Analgesic & Anti-inflammatory Drugs PDF

ANALGESICS & Anti-Inflamatory Drugs p.403 OBJECTIVES A. Drug treating severe pain. 1. Describe the core drug knowledge such as pharmacokinetics, pharmacodynamics, pharmacotherapeutics, adverse effects and drug interactions. 2. Describe nursing interventions...

ANALGESICS & Anti-Inflamatory Drugs p.403 OBJECTIVES A. Drug treating severe pain. 1. Describe the core drug knowledge such as pharmacokinetics, pharmacodynamics, pharmacotherapeutics, adverse effects and drug interactions. 2. Describe nursing interventions to maximize therapeutic effects and minimize adverse effects of drugs 3. Determine key points for patient and family education for drugs. 4. Integrate critical thinking skills in drug administration. 5. Educate patients and families safe utilization, risks, and precautions of drug administration  DRUGS TREATING SEVERE PAIN Morphine/Naloxone Codeine. PAIN MANAGEMENT Pain therapy are used to; ✓ Correct the pathophysiology causing pain; nitroglycerin (vasodilator) ✓ Decrease the pain response itself; (morphine after surgery). ✔ Preventing pain easier than decreasing pain. ✔ Easier to treat pain at lower level then in severe level.  PAIN DRUGS 1. Opioid Analgesics :Acts on CNS to interfere with pain experience 2. NSAIDs 3. Adjunct analgesics. Acts in peripheral nervous Drug used secondarily to system, used to treat mild to relieve the pain. moderate pain. Eg: antidepressant, Eg: Ibuprfen , Ponstan corticosteroids, antiepileptic. (Diclofenac sodium) Nonpharmacologic technique; relaxation therapy, music, exercise  Core Drug Knowledge: Morphine Pharmacotherapeuics Pharmacodynamics Pharmacokinetics Moderate to severe Onset: 15-30mts known as agonist that acute and chronic Duration: 3-7 h works on 3 opiate pain, post & pre Half life: 1.5- 2 h receptor sites (mu, operation sedation, kappa and delta ) MI, Pulmonary Metabolism – Liver & gut wall It reduces the release of edema , dyspnea neurotransmitters in the Excretion – urine, presynaptic space and stool & breast milk produces IM, SC, IV , epidural, Crosses the placenta, hyperpolarization of rectal, oral secreted in breast postsynaptic dorsal milk horn neurons  Hypersensitivity Preexisting respiratory depression Acute or severe bronchial asthma Upper airway obstruction Heart failure secondary to chronic lung disease Contraindication Cardiac arrhythmias During labor, premature infant. Increase intracranial or cerebrospinal pressure Head injury Brain tumor Avoid use morphine in the following conditions: In premature infants During convulsions & Precautions patients receiving other CNS depressants Older patients Patients with renal or hepatic impairment Patients who are sensitive to CNS effects  Respiratory depression Apnea Respiratory & cardiac arrest Constipation Adverse Cardiac arrest Effects Shock Urinary retention Bradycardia , hypotension, Nausea and vomiting Sweating It may interact with any other CNS Depressant that may produce Drug additive adverse effect Interactions Causes respiratory & CNS depression if is given with barbiturate, Monoine oxidase inhibitor, cimitedine, clomipramine amitriptyline.  Assessment of Relevant Core Patient Variables Assess for respiratory depression Assess for history of hypersensitivity Assess for current alterations in health status that place the patient at risk for increased CNS depression; renal, hepatic pulmonary disease, hypothyroidism, Addison disease. Health Status Before administration, perform physical examination. Assess for the presence and severity of pain. Assess for characteristics related: Age (to avoid respiratory depression & hypotension) Pregnancy (category C, can cause fetal dependency). Life Span & Labor (cause fetal respiratory depression & psychophysiological Gender effect) Lactation  Assessment of Relevant Core Patient Variables Tolerance; who receive for long time need more doses(cancer pt) & drugs addict. Dependence: withdrawal syndrome when morphine discontinued. Lifestyle, Diet, Addiction; compulsive use of the drug not for pain relive & Habits IV, IM, SC morphine should be given in clinical settings under observation. Culture and inherited traits Environment Refer to your text book at page 414-415.  