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NURS 615 Pharm Exam 3 Mega Review Study Guide
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Pharm Exam 3 Study GuideGout Medications
Colchicine – is an anti-inflammatory (gout) = can treat and prevent gout attacks, also Behcets syndrome
SE = always causes diarrhea, other GI symptoms include upset stomach, nausea, abdominal pain
Taking with food helps ↓ GI side effects
Check renal function before and during tx (BUN, creatinine)
Lower dose (1.2 mg followed by 0.6 mg one hour later) is as effective as high dose but w/ less SE
Allopurinol – xanthine oxidase inhibitor, uric acid reducer, tx gout/prevent flares and kidney stones
SE = skin rash, flu symptoms, painful or little urination, drowsiness/dizziness
Monitor renal (BUN, creatinine) and liver function
Febuxostat (Uloric) – xanthine oxidase inhibitor, uric acid reducer for pts with gout/prevent flares
SE = gout flares, nausea, mild rash, liver problems, heart attack symptoms
Monitor liver and renal function
Patient education = gout may worsen with therapy initially (can take NSAID or colchicine for up to 6
months w/ beginning of tx)
Probenecid (Benemid) & Sulfinpyrazone (Anturane) – uric acid reducer, uricosuric agent
SE = frequent urination, N/V, HA, dizziness, skin rash
Is NOT an anti-inflammatory, used for CHRONIC gout management
Watch CBC for blood dycrasias
Corticosteroids – ends in “sone” (prednisone), used to tx RA, lupus, asthma, allergies, etc.
SE = high BP, weight gain, muscle weakness, insomnia
Adverse effect of corticosteroids after six months or longer = worry about osteoporosis, can also
worsen diabetic control
Pt needs vitamin supplements to help prevent osteoporosis, check blood glucose levels
Report black tarry stools and abdominal pain
Adrenal suppression w/ long-term therapy (s&s = malaise, myalgia, fever, hyptension) so DO NOT stop
abruptly
Tapering is necessary to prevent withdrawal symptoms
If dose of corticosteroid exceeds 1 gram, prescribe a PPI (omeprazole)
Cox-1 Pathway – systemic, present in all tissues, blocking these account for GI adverse rxn
Cox-2 Pathway – inducible enzyme produced in response to pain and inflammation
NSAIDS (ibuprofen, naproxen, celecoxib, ketorolac) – 1st line for mild to moderate pain, inflammation
Ibuprofen = non-selective cox-2 inhibitor, decreases prostaglandins, antipyretic, inhibiting cox 1 gives
GI side effects
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, Black box warning = CV issues/events such as stroke, MI, thrombus, CV disease; GI issues such as bleed,
ulcer, perforation; ↑ risk for elderly and w/ increased dose
Celecoxib (Celebrex) = selective cox-2 inhibitor, less GI symptoms (does not inhibit cox- 1)
Drug interaction with Warfarin, can ↑ bleeding
NSAIDs are excreted threw kidneys, need to stay hydrated while taking (ibuprofen)
Monitor CBC at least annually when pt is on long-term aspirin therapy, if high dose also check salicylate
level and urine pH
Prescribe an H2 blocker (e.g. ranitidine) if taking aspirin and pt feels heartburn symptom
An early sign of aspirin toxicity is tinnitus
Acetaminophen (Tylenol) – not an anti-inflammatory, only is an analgesic and antipyretic
Highly selective cox-2, does not have ↑ bleeding effects
Is toxic to liver (liver damage) in large doses, hepatic/renal disease, alcohol abuse
Maximum dose has been 4 grams in 24 hours, 2 grams is now the maximum dose
Antidiabetic Agents
Hypoglycemia – dizziness, confusion, diaphoresis, tachycardia
Hyperglycemia – polyuria, polydipsia, weight loss
DKA – fruity breath odor, rapid respirations (Kussmaul’s respirations), lethargy, focal sign
Type 2 diabetes is a complex disorder involving a suboptimal response of insulin-sensitive tissues in the liver.
Routine screening of asymptomatic adults for diabetes is appropriate for Native Americas, African Americans,
and Hispanics.
Beta blockers mask the s&s of hypoglycemia except sweating.
Nonselective Beta-blockers and consuming alcohol can mask the s/s of altered glucose levels.
Pt w/ type 1 DM should check glucose level before, during, and after exercise, and should eat a snack w/ CHO
if on the lower side before exercising.
Insulin – used for type 1 and type 2 DM, start with daily dose of 0.2-0.4 units/kg for type 1 DM
Insulin acts by Increasing peripheral glucose uptake by skeletal muscle and fat
Rapid-acting (lispro, aspart, glulisine) = onset 5 min, peak 1 hour, duration 3-5 hours; compatible with
NPH (glulisine has the shortest onset and duration of action)
Short-acting (regular) = onset 30 min, peak 3-4 hours, duration 4-10 hours; compatible with NPH
Intermediate-acting (NPH) = onset 1 hour, peak 4-10 hours, duration 10-16 hours; cloudy when
properly mixed; “clear to cloudy”; given once or twice SQ daily
Long-acting (glargine, detemir) = basal insulin; onset 2-4 hours, no peak, duration up to 24 hours; not
compatible with other insulins; single dose
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