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Questions and Answers
What is the primary function of Leflunomide in the treatment of rheumatoid arthritis?
Which drug’s effect can be observed after 2 to 3 months of therapy?
What is a significant contraindication for the use of immunosuppressive agents in rheumatoid arthritis treatment?
Which medication is a kinase inhibitor and reserved for patients unresponsive to traditional therapies?
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What is the peak absorption time for Anakinra after subcutaneous administration?
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What should be encouraged to prevent kidney stone formation in patients taking uric acid-lowering medications?
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Which combination of medications can lead to severe toxic levels in patients?
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What is a common nursing implication when administering medications for gout?
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What therapeutic action does Allopurinol provide in the body?
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Which side effect may be observed in patients taking medications that lower uric acid levels?
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What can be a major adverse effect of Leflunomide?
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Which of the following drugs can lead to nephrotoxicity as a major adverse effect?
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What type of interaction could occur when combining Leflunomide with other hepatotoxic drugs?
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Which drug is used to control acute inflammation during a gout attack?
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What is a common side effect associated with gold compounds used in treatment?
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What condition is characterized by elevated uric acid and urate deposits in the kidneys and joints?
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Which risk is increased when using immune suppressants like Anakinra and Tofacitinib together?
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Which of the following statements is true regarding drug-drug interactions with penicillamine?
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What is the primary mechanism of action for allopurinol?
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Which of the following drugs has the longest half-life among the provided options?
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What should be monitored when administering colchicine?
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What is a potential adverse effect of probenecid?
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Which statement is true regarding the contraindications associated with febuxostat?
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What is a serious risk associated with the concurrent use of colchicine and Pgp or CYP3A4 inhibitors?
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What common side effect is associated with both colchicine and allopurinol?
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Which patient population is at an increased risk for hypersensitivity reactions when taking allopurinol?
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What is the primary therapeutic action of acetaminophen?
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Why should acetaminophen be used cautiously in patients with liver issues?
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What might happen if an overdose of acetaminophen occurs?
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Which of the following is a contraindication for acetaminophen use?
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What is a common adverse effect of acetaminophen?
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In which situation should acetaminophen be avoided due to the risk of hepatotoxicity?
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What is the peak absorption time for acetaminophen when taken orally?
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Which demographic should receive caution when administering acetaminophen?
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Study Notes
Acetaminophen (Tylenol, Ofirmeu)
- Treats mild to moderate pain and fever.
- Can be extremely toxic in high doses.
- Causes severe liver toxicity that can lead to death.
- Acts directly on the thermoregulatory cells in the hypothalamus to cause sweating and vasodilation, releasing heat and lowering fever.
- Treats pain and fever, including influenza, common colds, or prophylaxis of children receiving diphtheria-pertussis-tetanus immunizations.
- Relieves musculoskeletal pain associated with arthritis.
- Rapidly absorbed in the GI tract, reaching peak levels in 0.5-2 hours.
- Metabolized in the liver and excreted in the urine, with a half-life of 3 hours.
- Available intravenously for adults and children over 2 years old if oral administration is not possible.
- Crosses the placenta and enters human milk.
- Caution in patients with hepatic or renal impairment, which could interfere with drug metabolism and excretion, leading to toxic levels.
- Use cautiously during pregnancy and lactation due to potential adverse effects on the neonate or fetus.
- Caution for patients with allergies to acetaminophen due to hypersensitivity reactions.
- Use with caution in pregnant and lactating women, patients with hepatic dysfunction, and those with chronic alcoholism due to toxic effects on the liver.
- Toxic effects vary with age, other medications the patient is taking, and underlying hepatic function.
- N-acetylcysteine can be used as an antidote in cases of overdose.
- N-acetylcysteine restores glutathione levels, binding with the toxic metabolite from acetaminophen and allowing for safe excretion of the medication.
- Side effects include rash, fever, chest pain, liver toxicity and failure, and bone marrow suppression.
- Toxic effects on the liver can occur with oral coagulants and chronic ethanol ingestion.