Planning & Intervention A. Maximizing Therapeutic Effects Assessment of pain; using pain assessment tools. It is more effective when it is administered before the level. of pain becomes severe , give around the clock! B. Minimizing Adverse Effects Breakthrough pain and incidental pain may occur during pain management with drug therapy All patients being treated for pain need access to rescue doses (bolus) for breakthrough pain. It should be equianalgesic to 10%- 30% of the dose the patient receives in 24 hours and is added to the established pain management. Minimize adverse effect of the morphine: refer to Box 23.4, p. 418 Ongoing Assessment & Evaluation. Patient education: p. 419 NALOXONE (NARCAN) Opioid antagonists It is believed to antagonize the effects of narcotics by competing for opioid receptor sites It is used to reverse the effects of opiates and to treat opioid overdose It can used in adults, children and neonates It can be administered by the IM, SC or IV route The most rapid onset is achieved with IV and it is within 2 minutes  NALOXONE (NARCAN) Careful monitoring of the patient beyond initial response is necessary because the duration of action of the narcotic agonist may be longer than the duration of naloxone The patient may relapse into respiratory arrest or depression  2. MILD NARCOTIC AGONISTS: Codeine Pharmacotheraputic Codeine: used to control mild to moderate pain in adults and children Orally it may be combined with acetaminophen or with NSAIDs for better control of post operative pain It is used for cough suppression and it can be used alone, in the form of oral tablets or in combination with other drugs that are expectorants PHARMACOKINETICS Codeine is well absorbed from the GI tract Its peak effect occurs in 1-2 hours It is metabolized in the liver and is excreted in the urine It cross the placenta and is secreted in breast milk  2. MILD NARCOTIC AGONISTS: Codeine PHARMACODYNAMICS Codeine has pharmacologic effects similar to those of morphine but its actions are milder It acts at specific opioid receptors in the CNS to produce analgesia, euphoria and sedation Acts directly on the medullary cough center to depress the cough reflex It has a drying effect on mucous membranes and can increase the viscosity of respiratory tract secretions CONTRAINDICATIONS ADVERSE EFFECTS Avoid combination with other narcotics. As a cough suppressant: drowsiness, caution in patients who need to cough to sedation, dry mouth, nausea , vomiting and maintain the airways constipation caution in patients with pre-existing cardiac As an analgesic: similar to those of disease because of its potential to induce morphine but less severe bradycardia and peripheral vasodilation Allergic reactions: rashes and urticaria caution during pregnancy and lactation have been noted in highly sensitive people Caution when used for patients who have Respiratory and cardiovascular effects: experienced a head injury or undergone a have occurred with higher doses craniotomy (increase intracranial pressure)  Assessment of Relevant Core Patient Variables Assess pt who need to keep their airway patent, should not receive codeine (post operative, asthma, emphysema ). Health Status Obtain baseline assessment. Assess liver function. Elderly (low dose is advised) , risk for respiratory depression Life Span infant , risk for respiratory depression & during labor, can effect the infant Gender Patients must refrain from these activities until the drug’s sedative effects are assessed. (no activities, no driving) Patient & family education Environment Refer to text book p. 424  Maximizing Therapeutic Effects Minimize side effect Assessment of pain; using pain Safety precautions; side rail up, assessment tools. assist in walking. Monitor respiratory status. It is more effective when it is administered before the level of pain Should be avoided in pt who need becomes severe , give around the clock! strong cough reflex.  Anti-Inflammatory Drugs Prepared by Edited by: Habiba AL Manji, RN, MSN Fathi Al abri RN, APN ( EM )  Objectives B. Drug treating mild to moderate pain, fever, inflammation & migraine headache. 