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NURS 615 Advanced Pharmacotherapeutics Test 3 Study Guide Latest 2024 Updated.
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NURS 615 Advanced Pharmacotherapeutics Test 3 Study Guide Latest 2024 Updated.
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lOMoAR cPSD| 42147428NURS 615 Advanced
Pharmacotherapeutics Test 3 Study
Guide Latest 2024 Updated.
, lOMoAR cPSD| 42147428
Gout
Drugs used to manage the pain are non-steroidal anti-inflammatory drugs and corticosteroids
Monitor for effectiveness of therapy/clinical progress (Inflammation of the great toe)
Classic description (cannot stand to have a sheet on top of toe)
Anyone on Gout medication should have serum uric acid levels, BUN, and creatinine monitored
(Allopurinol, Colchicine, Probenecid, and Sulfinpyrazone)
Antigout Drugs (Xanthine Oxidase Inhibitors)
• Allopurinol and Febuxostat
o Reduce the inflammatory process or prevent the synthesis of uric acid
o Prevents formation of uric acid by inhibiting xanthine oxidase
▪ DO NOT ADMINISTER WITH xanthine oxidase metabolism medication
• Azathioprine, mercaptopurine, or theophylline
o Both medications require a week or more of treatment before full effects can be seen
(Goal serum uric acid levels less than 6)
o Febuxostat
▪ may be taken without regard to food
▪ Risk of liver function abnormalities
▪ Labs- Hepatic function test
o Allopurinol
▪ Widely distributed to tissues
▪ Associated with Hepatotoxicity, not recommended in patients with severe
hepatic dysfunction
• If patients develop anorexia, weight loss, or purities, evaluation of
liver function is needed
▪ Associated with maculopapular skin rash scaly or exfoliative (increases with
the presence of renal failure)- DISCONTINUE AT THE FIRST SIGN OF
RASH
▪ Severe reactions include fever, chills, arthralgia, cholestatic jaundice,
eosinophilia, mild leukocytosis, or leukopenia
▪ Labs- liver and renal function test (BUN, serum creatinine, and CrCL –
reassess dosages based on results)
o Patient education- can causes drowsiness and dizziness- avoid driving or activities
that require alertness
• Colchicine
o Decreases inflammation by decreasing movement of leukocytes into tissues
containing urate crystals (decreases the inflammatory response)
▪ Reduces lactic acid production by granulocytes, which decreases deposition of
uric acid, and it interferes with kinin formation and reduces phagocytosis
o FOR ACUTE ATTACKS- not an analgesic or a uricosuric/antipyretic
o Concentrated mainly in white blood cells
o Not effective in the presence of renal failure
, lOMoAR cPSD| 42147428
▪ DOSE ADJUSTMENT NEEDED WITH RENAL OR HEPATIC
DYSFUNCTION
o Associated with Hepatotoxicity, not recommended in patients with severe hepatic
dysfunction
▪ If patients develop anorexia, weight loss, or purities, evaluation of liver
function is needed
o Use cautiously in the presence of peptic ulcer disease or spastic colon- can make
disorders worse
▪ Adverse effects- Nausea, vomiting, diarrhea (at any dose), abdominal pain
o In a low-dose, patients are going to get diarrhea both ways, but the GI side effects are
fewer and the colchicine will help decrease inflammation. The high-dose is no longer
recommended.
o Labs- Vitamin B12 levels, liver function
o Patient Education
▪ Medication taken as prescribed- take missed dose as soon as possible
▪ Serious adverse events call provider
• Diarrhea/vomiting- unable to keep hydrated or keep electrolytes
up/unable to eat
• Not getting better within expected amount of time/worsening gout
symptoms
• Neuropathic, muscle pain/weakness needs to be reported immediately
▪ Take medication with food/milk to decrease GI upset
▪ Do not suddenly stop medication
▪ Alkaline diet (reduction in sodium, refined sugar, oxalate-rich foods (liver,
kidney. Anchovies, sardines, herring, mussels, bacon, codfish, scallops, trout,
haddock, veal, venison, turkey) – avoid high dose calcium supplements, drink
plenty of fluids, avoid alcohol, hypersensitivity should be reported
Uricosuric Drugs
• Increase the rate of uric acid secretion
• Probenecid
o Inhibits renal tubular reabsorption of urate and increases renal excretion of uric acid,
and decreases serum uric acid levels
o Lacks anti-inflammatory activity
o Most useful for patients with chronic reduced urinary excretion of uric acid
o NOT INTENDED FOR TREATMENT OF ACUTE ATTACKS/only for chronic gout
o Crosses the placenta without adverse effects in the fetus or infant
▪ Highly protein-bound, displaces other drugs that have a high affinity for the
same binding sites
o Dose may need to be reduced in the presence of renal impairment
o Use cautiously in the presence of peptic ulcer disease or spastic colon- can make
disorders worse
▪ Adverse effects- Nausea, vomiting, diarrhea, abdominal pain
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