Chapter 13, Drugs for Inflammation, Arthritis, and GoutOverview of Drugs for Inflammation

Question 1 of 18

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Which sign or symptom indicates a patient is experiencing inflammation after an injury to the wrist? Select all that apply. One, some, or all responses may be correct.

• Correct
  • Inability to bend the joint fullyThe lack of mobility to perform a function after an injury due to excessive fluid in the tissue is one of the main symptoms of inflammation.
• • Lack of feeling when touchedNumbness could accompany an injury and indicate damage to the nervous system, but this is not one of the main symptoms of inflammation.
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  • Pain that is throbbingThe sensation of pain from the release of chemical mediators is one of the main symptoms of inflammation.
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  • Redness is present on the skinRedness from dilated blood vessels is one of the main symptoms of inflammation.
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  • Localized swellingLocalized swelling caused by chemical mediators causing fluid to leak from capillaries is one of the main symptoms of inflammation.
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  • Feels warm in the areaDilated capillaries cause the skin to feel warm, and this is one of the main symptoms of inflammation.

Question 2 of 18

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Which purpose do the cyclooxygenase-1 (COX-1) enzymes serve during the arachidonic acid cascade when infection occurs?

• • Release prostaglandins to cause painIn the arachidonic acid cascade, the enzyme COX-2 converts arachidonic acid into chemical mediators that cause pain. COX-1 enzymes create protective processes to reduce damage.
• Correct
  • Create protective processes to reduce damageIn the arachidonic acid cascade, the enzyme COX-1 converts arachidonic acid into chemical mediators that cause a protective and helpful process of inflammation to mitigate damage caused by an infectious agent.
• • Convert fat from injured cell membranes into mediatorsThe arachidonic acid cascade begins with the conversion of fat from injured cell membranes into arachidonic acid. COX-1 enzymes create protective processes to reduce damage.
• • Limit normal function by destroying tissueIn the arachidonic acid cascade, the enzyme COX-2, not COX-1, converts arachidonic acid into chemical mediators that can damage tissues that can result in a loss of function. COX-1 enzymes create protective processes to reduce damage.

Question 3 of 18

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Which action occurs when white blood cells (WBCs) release growth factors during the inflammation process? Select all that apply. One, some, or all responses may be correct.

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  • Repair of tissue beginsWBCs release growth factors that begin the healing process by triggering the repair of damaged tissues and cells to regain function.
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  • Division of healthy cellsWBCs release growth factors that aid the healing process by stimulating healthy cells in the injured area to divide and replace damaged cells.
• • Destruction of connective tissueChronic inflammation can lead to the destruction of connective tissue by chemical mediators in disorders such as rheumatoid arthritis.
• • Conversion of cells into acidDuring the arachidonic acid cascade, fat from injured cell membranes is converted into arachidonic acid (AA) so cyclooxygenase enzymes can convert the AA into chemical mediators.
• Correct
  • Formation of scar tissueWBCs release growth factors that aid the healing process by promoting scar tissue formation in areas that cannot be healed by division of healthy tissue cells.

Question 4 of 18

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Which purpose do anti-inflammatory drugs serve? Select all that apply. One, some, or all responses may be correct.

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  • Decrease tissue swellingAnti-inflammatory drugs improve function by limiting or preventing the tissue response of swelling from excess fluids in the affected area.
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  • Limit blood vessel dilationAnti-inflammatory drugs improve function by limiting or preventing the blood vessel response to the affected area.
• • Increase uric acid productionAlthough some anti-inflammatory drugs may be used to treat gout flares, these drugs do not impact uric acid production.
• Correct
  • Reduce sensation of painDrugs that manage inflammation relieve pain that is the direct result of the inflammation process.
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  • Improve functionalityAnti-inflammatory drugs improve function by limiting the tissue response in the affected area.

Question 5 of 18

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Which action is related to selective nonsteroidal anti-inflammatory drugs (NSAIDs)?