1. Describe the core drug knowledge such as pharmacokinetics, pharmacodynamics, pharmacotherapeutics, adverse effects and drug interactions. 2. Describe nursing interventions to maximize therapeutic effects and minimize adverse effects of drugs 3. Determine key points for patient and family education for drugs. 4. Integrate critical thinking skills in drug administration. 5. Educate patients and families safe utilization, risks, and precautions of drug administration  Anti inflammatory Drugs Drugs treating Mild to Moderate Pain, Fever, Inflammation and Migraine Headache 1. Aspirin 2. Ibuprofen 3. Acetaminophen 4. Sumatriptan Drug Treating Rheumatoid Arthritis and Gout 1. Methothrexate 2. Etanercept 3. Colchicine 4. Allopurinol Drugs Treating Mild to Moderate Pain, Fever, Inflammation and Migraine Headache Fever, inflammation and pain are symptoms of acute illness. Inflammation and pain can be symptoms of chronic diseases such as arthritis and gout Inflammation may induce intense pain called migraine headache Drugs Treating Mild to Moderate Pain, Fever, Inflammation and Migraine Headache Fever, inflammation and pain commonly are treated with: Nonsteroidal anti-inflammatory drugs (NSAIDs) or para-aminophenol derivative drugs. Migraine headaches treated with serotonin-selective agonists called triptans or antimigraine agents. Non Steroidal Anti- Inflammatory Agents They are grouped by chemical classes: propionic acids, acetic acids, fenamates, oxicams and COX-2 inhibitors They all inhibit COX and prostaglandin synthesis All NSAIDs regardless of their preference for COX -1 or COX- 2 carry a Black Box warning stating that it increases the risk of MI and stroke NSAIDs NSAIDs  Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Acetylsalicylic acid (Aspirin) Systemic class/ classification: Nonsteroidal Anti-inflammatory Drugs (NSAIDs) - Salicylates Prototype: Acetylsalicylic acid (Aspirin) Drug therapy in Nursing textbook P. 436-441  Core drug knowledge Salicylates Acetylsalicylic acid (Aspirin) Pharmacotherapeutic: Mild to moderate pain related to inflammation; arthritis, RA. Relieve headache, myalgia, arthralgia, dental or oral surgery pain Fever Treating pericarditis in patients with SLE It useful in preventing MI, Transient Ischemic Attack (TIAs) and CVA The maximum recommended daily dose is 4 gm Pharmacodynamics: Acetylsalicylic acid (Aspirin) 1. Antipyretic effects: inhibit PGE2 synthesis in the hypothalamus. 2. Anti- inflammatory action: inhibit prostaglandin synthesis. 3. Analgesic effects: Inhibit COX2 result in decrease production of prostaglandin. 4. Antiplatelet action: irreversible inhibition of thromboxane A2, prostaglandin that induces platelets aggregation. Pharmacokinetics: Acetylsalicylic acid (Aspirin) Absorption: within 30 minutes in the stomach but most of it is absorbed in the small intestine. Cross through the milk & placenta. Metabolized into salicylate and other metabolites by the liver. Half life : 15 minutes whereas half life of salicylate is 2 hours Execration: kidneys Contraindications: Acetylsalicylic acid (Aspirin) Salicylate hypersensitivity Peptic ulcer or bleeding disorders Anticoagulation therapy Pregnancy, labor & breast feeding. Gout and those with renal or liver impairment In children with varicella or flu- like illness because it is associated with the occurrence of Reye Syndrome Smoker and alcohol abuse Precautions: Acetylsalicylic acid (Aspirin) Aspirin should be given with caution to patients with: Asthma Nasal polyps Hyperuricemia Older than 60 years Those on corticosteroids  Adverse Effects: Acetylsalicylic acid (Aspirin) Salicylism (mild aspirin toxicity), headache, dizziness, tachypneic, GI distress. Salicylate poisoning: life threat condition treated with gastric lavage & activated charcoal. GI system effects; ulceration bleeding, nausea, vomiting. Hypersensitivity reactions Ototoxicity (tinnitus) Excessive or abnormal bleeding Hepatotoxicity Acute Renal Failure (ARF) Decrease uric acid excretion lead to gout.  