NURS 615 PHARM EXAM 3 STUDY GUIDE
NURS 615 Pharm Exam 3 Study Guide Advanced
Pathophysiology (Maryville University)
GOUT
Xanthine Oxidase Inhibitors - colchicine, allopurinol, febuxostat
o Reduce the inflammatory process or prevent synthesis of uric acid
• Colchicine o Can be dosed for acute flares or long-term prophylaxis
o Low dose is as effective as high dose, with less side
effects
Initial dose of 1.2 mg at first sign of flare, then 0.6 mg 1 hour later (MAX: 1.8
mg/hour) o MOA
Decrease inflammation by decreasing leukocytes into the tissue containing urate
crystals ->
Decreases uric acid (no analgesic or antipyretic effects)
o Side effects:
Diarrhea! (take with food or milk)
Malabsorption of B12
Hepatotoxicity
• Anorexia, weight loss, pruritus -> LFTs
Renal stone development (increase fluid intake)
Myopathy & Neuropathy
• d/t increased levels of colchicine (renal dysfunction) -> weakness, proximal weakness and
increase serum creatinine kinase
• stopping the drug usually reverses the symptoms within 3-4 weeks
o Precaution in patients with peptic ulcer disease or spastic colon
GI side effects may make these disorders worse o Monitor: uric acid levels, B12, and renal
function before and during treatment (BUN, creatinine) and hepatic function
o Avoid NSAIDs
• Allopurinol (Zyloprim) o Prophylactic
treatment of gout, not for acute flares
o Prevents the formation of the uric acid by inhibiting xanthine oxidase
o Monitor: Uric acid level, BUN, creatinine, and creatinine clearance (Kidney function), LFTs o Avoid ACE
inhibitors
• Febuxostat o Gout may worsen with therapy
There is a risk of gout flare-up whenever uric acid agents are started. The sudden increase in serum
uric acid mobilization can precipitate a major attack before it is cleared.
o Monitor LFTs
Uricosuric Drugs - probenecid (Benemid), pegloticase, lesinurad, sulfinpyrazone (Anturane)
o Probenecid (Benemid) – used for chronic gout and increases urinary excretion of uric acid (increase fluids
to decrease risk of stone development)
o sulfinpyrazone (Anturane) – similar to probenecid and used for chronic gout o Increase the rate of uric
acid secretion
pg. 1
, NURS 615 PHARM EXAM 3 STUDY GUIDE
STEROIDS
• Corticosteroids aka glucocorticoids aka steroids o Hormones produced by adrenal cortex
(affect almost all body organs)
• Indications
o Rheumatoid arthritis, GI autoimmune disorders (ulcerative colitis, Crohn’s disease), allergic reactions –
anaphylaxis, asthma, COPD
• MOA: Inhibits arachidonic acid metabolism. Strengthens or stabilizes biologic membranes.
Inhibits the production of interleukin-1, tumor necrosis factor, and other cytokines. Impair
phagocytosis, lymphocytes and inhibit tissue repair.
• Contraindications o Allergy to the drug o Current infection
• Long-term use (reserved for life-threatening conditions or severe disabling symptoms) o
Side effects:
GI System
• Report any symptoms of GI bleeding o Black, tarry stools, abdominal pain
• Peptic ulcer disease o If patient has risk factors for PUD, then prophylaxis with PPI
u/c, NSAIDs, stress, nephrotic syndrome, hepatic disease
Muscle and Skin
• Thinning of skin
• Alopecia (hair loss)
• Acne
• Poor healing – immunosuppressed o May mask infections
o Avoid people with contagious illnesses and live vaccines o
Activation of TB
• Purpura
• Striae (stretch marks)
• Hirsutism (excessive hair growth)
• Shedding or peeling of skin
• Abdominal obesity
• Buffalo hump Moon face
Weight
gain
• Muscle wasting
Skeletal Tissues
Osteoporosis
o Skeletal fractures
o Treat with bisphosphonates alendronate (Fosamax) or risedronate (Actonel)
Ocular Tissues
• Subcapsular cataracts, glaucoma, ocular infections, damage to optic nerve Cardiovascular
System
Hypertension
• Fluid and electrolyte disturbances
CNS
• Delirium, agitation, insomnia, mood swings, severe depression (steroid psychosis)
Endocrine System
pg. 2
, NURS 615 PHARM EXAM 3 STUDY GUIDE
• Adrenal suppression, menstrual irregularities, increased blood glucose (diabetics need
more insulin, non-diabetic are also susceptible)
o Do not abruptly stop.
