Lecture notes
NUR 1025C Module 2 Pharmacology Notes
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This is a comprehensive and detailed note on module 2; Pharmacology for Nur 1025C.
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Module 2 PharmacologyAntiinflammatories
Inflammation is a reaction to tissue injury caused by the release of chemical mediators causing a vascular
response and migration of fluids/cells to the site. These chemical mediators and their reactions are:
Histamine- ARRIVES FIRST Causes dilation of arterioles and redness (think allergic reactions)
Kinins- cause pain (think child learning to talk- is “kinin with pain”)
Prostaglandins- vasodilation and fever @ site
Cardinal signs of inflammation are: THINK OF A SPRAINED ANKLE
Redness (erythema) IT’S WARM
Swelling (edema) IT’S SWOLLEN
Pain IT HURTS
Heat IT FEELS WARM TO THE TOUCH
Loss of function YOU CAN’T STAND ON IT
**Infection is a disease caused by pathogenic micro-organisms such as gm + or gm – bacteria, viruses, or
fungi (yeast or molds) **
THERE IS A RELATIONSHIP BETWEEN INFECTIONS AND INFLAMMATION. BUT INFLAMMATION OFTEN
OCCURS WITHOUT INFECTION!! THINK OF TRAUMA, SPRAINS, SURGERY, ABRASIONS, LACERATIONS,
FRACTURES ETC. SO, INFECTION AND INFLAMMATION ARE NOT INTERCHANGEABLE TERMS.
COX-cyclo-oxygenase, is an enzyme that converts arachidonic acid into prostaglandins causing pain and
inflammation at the site of injury. There are 2 types: COX 1 protects the stomach and regulates platelets.
COX2 triggers inflammation and pain.
KEEP IN MIND THAT ALL THE FIRST–GENERATION NSAIDS ARE NON-SELECTIVE, MEANING THEY INHIBIT
COX-1 (THEREBY AFFECTING THE STOMACH LINING AND INCREASING BLEEDING RISKS) AND COX-2
(INHIBITING INFLAMMATION AND PAIN)
ONLY THE SECOND-GENERATION NSAID (CELEBREX) IS SELECTIVE TO COX-2. THEREFORE THE STOMACH
LINING AND BLOOD PLATELETS ARE UNAFFECTED.
NSAIDS- nonsteroidal anti-inflammatory drugs- will inhibit COX. (1 st 7 on slide are COX-1 inhibitors)
Salicylates- COX-1 inhibitor with antipyretic, anti-inflammatory, and antiplatelet properties.
Aspirin, or ASA decreases platelet aggregation and is used in low doses as prophylaxis against
strokes or MIs. Will cause stomach irritation so give with food/milk. Watch for excessive bruising,
bleeding, petechiae, bleeding gums, etc. Don’t give PRN DOSES with anticoagulants. Discontinue
1 week prior to scheduled surgeries. Side effects are tinnitus (ringing in ears) and can cause
bronchospasms. Food interactions listed on slides. Don’t use with anyone with PUD.
Parachlorobenzoic acid derivatives- COX-1 inhibitor used for rheumatic arthritis and other
arthritic conditions. Indocin is prototype drug. Also give with food/milk
, Phenylacetic acid derivatives- similar to ASA but without as many side effects. Ketorolac
(Toradol) is drug prototype. Given IM or IV most often. Very little antipyretic effects (Don’t
reduce fevers). Used for post-op orthopedic purposes to reduce pain as well as inflammation.
Propionic Acid derivatives- Also COX-1 inhibitor. Has stronger actions with less GI upset than
others. Ibuprofen (Motrin, Advil) is good example. Can still cause GI upset though, so give with
food/milk. High risk for toxicity when taken with Ca+ Channel blockers, so watch closely. AVOID
1-2 DAYS BEFORE MENSTRUAL CYCLE. WILL INCREASE BLEEDING AND CLOT SIZE.
2nd generation/COX 2 Inhibitors- inhibit COX-2 but some COX-1 inhibition so still give with
food/milk. Vioxx pulled off of shelves due to association of heart related incidents. Still using
Celebrex. Mobic similar drug. Watch renal function. Watch elderly-GI upset more common with
them-drug dose may need to be adjusted.
REMEMBER, OSTEOARTHRITIS IS MOST PREVALENT IN THE ELDERLY POPULATION, AND THEY
OFTEN ALSO HAVE CHRONIC MUSCO-SKELETAL PAIN FROM PAST INJURIES – SO THE ELDERLY ARE
THE PRIME USERS OF NSAIDS. Remember the normal GI changes associated with aging so these
make the elderly at risk for complications associated with these meds.