Nursing Care Management: Acetylsalicylic acid (Aspirin) Maximize Therapeutic Effect. Give with milk or food, why? Use uncoated aspirin with cardiovascular disease – think bioavailability & antiplatelet effects greater. Minimize Adverse Effect. Check CBC, platelet count, liver & renal function test. Assess for pre-existing medical condition Use PPI to prevent stomach ulcer.  Health Education: Acetylsalicylic acid (Aspirin) What health education will you consider? Check P. 440-441 Memory Chip P. 441  Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Ibuprofen Systemic class/ classification: Nonsteroidal Anti-inflammatory Drugs (NSAIDs) - prostaglandin synthetase inhibitors Prototype: Ibuprofen Drug therapy in Nursing textbook P. 443-447  Pharmacodynamics: Ibuprofen Inhibit the synthesis or release of prostaglandins As an analgesic: it has peripheral rather than a central action Anti-inflammatory effect: required higher doses than for analgesic Anti-pyretic activity may be the result of action on the hypothalamus leading to increase peripheral blood flow, vasodilation and heat dissipation Contraindications and Precautions: Ibuprofen Contraindication: Patients with a history of or active GI disease Use before or after a coronary artery bypass graft procedure Cautions: Patients with pre-existing cardiovascular/ cerebrovascular disorders/ hepatic, renal or hematopoietic dysfunction PLUS age more than 60 years  Adverse Effects: Ibuprofen Serious adverse effects (black box warning): serious and potentially fatal cardiovascular thrombotic events GI effects (black box warning): Nausea, vomiting, diarrhea, constipation, flatulence, and abdominal pain The most serious adverse effects peptic ulcer disease or gastritis Renal system – Acute renal failure Hepatic and renal toxicity Excessive bleeding in hemophilic patients  Assessment of Relevant Core Patient Variables Health Status Assess for a history of MI or stroke. Assess for GI ulcer Assess for ototoxicity Obtain a baseline CBC, platelet count, and test results of renal and hepatic function.  Assessment of Relevant Core Patient Variables Life Span and Gender Not to be given to pregnant woman Caution to patients older than 60 years Lifestyle, Diet, and Habits Don’t take OTC medications Assess for alcohol or drug abuse Assess the patient for a history of cigarette smoking  Assessment of Relevant Core Patient Variables Environment Ibuprofen may be self-administered at home or given in any health care setting.  Nursing Care Management: Ibuprofen Maximize Therapeutic Effect. Give with milk or food, why? Minimize Adverse Effect. Check CBC, platelet count, liver & renal function test (long term therapy) Assess for pre-existing medical condition Administer misoprostol to patients at high risk for developing gastropathies What health education will you consider? P. 446-447 Memory Chip P. 447 Health Education: Acetylsalicylic acid (Aspirin) What health education will you consider? Check P. 440-441 Memory Chip P. 441  Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Acetaminophen (Tylenol) Systemic class/ classification: Nonsteroidal Anti-inflammatory Drugs (NSAIDs) - para-aminophenol derivative Prototype: Acetaminophen (Tylenol) Drug therapy in Nursing textbook P. 449- 451 Pharmacokinetics: Acetaminophen (Tylenol) Acetaminophen (Tylenol) is widely used analgesic and anti-pyretic Used for patients with hypersensitivity to aspirin or NSAIDs The recommended dose in 24 hours is 4 gm in adults 200 mg/ kg or 10 g/d in children It can be administered by oral, rectal and IV routes Pharmacokinetics: Acetaminophen (Tylenol) It is absorbed rapidly and completely from the GI tract or rectal mucosa It is metabolized in the liver into nontoxic substances and eliminated by the kidneys It is crosses the placenta and is secreted in breast milk Children metabolize less of the drug Pharmacodynamics: Acetaminophen (Tylenol) It is centrally acting has no effects on platelet aggregation. Analgesic effect: inhibit prostaglandin synthesis in CNS Antipyretic activity: inhibit prostaglandin synthesis in CNS= hypothalamus produce vasodilation=increase blood flow=sweating=heat loss.  