• • Reduce pain significantly more than nonselective NSAIDsBoth selective and nonselective anti-inflammatory drugs have the same analgesic action to reduce pain.
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  • Disrupt the inflammatory effects of cyclooxygenase-2 (COX-2) enzymesSelective NSAIDs have more inhibitory effects on the COX-2 enzyme, which produces the unpleasant effects of inflammation, than nonselective NSAIDs.
• • Cause more side effects than nonselective NSAIDsNonselective NSAIDs, not selective NSAIDs, have more side effects related to disrupting both the COX-1 and COX-2 enzymes.
• • Block the protective effects of COX-1 enzymesNonselective NSAIDs, not selective NSAIDs, block the protective and helpful cellular COX-1 effects.

Question 6 of 18

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Which condition would a nonsteroidal anti-inflammatory drug (NSAID) be used to treat? Select all that apply. One, some, or all responses may be correct.

• • Allergic reactionAnti-inflammatory drugs such as corticosteroids, not NSAIDs, are used to treat allergic reactions.
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  • Menstrual discomfortDysmenorrhea can be treated with NSAIDs to relieve discomfort associated with menstruation.
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  • Headache with feverThe anti-pyretic effects of NSAIDs reduce a fever, and the analgesic effects reduce the pain of a headache.
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  • Osteoarthritis painOsteoarthritis pain is often responsive to NSAIDs for reduction of symptoms related to the associated inflammation.
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  • Soft tissue injuryAcute inflammation and the associated discomfort related to a soft tissue injury can be reduced by administering NSAIDs.

Question 7 of 18

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Which risk would the nurse include when teaching a patient about the use of over-the-counter aspirin?

• • Kidney damageAlthough most non-selective nonsteroidal anti-inflammatory drugs have the adverse effect of kidney damage, aspirin does not increase the risk.
• • HyperglycemiaNon-selective nonsteroidal anti-inflammatory drugs have the adverse effect of hypoglycemia, not hyperglycemia, in patients with diabetes.
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  • Excessive bleedingNon-selective nonsteroidal anti-inflammatory drugs, such as aspirin, increase the risk of bleeding because they interfere with platelet function during the clotting process.
• • Heart attackMany nonsteroidal anti-inflammatory drugs increase the risk of hypertension through salt and water retention, as well as the risk of stroke and myocardial infarction, but aspirin in lower doses does not. It can reduce the risk for coronary heart disease by interfering with platelet aggregation (clumping).

Question 8 of 18

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Which information would the nurse include when teaching a patient about the administration of ibuprofen for the treatment of chronic inflammation? Select all that apply. One, some, or all responses may be correct.

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  • “Take this medication with food to prevent it from upsetting your stomach.”Nonsteroidal anti-inflammatory drugs such as ibuprofen have GI irritation as a common side effect, which can be reduced by taking the drug with a meal or a full glass of water.
• • “Since this is an over-the-counter drug, you can take more than the listed dose on the bottle to reduce severe pain.”Too much of even an OTC nonsteroidal anti-inflammatory drug could lead to overdose and toxicity, which could be life threatening.
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  • “Drink plenty of water to stay well hydrated to reduce adverse reactions.”Drinking 8–10 glasses of water a day will reduce the risk of dehydration that could lead to GI upset or kidney damage while taking nonsteroidal anti-inflammatory drugs such as ibuprofen.
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  • “Because this drug could increase water retention, note any weight gain.”Nonsteroidal anti-inflammatory drugs such as ibuprofen can increase salt and water retention in a patient, which would result in weight gain, hypertension, and increase the risk of heart failure in patients with heart disease.
• • “Discontinue this medication if you do not notice a reduction in symptoms after using it a few days.”Symptom relief of a condition associated with chronic inflammation may require taking the drug for longer than 1–2 weeks before a significant decrease in symptoms is noticed.

Question 9 of 18

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Which action is related to corticosteroid drugs?

