment of inflammation.
• Uricosuric medications treat gout by lowering uric acid levels.
• Glucocorticoids mimic cortisol and have a strong anti-inflammatory and immune response effect.
They treat inflammatory and autoimmune diseases, allergic reactions, and prevent organ
rejection after organ transplant.
The nurse should recognize the findings that require immediate follow-up are aspirin, headache, ringing in
ears, feeling dizzy, diaphoretic, obtunded, temperature 39.1° C (102.3° F), respiratory rate 34/min, and
oxygen saturation of 93% on room air. These findings are associated with salicylism, which requires
immediate intervention and therefore are priority findings. Salicylism is a syndrome that occurs when a
client takes too much aspirin, either acutely (overdose) or with chronic use. With elevated aspirin blood
levels, a client can have manifestations of tinnitus (ringing in ears), sweating, headache, and dizziness. If
immediate actions are not taken, acid-base imbalance occurs. Excess aspirin affects the CNS and increases
respiratory rate, leading to an increase loss in carbon dioxide when exhaling faster. This in turn can produce
respiratory alkalosis. The client has manifestations of respiratory alkalosis which are increased heart rate,
low blood pressure, and increased respiratory rate.
Nurse is cariong for a client who takes low dose aspirin to prevent cva. Clients asks if taking ibuprofen to
treat RA,
IBuprofen and NSAIDS, reduce cardio protective effects of low dose aspirin
- Low-dose aspirin can interact with ibuprofen to increase its anti-inflammatory effect
- it decreases platelet aggregation and should not take it--
A nurse is teaching a client who has a new prescription for tramadol. Which of the following
instructions should the nurse include? (Select all that apply.)
Increase fiber and fluid intake is correct. Tramadol can cause constipation and dry mouth. Clients taking the
medication should increase fluid and fiber intake to minimize constipation, and sip water, suck on hard
candy, or chew gum to relieve dry mouth.
Take the medication with food is correct. Tramadol can cause nausea and vomiting. Clients should take the
medication with food or milk and lie down if feeling nauseated.
Avoid driving after taking the medication is correct. Tramadol can cause sedation and drowsiness. Clients
taking the medication should avoid driving or other activities that require alertness.
Change positions gradually is correct. Tramadol can cause sedation and dizziness. Clients taking the
medication should use caution when changing positions and ambulating.
A nurse is caring for a child who has a viral infection. The nurse should identify that which
of the following medications can increase the risk of Reye syndrome in children who have
viral infections?
Aspirin
--Aspirin can increase the risk for Reye syndrome in children who have a viral infection,
particularly chickenpox or influenza. Manifestations of Reye syndrome include lethargy and
persistent vomiting.
To reduce fever is correct.
A nurse is teaching a client who is taking allopurinol about minimizing adverse effects.
Which of the following instructions should the nurse include?
eat a small meal before taking the medication.
Taking allopurinol after eating a meal or drinking a glass of milk can prevent stomach upset.
A nurse is caring for a client who is receiving morphine to relieve severe pain. The nurse should
monitor the client for which of the following adverse drug reactions? (Select all that apply.)
Urinary retention
monitor the client's fluid intake and output and assess for bladder distention.
Respiratory depression
withhold the medication for a respiratory rate below 12/min.
Orthostatic hypotension
can cause hypotension and postural hypotension. Clients change positions gradually.
Sedation
can cause sedation, dizziness, and lightheadedness. Clients who are taking should avoid
activities that require alertness.
A nurse is caring for a group of postoperative clients. The nurse should identify that
morphine is client who had a cholecystectomy
client who had a cholecystectomy
Morphine can cause biliary colic. It should not be administered to a client who has just had
biliary tract surgery, such as a cholecystectomy.
The nurse is caring for a client who has a new prescription for celecoxib. The nurse should tell the client
to report which of the following adverse drug reactions?
Chest pain
Celecoxib, a COX-2 inhibitor, can cause cardiovascular or cerebrovascular events. Clients should
report chest pain, shortness of breath, headache, numbness, weakness, or confusion. Providers
should prescribe the lowest effective dosage of the medication for the shortest time period
possible.
Salicylism, due to aspirin toxicity, can cause diaphoresis, tinnitus, and headache.
A nurse is teaching a client who has a new prescription for allopurinol. The nurse
should instruct the client to report which of the following adverse medication
reactions? (Select all that apply.)
Sore throat is correct.
Allopurinol, an antigout medication, can cause agranulocytosis. The nurse should monitor the
client's WBC count, and instruct the client to report fever. avoid crowds or exposure to people
who might have communicable diseases.
Vertigo is correct.
Allopurinol, an antigout medication, can cause drowsiness and vertigo. The nurse should instruct the
client to report these adverse effects and avoid activities that require mental alertness until they know
how the medication will affect them.
Bruising is correct.
Allopurinol, an antigout medication, can cause thrombocytopenia. The nurse should monitor the client's
platelet count and instruct the client to report any bleeding or bruising.
Vision changes is correct.
Allopurinol, an antigout medication, can cause cataracts with extended use. The nurse should instruct the
client to report vision changes, such as cloudiness or halos around lights, and have eye examinations at
recommended intervals.
Acetaminophen can cause liver toxicity. Clients who have a history of alcohol use disorder
should not take acetaminophen.
A nurse is reviewing the medical record of a client who has a new prescription for tramadol.