Taper!
Need to reactivate the HPA axis
Avoid adrenal insufficiency – Withdrawal Syndrome – Addisonian Crisis
Anorexia, malaise, myalgia, fever, nausea, weakness, fatigue, dyspnea,
hypotension/HTN,
hypoglycemia
Life-threatening
o May need to increase dose with stress
• Scheduling Guidelines o Short-term use (< 1 week): Large divided doses for 48 to 72 hours, then tapered until
discontinued
o Replacement therapy: Daily administration administered between 6am-9am
o Alternate-day therapy (ADT): Double dose taken every other day in the morning; used only for
maintenance therapy
• Use local over systemic steroid therapy when possible
• Joint injection for pain control (tissue can become damaged if given too often)
• Prednisone
o Total dose > 1 g, also prescribe omeprazole, a proton pump inhibitor to prevent peptic ulcer
disease
• Methylprednisolone (Medrol): dose pack for poison ivy
• Methylprednisolone sodium succinate (Solumedrol): Given IV short-term for acute problems (asthma)
• Dexamethasone: short-term use requiring max anti-inflammatory activity (cerebral edema). Croup, skin conditions
PAIN MEDICATIONS
• NSAIDs
o Indications: mild to moderate pain relief, fever, and inflammation
o Inhibition of prostaglandins, COX-1, and COX-
2
COX-1 inhibition
• Alters gastric acid secretion and protective mucus in the stomach o GI side effects -> GI
bleed, ulcers
COX-2 inhibition
• Anti-inflammatory
o Black Box
Warning
GI bleeds, ulceration of perforation (increased risk with elderly and higher doses)
Cardiovascular events (MI, stroke, thrombus, CV disease) o Not safe to use with digoxin,
warfarin or sulfa (highly-protein bound meds) o Keep well hydrated while using NSAIDs because they
are excreted by the kidney o Ibuprofen
Inhibits COX-1 and COX-
2 Side Effects:
Inhibiting COX-1 (Food reduces GI
adverse reactions) o GI bleeding, peptic ulcers
o Antiplatelet effect = increased risk of bleeding
o Compromised kidney function (HF, old age) = increased risk of kidney injury
pg. 3
NURS 615 Pharm Exam 3 Study Guide Advanced
Pathophysiology (Maryville University)
GOUT
Xanthine Oxidase Inhibitors - colchicine, allopurinol, febuxostat
o Reduce the inflammatory process or prevent synthesis of uric acid
• Colchicine o Can be dosed for acute flares or long-term prophylaxis
o Low dose is as effective as high dose, with less side
effects
Initial dose of 1.2 mg at first sign of flare, then 0.6 mg 1 hour later (MAX: 1.8
mg/hour) o MOA
Decrease inflammation by decreasing leukocytes into the tissue containing urate
crystals ->
Decreases uric acid (no analgesic or antipyretic effects)
o Side effects:
Diarrhea! (take with food or milk)
Malabsorption of B12
Hepatotoxicity
• Anorexia, weight loss, pruritus -> LFTs
Renal stone development (increase fluid intake)
Myopathy & Neuropathy
• d/t increased levels of colchicine (renal dysfunction) -> weakness, proximal weakness and
increase serum creatinine kinase
• stopping the drug usually reverses the symptoms within 3-4 weeks
o Precaution in patients with peptic ulcer disease or spastic colon
GI side effects may make these disorders worse o Monitor: uric acid levels, B12, and renal
function before and during treatment (BUN, creatinine) and hepatic function
o Avoid NSAIDs
• Allopurinol (Zyloprim) o Prophylactic
treatment of gout, not for acute flares
o Prevents the formation of the uric acid by inhibiting xanthine oxidase
o Monitor: Uric acid level, BUN, creatinine, and creatinine clearance (Kidney function), LFTs o Avoid ACE
inhibitors
• Febuxostat o Gout may worsen with therapy
There is a risk of gout flare-up whenever uric acid agents are started. The sudden increase in serum
uric acid mobilization can precipitate a major attack before it is cleared.
o Monitor LFTs
Uricosuric Drugs - probenecid (Benemid), pegloticase, lesinurad, sulfinpyrazone (Anturane)
o Probenecid (Benemid) – used for chronic gout and increases urinary excretion of uric acid (increase fluids
to decrease risk of stone development)
o sulfinpyrazone (Anturane) – similar to probenecid and used for chronic gout o Increase the rate of uric
acid secretion
pg. 1
, NURS 615 PHARM EXAM 3 STUDY GUIDE
STEROIDS
• Corticosteroids aka glucocorticoids aka steroids o Hormones produced by adrenal cortex
(affect almost all body organs)
• Indications
o Rheumatoid arthritis, GI autoimmune disorders (ulcerative colitis, Crohn’s disease), allergic reactions –
anaphylaxis, asthma, COPD
• MOA: Inhibits arachidonic acid metabolism. Strengthens or stabilizes biologic membranes.
