Exam 3 Review Sheet
1. Differentiate between low dose and high dose colchicine.
Colchicine is used for gout. At low dose colchicine is given for the initial flare up
at 1.2mg, followed by 0.6mg an hour later. High dose colchicine is 1.2mg
followed by 0.6mg every 4-6 hours for a total of 4.8mg until relief is achieved.
Low dose colchicine is as effective as high dose colchicine with fewer adverse
effects.
**Adverse effects: N/V, diarrhea (even with low dose), but mostly placebo
effects with low dose. May need to adjust dosage if renal or hepatic issues
arise.**
2. What lab values should be monitored with gout?
Renal function panel (BUN/Crt.), uric acid, liver function panel, and a CBC for
possible anemia and platelet count
**Overall acid-base function**
3. What patient education should you provide when prescribing colchicine?
Main side effects include GI upset, and severe diarrhea. Not indicated for patients
with renal issues and can cause hepatotoxicity
** Take medication as prescribed, and take any missed doses as soon as they
remember. If encounter any serious adverse events, should call provider,
Taking medication with food or milk may help relieve GI related adverse
effects, Do not just suddenly stop taking drug without advice from provider,
describe alkaline diet, drink plenty of fluids, avoid alcohol, report any
hypersensitivity**
4. What are the adverse effects of corticosteroids if administered for six months or
more?
Osteoporosis, and worsening diabetes
**topical steroids—thinning of skin, systemic absorption—hair loss, acne
breakouts, poor healing (infections-viral or fungal), could active TB, extra
hair growth, muscle pain/weakness, muscle wasting, altered body fat
distribution (moon face, truncal obesity), develop glaucoma, can cause peptic
ulcer disease, can cause or exacerbate HTN, can cause delirium and agitation
in elderly, emotional volatility, can cause depression, adrenal suppression
, (will need to taper off, may take up to 12 months), may mask symptoms of
DM. **
5. Why is it important to taper the corticosteroid?
Gives the adrenal glands to return to normal function; this will prevent an adrenal
insufficiency crisis. Symptoms of adrenal crisis include: abdominal/flank pain,
decreased LOC, coma, dehydration, dizziness, fatigue, severe weakness,
headache, fever, loss of appetite, low BP, high HR, n/v, and rapid respiratory rate
6. What are the black box warnings on NSAIDS?
Increased risk for cardiovascular thrombotic events, can also cause GI bleeding,
ulceration, and perforation of stomach and/or intestines
7. What are the recommendations in the treatment of pain?
Start with non-opioid analgesics first and then work your way up to narcotics.
**Take comorbidities into consideration, not to be taken for the long term**
8. What is the mechanism of action of ibuprofen?
Ibuprofen is a non-selective inhibitor of an enzyme called cyclooxygenase
(COX), Cyclooxygenase is required to convert arachidonic acid into
thromboxanes, prostaglandins, and prostacyclins
**Inhibits COX 1 & COX 2**
9. What are the serious side effects associated with acetaminophen?
Liver failure due to acetaminophen poisoning, liver damage can occur when a
person exceeds the maximum daily dose of 4,000 milligrams
**Both intentional or uninitentional overdose can occur, can cause necrosis
of liver at 10-15g, 25g< death will occur, N/V, can become obtunded, sleepy,
renal failure, liver tenderness, pancytopenia, thrombocytopenia**
1. Identify the symptoms of hypoglycemia, hyperglycemia, and ketoacidosis.
Hypoglycemia Tachycardia, dizziness, diaphoresis, confusion
Hyperglycemia polyuria, polydipsia, polyphagia, blurry vision, & fatigue
1. Differentiate between low dose and high dose colchicine.
Colchicine is used for gout. At low dose colchicine is given for the initial flare up
at 1.2mg, followed by 0.6mg an hour later. High dose colchicine is 1.2mg
followed by 0.6mg every 4-6 hours for a total of 4.8mg until relief is achieved.
Low dose colchicine is as effective as high dose colchicine with fewer adverse
effects.
**Adverse effects: N/V, diarrhea (even with low dose), but mostly placebo
effects with low dose. May need to adjust dosage if renal or hepatic issues
arise.**
2. What lab values should be monitored with gout?
Renal function panel (BUN/Crt.), uric acid, liver function panel, and a CBC for
possible anemia and platelet count
**Overall acid-base function**
3. What patient education should you provide when prescribing colchicine?
Main side effects include GI upset, and severe diarrhea. Not indicated for patients
with renal issues and can cause hepatotoxicity
** Take medication as prescribed, and take any missed doses as soon as they
remember. If encounter any serious adverse events, should call provider,
Taking medication with food or milk may help relieve GI related adverse
effects, Do not just suddenly stop taking drug without advice from provider,
describe alkaline diet, drink plenty of fluids, avoid alcohol, report any
hypersensitivity**
4. What are the adverse effects of corticosteroids if administered for six months or
more?
Osteoporosis, and worsening diabetes
**topical steroids—thinning of skin, systemic absorption—hair loss, acne
breakouts, poor healing (infections-viral or fungal), could active TB, extra
hair growth, muscle pain/weakness, muscle wasting, altered body fat
distribution (moon face, truncal obesity), develop glaucoma, can cause peptic
ulcer disease, can cause or exacerbate HTN, can cause delirium and agitation
in elderly, emotional volatility, can cause depression, adrenal suppression
, (will need to taper off, may take up to 12 months), may mask symptoms of
DM. **
5. Why is it important to taper the corticosteroid?
Gives the adrenal glands to return to normal function; this will prevent an adrenal
insufficiency crisis. Symptoms of adrenal crisis include: abdominal/flank pain,
decreased LOC, coma, dehydration, dizziness, fatigue, severe weakness,
headache, fever, loss of appetite, low BP, high HR, n/v, and rapid respiratory rate
6. What are the black box warnings on NSAIDS?
Increased risk for cardiovascular thrombotic events, can also cause GI bleeding,
ulceration, and perforation of stomach and/or intestines
7. What are the recommendations in the treatment of pain?
Start with non-opioid analgesics first and then work your way up to narcotics.
**Take comorbidities into consideration, not to be taken for the long term**
8. What is the mechanism of action of ibuprofen?
Ibuprofen is a non-selective inhibitor of an enzyme called cyclooxygenase
(COX), Cyclooxygenase is required to convert arachidonic acid into
thromboxanes, prostaglandins, and prostacyclins
**Inhibits COX 1 & COX 2**
9. What are the serious side effects associated with acetaminophen?
Liver failure due to acetaminophen poisoning, liver damage can occur when a
person exceeds the maximum daily dose of 4,000 milligrams
**Both intentional or uninitentional overdose can occur, can cause necrosis
of liver at 10-15g, 25g< death will occur, N/V, can become obtunded, sleepy,
renal failure, liver tenderness, pancytopenia, thrombocytopenia**
1. Identify the symptoms of hypoglycemia, hyperglycemia, and ketoacidosis.
Hypoglycemia Tachycardia, dizziness, diaphoresis, confusion
Hyperglycemia polyuria, polydipsia, polyphagia, blurry vision, & fatigue