Contraindications and Precautions: Acetaminophen (Tylenol) Contraindication: Precautions/ Cautions: Active hepatic disease & viral Patients with pre-existing hepatitis, anemia Chronic malnutrition Patients who take warfarin Severe hypovolemia or In pregnant or lactating alcoholism women Renal impairment  Adverse Effects: Acetaminophen (Tylenol) It is well tolerated in general Most adverse effects occur when the drug is taken in high doses or for prolonged periods Hepatotoxicity and hepatic necrosis Renal toxicity and it may cause Acute Renal Failure (ARF) Overdose of acetaminophen is potentially fatal and emergency The patient must receive treatment in an acute care facility and should be managed with the used of acetylcysteine as an antidote  Assessment of Relevant Core Patient Variables Health Status Assess for pre-existing medical conditions or drug therapy that contraindicates using acetaminophen. Document baseline CBC, platelet count, and renal and hepatic function values.  Assessment of Relevant Core Patient Variables Life Span and Gender Elderly patients are more likely to develop hepatic and renal toxicity because of age-related decreases in hepatic and renal function. Acetaminophen is the drug of choice for pregnant women because it does not have any antiplatelet activity.  Assessment of Relevant Core Patient Variables Lifestyle, Diet, and Habits Inquire about the patient’s use of OTC drugs because many of these products contain acetaminophen as an ingredient. Assess for alcohol or drug abuse because the patient.  Assessment of Relevant Core Patient Variables Environment Acetaminophen is self-administered easily at home without medical supervision. Nursing Care Management: Acetaminophen (Tylenol) Maximize Therapeutic Effect. With or without regard to food Monitor for therapeutic effects Minimize Adverse Effect. Check CBC, platelet count, liver & renal function test (long term therapy) Assess for pre-existing medical condition that contradicts given tylenol Overdosage: treat with anti-dote, acetylcysteine orally or IV (15 minute infusion) What health education will you consider? P. 451 Memory Chip P. 451  Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Sumatriptan Systemic class/ classification: Nonsteroidal Anti-inflammatory Drugs (NSAIDs) - Serotonin-selective agonists Prototype: Sumatriptan Drug therapy in Nursing textbook P. 452-455  Pharmacokinetics: Sumatriptan Administered orally, intranasally or S/C When administered orally pain relief begins within 1 hour and complete pain relief occurs within 4 hours in 50%- 60% of patients When administered Intranasally absorption is rapid; the onset of action is 15 minutes When administered S/C onset of pain relief occurs within 10 minutes It is metabolized in the liver and excreted by the kidneys  Pharmacotheraputics: Sumatriptan Used to relieve pain and inflammation related to migraine headache They also known as a triptans and considered first line drugs for the treatment of acute migraine headache. Sumatriptan is used to treat acute migraine headache with or without aura and to manage cluster headache. Sumatriptan (Imitrex) is the first 5- HT agonist approved in US  Pharmacodynamic: Sumatriptan (Imitrex) Pharmacodynamic  Contraindications and Precautions: Sumatriptan (Imitrex) Contraindication: Coronary artery disease (CAD) Arteriosclerosis Ischemic cardiac diseases such as uncontrolled hypertension, angina pectoris—especially vasospastic angina—and acute MI  Adverse Effects: Sumatriptan (Imitrex) Coronary artery vasospasm Cardiac dysrhythmias such as ventricular tachycardia, or ventricular fibrillation, Angina & myocardial ischemia (including MI), and cardiac arrest  Assessment of Relevant Core Patient Variables Health Status Assess the characteristics of the headache, including location, quality, intensity, and presence or absence of an aura. Take a careful patient history, focusing on cardiovascular and cerebrovascular disorders or diseases. Question patients with diabetes mellitus, hypertension, hypercholesterolemia, or obesity for signs and symptoms that may suggest CAD. Evaluate available laboratory tests, especially liver and renal function tests.  