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  • Inhibit proteins and enzymes in the arachidonic acid cascadeCorticosteroids drugs inhibit enzymes and proteins that allow the cyclooxygenase enzyme systems to produce inflammatory mediators from arachidonic acid in the cascade response.
• • Increase production of white blood cells (WBCs) in the bone marrowCorticosteroid drugs decrease the production of WBCs in the bone marrow to reduce the source of triggering inflammation.
• • Trigger protective chemical processes in response to infection or injuryCorticosteroid drugs suppress the cyclooxygenase-1 enzyme that provides protective responses in the inflammation process.
• • Activate histamine mediators in the affected areaCorticosteroid drugs decrease the production of all known mediators that trigger inflammation, including histamines.

Question 10 of 18

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Which condition is treated with corticosteroids? Select all that apply. One, some, or all responses may be correct.

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  • Acute adrenal emergencyCorticosteroids are similar to the natural cortisol hormones secreted by the adrenal gland and are administered to a patient experiencing an acute adrenal emergency.
• • Cushing syndromeCushing syndrome is a condition that results from a high level of cortisol and is an adverse effect of corticosteroid therapy.
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  • Inflammatory bowel diseaseCorticosteroids are appropriate for use in chronic inflammatory conditions such as inflammatory bowel disease that could lead to tissue damage.
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  • Lupus erythematosusCorticosteroids are appropriate for use in chronic autoimmune diseases such as lupus erythematosus that could lead to long-term tissue damage.
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  • Severe asthmaSevere asthma may be treated with inhaled corticosteroids to provide immediate reduction in the inflammation response to prevent a life-threatening situation.

Question 11 of 18

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Which physical effect is associated with corticosteroid therapy? Select all that apply. One, some, or all responses may be correct.

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  • Acne flare-upIncreased acne on the face and back are some of the adverse effects of corticosteroid therapy due to adrenal hormone changes.
• • Muscle increaseMuscle weakness from atrophy of the muscles related to natural adrenal suppression is one of the adverse effects of corticosteroid therapy. An increase in muscle is not expected.
• • Body hair lossIncreased facial and body hair, as well as thinning scalp hair, are common adverse reactions due to changes in the adrenal response.
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  • Stretch marksStriae from skin stretching from fluid retention and rapid weight gain are common physical symptoms of corticosteroid therapy.
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  • Fat redistributionMoon face and buffalo hump are types of body fat redistribution to the face and back that are common with corticosteroid therapy.

Question 12 of 18

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Which statement would a nurse tell a patient who has been prescribed an oral corticosteroid? Select all that apply. One, some, or all responses may be correct.

• • “Stop taking this medication immediately if you notice any changes in your mood.”Corticosteroids often cause changes in mood and should not be stopped suddenly but tapered off to allow the adrenal glands to produce sufficient cortisol.
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  • “Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief while on this drug.”NSAIDs can exaggerate side effects such as GI irritation and bleeding and should not be combined with corticosteroids.
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  • “Using tobacco while taking this drug is dangerous.”Nicotine found in tobacco raises the blood level of naturally secreted cortisol in the body, which is dangerous.
• • “Expect some weight loss to occur while taking this drug.”Corticosteroid therapy often results in weight gain, fat redistribution, and tissue fluid retention due to increases in the cortisol hormone.
• Correct
  • “This medication reduces your resistance to infection.”Since corticosteroids lower the natural and protective immune response caused by inflammation, a patient is at higher risk for infection.

Question 13 of 18

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Which mediator do disease-modifying antirheumatic drugs (DMARDs) primarily inhibit?

• • Cyclooxygenase enzymes (COX)COX enzymes are important in the arachidonic acid cascade in the inflammatory response and are targeted by other drugs, such as nonsteroidal anti-inflammatory drugs, but not the primary target of DMARDs.
• • CytokinesCorticosteroids slow or stop the pathways of cytokine production in the inflammatory response.
• • ProstaglandinsProstaglandins are chemical mediators that are active in the inflammatory response but are not the primary target of DMARDs.
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  • Tumor necrosis factor (TNF)DMARDs reduce the progression and destruction of the inflammatory process by inhibiting TNF.

Question 14 of 18

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Which condition would a disease modifying antirheumatic drug (DMARD) be used to treat?