Corticosteroids- used to control “flare-ups” when other NSAIDs aren’t controlling symptoms.
Have long half-life. Need to taper before d/c. Watch blood sugars-will elevate them. Also give
with food/milk; very irritating to stomach.
NOW THE TOPIC SWTICHES FROM ACUTE AND CHRONIC INFLAMMATIONS SUCH AS
OSTEOARTHRITIS TO RHEUMATOID ARTHRITIS – A CHRONIC, PROGRESSIVE, INCURABLE
AUTOIMMUNE DISEASE
DMARDs-disease-modifying anti-rheumatic drugs-used when pt. not responding to other
NSAIDs. Sort of “end of the line” for pain relief. Are palliative only; will slow progression and
allow maximum level of function for the individual. Types are:
o Immunosuppressive agents- chemotherapy agents (methotrexate and cytoxin are
common ones) force fluids with cytoxin as can cause hemorrhagic cystitis.
o Immunomodulators-newest one. Given IV (Remicade). Suppresses inflammation. Also
used for other chronic inflammatory processes such as Crohn’s disease to decrease
inflammation.
o Antimalarials- mechanism of action unknown but will suppress inflammation.
ANTIMALARIALS ARE GIVEN WITH NSAIDS IN TREATING RHEUMATIOD ARTHRITIS. Again,
may take several weeks to see effects.
Antigout drugs-Gout is known as “disease of kings”. Gout is inflammatory condition attacking
joints, tendons, and other tissue. Big toe is most common site. Is a uric acid buildup. Foods
containing purine (wine, alcohol, organ meats, sardines, salmon, gravies). Body breaks purine
down into uric acid and body cannot excrete. May actually see buildup of uric acid crystals on
the skin. VERY painful! 2 stages: acute or chronic. Teach your clients to use TYLENOL for general
aches/pains/fevers instead of ASA as ASA causes uric acid retention and will increase the pain of
the gout! Drugs treat specific stage:
, o Colchicine-inhibits leukocytes from migrating to the site of inflammation. Does NOT
affect uric acid excretion. MUST have stable renal, GI, and cardiac systems to take.
TREATS ACUTE ATTACKS ONLY. Give with food/milk.
o PROPHYLACTIC TREATMENT CENTERS ON DIAGOSING THE PATIENT EITHER AS AN OVER
PRODUCER OF URIC ACID (GIVE THE URIC ACID INHIBITOR) OR AS AN UNDER-EXCRETOR
(GIVE THE UROSURIC TO PROMOTE EXCRETION OF URIC ACID)
o Uric acid inhibitors- used as PROPHYLAXIS only to prevent attacks. Is drug of choice for
pts with renal impairment. Need to increase fluids to prevent alkalinization of urine. May
elevate BUN & creat & liver enzymes. Drug is allopurinol (Zyloprim). ALLOPURINOL IS
ALSO OFTEN GIVEN TO CANCER PATIENTS TO HELP THEM REMOVE THE CELLULAR
DEBRIS OF TUMOR LYSIS FOLLOWING CHEMOTHERAPY AND RADIATION. SO, IF YOU
DON’T SEE “GOUT” AS A DIAGNOSIS IN THE PATIENT’S H & P IN THE CHART, LOOK FOR A
CANCER DIAGNOSIS.
o Uricosurics- helps prevent acute attacks (PROPHYLAXIS)-not helpful in actual acute
attacks. Give with food/milk. Will increase uric acid excretion. Drug is probenecid
(Benemid) A VERY HIGHLY PROTEIN-BOUND DRUG WITH LOTS OF DRUG INTERACTIONS
Meds for Upper Respiratory Infections
Since these common disorders are viral in nature, antibiotics are not warranted. We treat the
SYMPTOMS associated with the common cold and other upper respiratory disorders.
Upper respiratory infections include:
Common cold
Acute rhinitis
Sinusitis
Acute pharyngitis
Etiology of the common cold
Rhinovirus
Adults usually have 2-4/year. Since children put “stuff” in their mouths, share drinks, etc,
they tend to have more (up to a dozen/year.)
Contagious period of common cold- from 1-4 days before onset of symptoms and 1st 3 days of
symptoms. Since one is contagious before even knowing of having a cold, good handwashing is a
MUST!
Symptoms of common cold
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