- Hepatotoxicity can occur with barbiturates, carbamazepine, hydantoins, or rifampin.
- Combinations of these medications should be avoided; if used, appropriate dose adjustments should be made, and patients should be monitored closely.
Leflunomide
- Used for 3-5 weeks.
- Directly inhibits dihydroorotate dehydrogenase, an enzyme involved in the autoimmune process that leads to rheumatoid arthritis.
- Relieves signs and symptoms of inflammation.
- Blocks structural damage caused by inflammation, slowing disease progression.
- Slowly absorbed from the GI tract.
- Peak levels occur in 6-12 hours.
- Metabolized in the liver.
- Excreted in the urine.
- Has a half-life of 14-18 days.
- Contraindicated in pregnancy or lactation due to potential adverse effects on the fetus or neonate.
- Contraindicated in acute infection due to blocking of normal inflammatory pathways.
- Major adverse effects include irritation at injection sites, pain with injection, increased risk of infection, fatal hepatic toxicity, and rashes.
- Close monitoring of liver function is required.
- Can cause severe liver dysfunction if combined with other hepatotoxic drugs.
- Decreased absorption with iron salts or antacids.
Sarilumab
- An interleukin-6 receptor antagonist.
- Blocks inflammatory processes systematically and locally within the joints, relieving symptoms.
- Reserved for patients who do not respond to other DMARDs.
- Increased risk of serious fatal infections, including tuberculosis, the development of lymphomas and other cancers.
- Toxicity: nephrotoxicity, hepatotoxicity.
Penicillamine
- Lowers immunoglobulin M-rheumatoid factors in patients with acute rheumatoid arthritis, relieving signs and symptoms of inflammation.
- Takes 2-3 months of therapy to see a response.
- Peak levels occur 1-3 hours after oral administration.
- Metabolized in the liver.
- Excreted in the urine.
- Half-life of 3 hours.
- Contraindicated in pregnancy or lactation due to potential adverse effects on the fetus or neonate.
- Contraindicated in acute infection due to blocking of normal inflammatory pathways.
- Major adverse effects include: fatal myasthenic syndrome, bone marrow depression, thrombocytopenia.
- Decreased absorption if taken with iron salts or antacids.
- Can cause severe liver dysfunction if combined with other hepatotoxic drugs.
Tofacitinib
- A kinase inhibitor that blocks signaling pathways within immune cells to prevent their activity.
- Oral agent reserved for patients who do not respond to traditional therapies.
- Increased risk of serious fatal infections, including tuberculosis, the development of lymphomas and other cancers.
- Toxicity: nephrotoxicity, hepatotoxicity.
- Increased risk of serious infection if used with other immunosuppressants.
Anakinra
- Slowly absorbed from subcutaneous tissue.
- Peak levels occur in 3-7 hours.
- Metabolized in the tissues and excreted in the urine.
- Half-life of 4-6 hours.
- Hyaluronidase is not absorbed systemically.
- Contraindicated in pregnancy or lactation due to potential adverse effects on the fetus or neonate.
- Contraindicated in acute infection due to blocking of normal inflammatory pathways.
- Major adverse effects include irritation at injection sites and pain with injection.
- Increased risk of serious infection if used with other immunosuppressants.
Gold Compounds (Chrysotherapy):
- Bring about phagocytosis in joints.
- Include gold sodium thiomalate (Myochrysine) and aurothioglucose (Solganal).
NSAID Propionic Acids:
- Include fenoprofen (Nalfon), flurbiprofen (Ansaid), ibuprofen (Motrin, Advil, Caldolor IV), ketoprofen (Orudis), naproxen (Naprosyn), and oxaprozin (Daypro).
Fenamates:
- Include meclofenamate (generic) and mefenamic acid (Pontel).
Oxicam Derivatives:
- Include piroxicam (Feldene).
Gout Disorder:
- Characterized by elevated uric acid and urate deposits in kidneys and joints.
- Extremely painful due to crystal deposits causing local acute inflammation.
- Controlled with antineoplastic drug therapy.
Colchicine
- Used to control acute inflammation.