The nurse should identify that which of the following conditions is a contraindication for
tramadol?
Seizure disorder
Tramadol, a nonopioid analgesic, can cause seizure activity. Clients who have seizure disorders,
head injuries, or increased intracranial pressure should not take tramadol.
The nurse is reviewing the medical record of a client who has a new prescription for celecoxib. The nurse
should identify that which of the following conditions is a contraindication to celecoxi b
Sulfonamide allergy
Clients who are allergic to sulfonamides can have severe allergic reactions to celecoxib, a COX-2
inhibitor. Clients who are allergic to salicylates can also react adversely to celecoxib.
Clients who have adrenocortical insufficiency may take celecoxib, a COX-2 inhibitor. Celecoxib is
an unsafe choice, however, for clients who have advanced renal or liver disease.
Celecoxib, a COX-2 inhibitor, treats ankylosing spondylitis. Caution is essential, however, when
using the medication for clients who have hypertension or asthma.
Celecoxib, a COX-2 inhibitor, treats rheumatoid arthritis. Caution is essential, however, when
using the medication for clients who have heart failure or diabetes mellitus.
A nurse is caring for a client who is opioid dependent and has a new prescription for
butorphanol. The nurse should monitor the client for which of the following
manifestations of withdrawal? (Select all that apply
Abdominal cramp
Muscle pain
Tremor
nurse is caring for a client who has a new prescription for butorphanol. The nurse should
monitor the client for which of the following adverse medication reactions? (Select all
that apply.)
Nausea. Clients who are taking the medication should lie down when feeling nauseated.
Dizziness butorphanol, an opioid agonist-antagonist, can cause dizziness and drowsiness. Clients who
are taking the medication should avoid activities that require alertness.
Butorphanol, an opioid agonist-antagonist, causes bradycardia, not tachycardia.
Headache Butorphanol, an opioid agonist-antagonist, can cause headaches and increased intracranial
pressure. Clients who are taking the medication should report severe head nurse is teaching a client
who has a new prescription for allopurinol. Which of the following instructions should
the nurse include?
. Avoid driving or activities that require mental alertness.
Allopurinol can cause drowsiness. The nurse should instruct the client to avoid driving or
activities that require mental alertness until they know the effect the medication will have on
them.
A nurse is teaching a client who has a new prescription for prednisone. Which of the
following instructions should the nurse include? (Select all that apply.)
Reduce the dose during periods of stress is incorrect. Clients might need higher doses of prednisone
during times of stress. The nurse should tell the client to report stressful events.
Discontinue the medication gradually is correct. Prednisone, a glucocorticoid, suppresses adrenal
function. The nurse should instruct the client to taper the dosage before discontinuing it to allow for
resumption of adrenal activity.
Report illness or infection is correct. Clients can need higher doses of prednisone during illness or
infection. The nurse should instruct the client to report manifestations of infection.
Increase intake of calcium and vitamin D is correct. Prednisone, a glucocorticoid, can cause bone loss
and reduced calcium absorption. The nurse should instruct the client to increase their intake of calcium
and vitamin D.
Monitor for manifestations of gastric bleeding is correct. Prednisone, a glucocorticoid, can cause
peptic ulcer disease. The nurse should instruct the client to report manifestations of gastric bleeding,
such as hematemesis or black tarry stools.
nurse is caring for a client who has a new prescription for prednisone for long-term
treatment of rheumatoid arthritis. The nurse should monitor the client for which of the
following adverse medication reactions?
Bone loss
Prednisone, a glucocorti utorphanol, an opioid agonist-antagonist, can cause nausea. Clients
who are taking the medication should lie down when feeling nauseated.
coid, can cause osteoporosis, especially with long-term use. Clients who are taking the
medication should increase weight-bearing activity and report back pain. The nurse should
monitor the client's bone density.
A nurse is caring for a client who is taking allopurinol to treat gout. The nurse should
monitor the client for which of the following manifestations of hypersensitivity
syndrome?
Fever
Allopurinol, an antigout medication, can cause hypersensitivity syndrome. The nurse should
monitor the client for rash, itching, or fever, as manifestations of hypersensitivity syndrome,
which can lead to renal or liver dysfunction. Clients who develop this type of reaction should
stop taking the medication.
A nurse is reviewing the medication list for a client who has a new prescription for
allopurinol. The nurse should identify that which of the following medications
interacts with allopurinol?
Warfarin
Allopurinol can increase the effectiveness of warfarin. A lower dosage of warfarin might be
required.
A nurse is caring for a client who currently takes furosemide and has a new prescription for prednisone.
The nurse should monitor the client for which of the following manifestations during concurrent use of
the two medications?
Hypokalemia
Prednisone, a glucocorticoid, can cause hypokalemia. The risk for this electrolyte imbalance
increases when the client is taking potassium-depleting diuretics, such as furosemide. The
nurse should clarify the prescription with the provider and monitor the client's potassium
levels.
A nurse is caring for a client who has a prescription for aspirin to treat an ankle sprain. The nurse should
instruct the client to report which of the following adverse drug reactions?
Weight gain
Aspirin use can cause renal impairment, which can result in the retention of salt and water.
Clients should report reduced urine output, weight gain, edema, or bloating. The nurse should
monitor BUN and creatinine levels and stop aspirin therapy for clients who develop
manifestations of renal dysfunction.