Inhibits the production of interleukin-1, tumor necrosis factor, and other cytokines. Impair
phagocytosis, lymphocytes and inhibit tissue repair.
• Contraindications o Allergy to the drug o Current infection
• Long-term use (reserved for life-threatening conditions or severe disabling symptoms) o
Side effects:
GI System
• Report any symptoms of GI bleeding o Black, tarry stools, abdominal pain
• Peptic ulcer disease o If patient has risk factors for PUD, then prophylaxis with PPI
u/c, NSAIDs, stress, nephrotic syndrome, hepatic disease
Muscle and Skin
• Thinning of skin
• Alopecia (hair loss)
• Acne
• Poor healing – immunosuppressed o May mask infections
o Avoid people with contagious illnesses and live vaccines o
Activation of TB
• Purpura
• Striae (stretch marks)
• Hirsutism (excessive hair growth)
• Shedding or peeling of skin
• Abdominal obesity
• Buffalo hump Moon face
Weight
gain
• Muscle wasting
Skeletal Tissues
Osteoporosis
o Skeletal fractures
o Treat with bisphosphonates alendronate (Fosamax) or risedronate (Actonel)
Ocular Tissues
• Subcapsular cataracts, glaucoma, ocular infections, damage to optic nerve Cardiovascular
System
Hypertension
• Fluid and electrolyte disturbances
CNS
• Delirium, agitation, insomnia, mood swings, severe depression (steroid psychosis)
Endocrine System
pg. 2
, NURS 615 PHARM EXAM 3 STUDY GUIDE
• Adrenal suppression, menstrual irregularities, increased blood glucose (diabetics need
more insulin, non-diabetic are also susceptible)
o Do not abruptly stop.
Taper!
Need to reactivate the HPA axis
Avoid adrenal insufficiency – Withdrawal Syndrome – Addisonian Crisis
Anorexia, malaise, myalgia, fever, nausea, weakness, fatigue, dyspnea,
hypotension/HTN,
hypoglycemia
Life-threatening
o May need to increase dose with stress
• Scheduling Guidelines o Short-term use (< 1 week): Large divided doses for 48 to 72 hours, then tapered until
discontinued
o Replacement therapy: Daily administration administered between 6am-9am
o Alternate-day therapy (ADT): Double dose taken every other day in the morning; used only for
maintenance therapy
• Use local over systemic steroid therapy when possible
• Joint injection for pain control (tissue can become damaged if given too often)
• Prednisone
o Total dose > 1 g, also prescribe omeprazole, a proton pump inhibitor to prevent peptic ulcer
disease
• Methylprednisolone (Medrol): dose pack for poison ivy
• Methylprednisolone sodium succinate (Solumedrol): Given IV short-term for acute problems (asthma)
• Dexamethasone: short-term use requiring max anti-inflammatory activity (cerebral edema). Croup, skin conditions
PAIN MEDICATIONS
• NSAIDs
o Indications: mild to moderate pain relief, fever, and inflammation
o Inhibition of prostaglandins, COX-1, and COX-
2
COX-1 inhibition
• Alters gastric acid secretion and protective mucus in the stomach o GI side effects -> GI
bleed, ulcers
COX-2 inhibition
• Anti-inflammatory
o Black Box
Warning
GI bleeds, ulceration of perforation (increased risk with elderly and higher doses)
Cardiovascular events (MI, stroke, thrombus, CV disease) o Not safe to use with digoxin,
warfarin or sulfa (highly-protein bound meds) o Keep well hydrated while using NSAIDs because they
are excreted by the kidney o Ibuprofen
Inhibits COX-1 and COX-
2 Side Effects:
Inhibiting COX-1 (Food reduces GI
adverse reactions) o GI bleeding, peptic ulcers
o Antiplatelet effect = increased risk of bleeding
o Compromised kidney function (HF, old age) = increased risk of kidney injury
pg. 3
