Gout: a metabolic disease associated with the development of high URIC ACID in the blood. NOT CAUSED BY EXCESS INTAKE OF MEAT! Drugs that treat Gout:
Allopurinol: Prevents formation of uric acid. **MOST COMMONLY USED FOR GOUT** (LongTerm Control) * Side Effects: hepatotoxicity, skin rash
* Nursing Implications: keep urine slightly alkaline to prevent urine acid stones from forming; IV dose should be given as a single infusion. (kidney stones, kidney failure, gouty arthritis)
Colchicine: used during an acute attack
* Side Effects: nausea, vomiting, diarrhea, dizziness, alopecia headaches, frequent urination * Nursing Implications: Monitor effectiveness of therapy, both as to pain control and monitoring uric acid levels, monitor for toxicity, IV administration can cause phlebitis, should be taken at the first sign of gout attack. Probenicid:
* Side Effect: headaches, dizziness
* Nursing Implications: do not start this until acute attack subsudes, monitor cbc, uric acid, liver, renal function. DRINK PLENTY OF FLUIDS! Avoid foods high in purine!! * CAN BE USED IN COMBINATION WITH COLCHICINE!
NSAID’s ( Nonsteroidal Anti-inflammatory Agents): Treat Acute Gouty Arthritis: use for short period of time, 1-4 weeks, can Produce NEUROTOXICITY! * Naproxen/Aleve:
* Side Effect: GI distress
* Nursing Implications: administer in the morning and in the evening, delayed release form NOT used for initial treatment of pain, note aspirin or non-steroidal anti-inflammatory drug allergy.
Indomethacin(Indocin); can produce neuro toxicity
* Side Effect: CNS symptoms in elderly clients with pre-existing CNS disorders, nausea, vomiting, abdominal pain. * Nursing Implications: Monitor for GI irritation, DO NOT CRUSH the sustained release form, use smallest effective dose.
* Side Effects: GI pain
* Nursing Implications: Note aspirin or NSAID allergy; monitor CBC, renal, and liver function.
THERAPY OF ANTIACIDS
3 Forms: aluminum(causes Constipation), magnesium(causes Diarrhea), calcium(causes constipation) Administer antacids 1-2 hours after drug
Stomach Hyperchlorhydria: excessive acid in the stomach; produced from : eating high fat meals, increased alcohol intake, emotional turmoil. THESE ARE NONSYSTEMIC:
Aluminum Hydroxide gel:
* Side Effects: Constipation
* Nursing Implications: interferes with phosphate absorption, prolonged use may interfere with serum phosphate levels, monitor for hypophosphatemia, constipation may be managed by laxatives or stool softeners Aluminum Phosphate gel:
* Side Effects: Constipation
* Nursing Implications: does not interfere with phosphate absorption, no longer used as an antacid, used to reduce fecal elimination of phosphates, constipation may be managed by giving laxatives or stool softeners Calcium Carbonate, Precipitated Chalk:
* Side Effects: Constipation, bloating, hypercalcemia
* Nursing Implications: releases co2 in the stomach, may increase acid secretion in stomach, observe client for signs of hypercalcemia, commonly used as a dietary calcium supplement Magaldrate:
* Side Effects: Diarrhea/constipation
* Nursing Implications: chemical combination of aluminum and magnesium hydroxides.
* Side Effects: diarrhea
* Nursing Implications: laxative in doses above 15mL, may cause hypermagnesemia in clients with impaired renal function, contraindicated in seer renal disease THESE ARE SYSTEMIC:
* Side Effects: systemic alkalosis acid rebound, bloating * Nursing Implications: releases co2 gas in the stomach, contraindicated in clients with CHF, hypertension, or salt restriction. Each gram contains 274mg of sodium. Histaine H2 Receptor Antagonist: examps Tagamet, pepsid, zantac Cimetidine:
* Nursing Implications: cigarette smoking may diminish the...