Assessment of Relevant Core Patient Variables Life Span and Gender Evaluate female patients for pregnancy, breast-feeding, or menopausal symptoms. there is no evidence that establishes that sumatriptan is a human teratogen. Postmenopausal women and men older than 40 years should have a cardiovascular workup before receiving sumatriptan, to rule out the potential for CAD.  Assessment of Relevant Core Patient Variables Lifestyle, Diet, and Habits Identify trigger factors that may be part of the patient’s lifestyle. Evaluate the patient for a history of smoking tobacco because smoking is a risk factor for the development of CAD. Environment Sumatriptan is routinely given in the outpatient area. Nursing Care Management: Sumatriptan (Imitrex) Maximize Therapeutic Effect. Administer sumatriptan as soon as the headache begins Decrease environmental stimuli during migraine attack Minimize Adverse Effect. Cardiovascular assessment Monitor for signs and symptoms of vasospasm and allergy Use aseptic technique when administering subcutaneously What health education will you consider? P. 455 Memory Chip P. 455  Drug Treating Rheumatoid Arthritis and Gout 1. Methothrexate 2. Etanercept 3. Colchicine 4. Allopurinol  Disease-Modifying Antirheumatic Drugs (DMARDs): Methotrexate Systemic class/ classification: Disease-Modifying Antirheumatic Drugs (DMARDs) Prototype: Methotrexate Drug therapy in Nursing textbook P. 464- 469 Pharmacotherapeutic & Pharmacokinetics: Methotrexate Pharmacotherapeutic: Malignancies, head & neck ca, lung & breast cancer , adult & juvenile RA & psoriasis. Used as monotherapy or in combination with glucocorticoid steroids, NSAIDs, or other DMARDs to decrease the symptoms of RA. Pharmacokinetics: Oral Metabolism: liver Excretion: kidney.  Pharmacodynamics Methotrexate Immunosuppressive effect: inhibit the replication & function of T lymphocyte that stimulate release of cytokines. Inhibit purine synthesis which result in DNA, RNA & protein synthesis arrest. Adverse Effects: Methotrexate Stomatitis and oral ulcers Mild alopecia Headache Fatigue Hepatic cirrhosis Pneumonitis. Myelosupression. Contraindications and Precautions: Methotrexate Immunosuppression Impaired bone marrow During pregnancy and lactation Chronic liver disease Malnutrition & ulcerative colitis Blood dyscrasias  Nursing Care Management: Methotrexate Maximizing therapeutic effects: remain hydrated (avoid nephrotoxicity), encourage pt to continue taking the drug even if not yet has effect. Minimizing adverse effects: Take vitamin B (folic acid), 5 mg every day, protect from sun exposure; allopurinol solution as mouthwash (mouth ulcer). Most important patient education: Substantial (extensive) adverse effects may occur. Be sure to contact the health care provider if they occur. Black box warning: See Box 25.2 Memory Chip: P. 469 Tumor Necrosis Factor Inhibitors: Etanercept Systemic class/ classification: Tumor Necrosis Factor Inhibitors Prototype: Etanercept Drug therapy in Nursing textbook P. 471- 474  Pharmacotherapeutic & Pharmacokinetics: Etanercept (Abatacept) Disease-modifying antirheumatic drug (DMARD) used in combination with methotrexate to decrease the progression of RA. Pharmacotherapeutic: RA, active polyarticular-course juvenile idiopathic RA, psoriatic arthritis, ankylosing spondylitis & psoriasis. Pharmacokinetics: Weekly SC injections. Slow onset.  Pharmacodynamic Etanercept (Abatacept) In RA, TNF (inflammatory mediators) released by T cells Bind to circulating TNF, preventing it to bind to TNF receptors on cell membrane.  Etanercept (Abatacept) Major contraindications: immunosuppression, poorly controlled DM, Active infection, hypersensitivity. Most common adverse effects: nausea, headache, upper respiratory infections, injection site reactions Most serious adverse effects: URT infections, blood dyscrasias, seizure, injection site irritation. Maximizing therapeutic effects: rotate site of injection Minimizing adverse effects: Use aseptic technique, avoid live-virus vaccine, don’t keep pt with other who have flu symptoms.  