• • Allergic rhinitisAllergic rhinitis is an inflammatory condition that topical corticosteroids, not a DMARD, might be used to treat.
• Correct
  • Psoriatic arthritisPsoriatic arthritis is a chronic inflammatory disease that DMARDs are used to treat by inhibiting the tumor necrosis factor.
• • Muscle injuryA muscle injury would be treated with a nonsteroidal anti-inflammatory drug, not a DMARD, to treat the inflammation and pain.
• • Addison diseaseAdrenal insufficiency caused by Addison disease would be treated with oral or parenteral corticosteroids, not a DMARD.

Question 15 of 18

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Which instruction would a nurse provide a patient who has been prescribed a self-injectable disease-modifying antirheumatic drug (DMARD)?

• Correct
  • “You will need to have your first dose administered by your health care provider or nurse.”The first dose of an injectable DMARD must be given by a physician or a nurse. The patient must be monitored closely in a setting that can respond quickly if an allergic reaction occurs.
• • “Use the same injection site each time.”A patient should rotate injection sites on the front of the thighs and on the abdomen to ensure best absorption and to prevent skin problems.
• • “Shake the prefilled syringe before injecting.”A patient should not shake the prefilled syringe before injecting it because shaking may damage the drug.
• • “Inject the medication into an area with a psoriatic lesion.”A patient should not inject a DMARD directly into a psoriatic lesion because it will delay drug absorption and possibly hide adverse skin reactions to the drug.

Question 16 of 18

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Which statement describes the pharmacodynamic parameters of antigout drugs?

• • Limit white blood cell (WBC) production in bone marrowCorticosteroids, not antigout drugs, act to limit the production of WBCs in the bone marrow.
• Correct
  • Reduce the conversion of purines into uric acidAntigout drugs reduce uric acid levels by interfering with the synthesis of purines into uric acid.
• • Suppress cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzyme functionNonsteroidal anti-inflammatory drugs and corticosteroids, not antigout drugs, suppress COX-1 and COX-2 enzyme function in the arachidonic acid cascade.
• • Inhibit tumor necrosis factor (TNF) from binding to cellsDMARDs, not antigout drugs, work by inhibiting TNF from binding to receptor sites in cells to prevent tissue damage from chronic inflammation.

Question 17 of 18

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Which food would the nurse encourage a patient to avoid to decrease gout flare-ups while receiving antigout drug therapy? Select all that apply. One, some, or all responses may be correct.

• Correct
  • ClamsShellfish, such as clams, increase uric acid production in the body and can contribute to flare-ups.
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  • BeefRed meat, such as beef, produces uric acid, which contributes to flare-ups of gout.
• • MilkA patient may include low-fat dairy products, such as low-fat or skim milk, to reduce risk of flare-ups.
• • OatmealComplex carbohydrates, such as oatmeal, in a patient’s diet may reduce the risk of flare-ups.
• Correct
  • SalmonCertain fish, such as salmon, increase blood uric acid levels and cause uric acid buildup and flare-ups of gout.

Question 18 of 18

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Which instruction would the nurse include when teaching a patient about the administration of febuxstat?

• • “Wait at least 3 hours after taking an antacid before taking this medicine.”Allopurinol should not be combined with aluminum that is commonly found in antacids because it inhibits absorption, but febuxostat is not affected by antacids.
• • “Be sure to take this medication after eating a meal to prevent gastric upset.”Allopurinol commonly causes gastric upset and should be taken after eating a full meal, but febuxostat can be taken with or without a meal.
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  • “Drink plenty of water throughout the day to reduce kidney complications while taking this medication.”It is important for patients to drink 8 to 16 glasses of liquid, especially water, throughout the day to dilute uric acid and prevent kidney problems while taking febuxostat.
• • “Taking a nonsteroidal anti-inflammatory drug (NSAID) along with this medication will prevent further joint damage from gout.”NSAIDs can be taken with antigout drugs to manage flares but will not prevent gout or any associated joint damage.