- Prevents the action of neutrophils that facilitate inflammation.
- Decreases uric acid crystal deposits by inhibiting lactic acid production by leukocytes.
- Absorbed orally and takes effect in 1-2 hours.
- Crosses the placenta and enters human milk.
- Metabolized by the CYP3A4 enzymes in the liver.
- Increased risk of toxicity in patients with severe renal and hepatic disease.
- Dose adjustments are required for patients undergoing hemodialysis, as the medication is not dialyzed out.
- Side effects include bone marrow depression, anemia, nausea, vomiting, diarrhea, blood dyscrasias, skin rash and fever, liver damage, and blood dyscrasias due to suppressed bone marrow.
- Concurrent use of Pgp and CYP3A4 inhibitors with colchicine can cause an overdose, potentially leading to mortality. All medications must be evaluated prior to administration.
Allopurinol
- Decreases the production of uric acid.
- Inhibits xanthine oxidase, an enzyme needed to convert xanthine to uric acid.
- Blocks the formation of uric acid within the body.
- Absorbed orally.
- Peak serum levels occur about 1.5 hours after administration.
- Has a half-life of 1-2 hours.
- Excreted renally and via feces.
- Allergic reaction (rash) may occur and necessitates discontinuation.
- Hypersensitivity reactions are higher in patients with renal insufficiency and those receiving thiazide medications.
- May slow the metabolism of warfarin, increasing the risk of bleeding.
- Side effects include kidney stones, bone marrow depression, anemia, nausea, vomiting, diarrhea, blood dyscrasias, skin rash and fever, and liver damage.
Febuxostat
- Decreases the production of uric acid.
- Inhibits xanthine oxidase, an enzyme needed to convert xanthine to uric acid.
- Blocks the formation of uric acid within the body.
- Absorbed orally.
- Maximum plasma levels occur in 1-1.5 hours.
- Metabolized in the liver.
- Has a half-life of 5-8 hours.
- Excreted renally and hepatically.
- Associated with a higher risk of cardiovascular death than allopurinol for gout therapy.
- Side effects include kidney stones, bone marrow depression, anemia, nausea, vomiting, diarrhea, blood dyscrasias, skin rash, and fever.
Pegloticase
- Increases uric acid excretion (uricosuric).
- Lowers uric acid by increasing oxidation to allantoin, which is easily eliminated via renal excretion.
- May cause anaphylaxis and infusion reactions.
- Should be administered in a healthcare setting.
- Side effects include kidney stones, bone marrow depression, anemia, nausea, vomiting, diarrhea, blood dyscrasias, skin rash and fever, and liver damage.
Probenecid (Benemid)
- Increases uric acid excretion (uricosuric).
- Prevents tophi formation by inhibiting the reabsorption of uric acid by the kidneys.
- Side effects include: kidney stones, bone marrow depression, anemia, nausea, vomiting, diarrhea, blood dyscrasias, skin rash, and fever.
- May increase the risk of acute gout attacks, so it is given during or recently after an acute attack.
Nursing Implications
- Encourage fluid intake of at least 2-3 liters per day to prevent kidney stone formation.
- Stress compliance with treatment and a diet of low-purine foods (limit beer, wine, shellfish, and legumes) to prevent recurrence.
- Monitor complete blood count (CBC) for a decrease in values, agranulocytosis.
- Administer anti-inflammatory drugs (prednisone, Indocin) in addition to drugs that lower serum uric acid during the acute phase.
- Encourage weight reduction.
- Administer medication with meals to reduce GI irritation.
Common Drugs:
- Allopurinol (Zyloprim): blocks formation of uric acid within the body.
- Colchicine (Novocolchine): decreases uric acid crystal deposits by inhibiting lactic acid production by leukocytes; used for acute attacks.
- Probenecid (Benemid): prevents the formation of tophi by inhibiting the reabsorption of uric acid by the kidneys.
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Description
This quiz covers essential information about Acetaminophen, including its uses in treating pain and fever, mechanisms of action, and potential toxicity. Explore key safety precautions and pharmacokinetics of this commonly used medication.