Etanercept (Abatacept) Most important patient education: high risk for severe infection. Be sure to contact the health care provider if they occur. Black box warning: Risk/benefit ratio due to serious infections and malignancies. Increased risk for lymphoma with children and adolescents Abatacept is a pregnancy category C drug and not recommended for use in women who are breast-feeding. It is not approved for use in children. Memory Chip: 474  Anti-Gout Drug: Colchicine Systemic class/ classification: Anti-Gout Drug - Acute gout Prototype: Colchicine Drug therapy in Nursing textbook P. 476 - 479  Pharmacokinetics: Colchicine (Colcrys) Colchicine can be given either orally or intravenously. Parenteral use is avoided because of potential toxicity. Colchicine should never be injected subcutaneously or intramuscularly because such injections cause severe local irritation. Oral colchicine is rapidly absorbed, metabolized in the liver, and excreted primarily in the feces.  Pharmacotherapeutics: Colchicine (Colcrys) The most common use of colchicine is for treating acute gouty arthritis and as pre surgical prophylaxis to prevent gout. A short course of colchicine may be given when uricosuric drug therapy is initiated to prevent a flare-up of gout symptoms.  Pharmacodynamics: Colchicine (Colcrys) Interruption of the inflammatory process by Inhibiting the activity of leukocytes Prevent release of glycoprotein from phagocytes.  Colchicine (Colcrys) Decreases the inflammatory reaction of acute gout Major contraindications: severe cardiac, hepatic, or renal diseases Most common adverse effects: related to Gastrointestinal system Most serious adverse effects: blood dyscrasias, including bone marrow suppression  Contraindications and Precautions: Colchicine (Colcrys) Colchicine is contraindicated in patients with: Severe cardiac disease, hepatic disease, and renal disease because these patients are at risk for developing cumulative toxicity.  Adverse Effects: Colchicine (Colcrys) Most common: GI tract (80%) e.g. nausea, vomiting, diarrhea, abdominal pain, and paralytic ileus. Long-term therapy: may depress bone marrow function, inducing aplastic anemia, pancytopenia, thrombocytopenia, leukopenia, or agranulocytosis.  Colchicine (Colcrys) Maximizing therapeutic effects: adherence to diet (low red meat & sea food) and alcohol restrictions to reduce hyperuricemia Minimizing adverse effects: Take colchicine at the first sign of an attack, then only until the symptoms start to resolve. Most important patient education: related to diet and alcohol restrictions Memory Chip: 479  Antigout Drugs: Allopurinol Systemic class/ classification: Antigout Drugs – Chronic Gout Prototype: Allopurinol Drug therapy in Nursing textbook P. 479 -  Pharmacotherapeutics: Allopurinol Management of chronic gout, recurrent calcium renal stones, and hyperuricemia related to cancer or tumor lysis syndrome. Prevention of ischemic reperfusion tissue damage and arrhythmias.  Pharmacokinetics: Allopurinol Allopurinol may be administered orally or intravenously. When given orally, approximately 90% is absorbed. Hepatic metabolism.  Pharmacodynamics: Allopurinol Allopurinol decreases the production of uric acid by inhibiting the action of xanthine oxidase, an enzyme that converts hypoxanthine to xanthine and xanthine to uric acid. xnathine oxidase Hypoxanthine xnathine uric acid  Allopurinol Major contraindications: co administration with drugs that induce myelosuppression. Most common adverse effects: pruritus, maculopapular rash, nausea and vomiting, elevated liver function test values, and acute gout symptoms Most serious adverse effects: blood dyscrasias, myelosuppression, hepatic or renal toxicity, exfoliative dermatitis, and Stevens-Johnson syndrome  Allopurinol Stevens-Johns on syndrome  Allopurinol Contraindications and Precautions The only contraindication to allopurinol is hypersensitivity. The drug should be given cautiously to patients who cannot sustain a fluid intake of 2 L/d.  Allopurinol Maximizing therapeutic effects: adhere to diet that limits uric acid production Minimizing adverse effects: Ingest 2.5 to 3 L of fluid daily (prevent renal stone). Most important patient education: Any rash must be evaluated by the health care provider and be patient to see effect ( 2-6 weeks at least) Nursing alert: Many drugs increase the incidence of hypersensitivity that is potentially fatal. Memory Chip: 482 Questions