Summary Nurs 615 pharm exam 3 study guide 2025

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NURS 615 EXAM 3 STUDY GUIDE




Nurs 615 pharm exam 3 study guide
2025


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


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NURS 615 EXAM 3 STUDY GUIDE

• 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

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


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NURS 615 EXAM 3 STUDY GUIDE
• 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
• 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


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