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Adverse Reactions/Side Effects
CV: hypotension, flushing, hypertension, bradycardia, and heart failure (reported
with IV administration). CNS: drowsiness. GI: diarrhea, hepatitis, nausea, vomiting.
GU: renal failure, hematuria. Derm: rash (discontinue drug at first sign of rash),
urticaria. Hemat: bone marrow depression. Misc: hypersensitivity reactions.
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allopurinol (al-oh-pure-i-nole)
Aloprim, Alloprin, Lopurin, Zyloprim
Classification
Therapeutic: antigout agents, antihyperuricemics
Pharmacologic: xanthine oxidase inhibitors
Pregnancy Category C
Interactions
Drug-Drug: Use with mercaptopurine and azathioprineqbone marrow de-
Indications
PO: Prevention of attack of gouty arthritis and nephropathy. PO, IV: Treatment of
secondary hyperuricemia, which may occur during treatment of tumors or leukemias.
Action
Inhibits the production of uric acid by inhibiting the action of xanthine oxidase.
Therapeutic Effects: Lowering of serum uric acid levels.
Pharmacokinetics
Absorption: Well absorbed (80%) following oral administration.
Distribution: Widely distributed in tissue and breast milk.
Protein Binding: ⬍1%.
Metabolism and Excretion: Metabolized to oxypurinol, an active compound
pressant properties— doses of these drugs should bep. Use with ampicillin or
amoxicillinqrisk of rash. Use with oral hypoglycemic agents and warfarinq
effects of these drugs. Use with thiazide diuretics or ACE inhibitorsqrisk of hypersensitivity reactions. Large doses of allopurinol mayqrisk of theophylline toxicity. Mayqcyclosporine levels.
Route/Dosage
Management of Gout
PO (Adults and Children ⬎10 yr): Initially— 100 mg/day;qat weekly intervals
based on serum uric acid (not to exceed 800 mg/day). Doses ⬎300 mg/day should
be given in divided doses; Maintenance dose— 100– 200 mg 2– 3 times daily.
Doses of ⱕ300 mg may be given as a single daily dose.
with a long half-life. 12% excreted unchanged, 76% excreted as oxypurinol.
Half-life: 1– 3 hr (oxypurinol 18– 30 hr).
Management of Secondary Hyperuricemia
TIME/ACTION PROFILE (hypouricemic effect)
ROUTE
ONSET
PEAK
DURATION
PO, IV
1–2 days
1–2 wk
1–3 wk†
†Duration after discontinuation of allopurinol
Contraindications/Precautions
Contraindicated in: Hypersensitivity.
Use Cautiously in: Acute attacks of gout; Renal insufficiency (doseprequired if
CCr ⬍20 mL/min); Dehydration (adequate hydration necessary); OB, Lactation:
Rarely used; Geri: Begin at lower end of dosage range.
⫽ Canadian drug name.
⫽ Genetic Implication.
PO (Adults and Children ⬎10 yr): 600– 800 mg/day in 2– 3 divided doses starting 1– 2 days before chemotherapy or radiation.
PO (Children 6– 10 yr): 10 mg/kg/day in 2– 3 divided doses (maximum 800 mg/
day) or 300 mg daily in 2– 3 divided doses.
PO (Children ⬍6 yr): 10 mg/kg/day in 2– 3 divided doses (maximum 800 mg/day)
or 150 mg daily in 3 divided doses.
IV (Adults and Children ⬎10 yr): 200– 400 mg/m2/day (up to 600 mg/day) as a
single daily dose or in divided doses q 8– 24 hr.
IV (Children ⬍10 yr): 200 mg/m2/day initially as a single daily dose or in divided
doses q 8– 24 hr (maximum dose 600 mg/day).
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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Renal Impairment
(Adults and Children): CCr 10– 50 mL/min—pdose to 50% of recommended;
CCr ⬍10 mL/min—pdosage to 30% of recommended.
NURSING IMPLICATIONS
Assessment
● Monitor intake and output ratios. Decreased kidney function can cause drug accu-
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IV Administration
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mulation and toxic effects. Ensure that patient maintains adequate fluid intake
(minimum 2500– 3000 mL/day) to minimize risk of kidney stone formation.
Assess patient for rash or more severe hypersensitivity reactions. Discontinue allopurinol immediately if rash occurs. Therapy should be discontinued permanently
if reaction is severe. Therapy may be reinstated after a mild reaction has subsided,
at a lower dose (50 mg/day with very gradual titration). If skin rash recurs, discontinue permanently.
Gout: Monitor for joint pain and swelling. Addition of colchicine or NSAIDs may
be necessary for acute attacks. Prophylactic doses of colchicine or an NSAID
should be administered concurrently during the first 3– 6 mo of therapy because
of an increased frequency of acute attacks of gouty arthritis during early therapy.
Lab Test Considerations: Serum and urine uric acid levels usually begin top
2– 3 days after initiation of oral therapy.
Monitor blood glucose in patients receiving oral hypoglycemic agents. May cause
hypoglycemia.
Monitor hematologic, renal, and liver function tests before and periodically during therapy, especially during the first few mo. May causeqserum alkaline phosphatase, bilirubin, AST, and ALT levels.pCBC and platelets may indicate bone
marrow depression.qBUN, serum creatinine, and CCr may indicate nephrotoxicity. These are usually reversed with discontinuation of therapy.
Potential Nursing Diagnoses
Acute pain (Indications)
Implementation
● PO: May be administered after milk or meals to minimize gastric irritation; give
with plenty of fluid. May be crushed and given with fluid or mixed with food for
patients who have difficulty swallowing.
● pH: 10.8– 11.8.
● Intermittent Infusion: Reconstitute each 500 mg vial with 25 mL of sterile water
for injection. Solution should be clear and almost colorless with only slight opalescence. Diluent: Dilute to desired concentration with 0.9% NaCl or D5W. Administer within 10 hr of reconstitution; do not refrigerate. Do not administer solutions that are discolored or contain particulate matter. Concentration: Not
⬎6 mg/mL. Rate: Infusion should be initiated 24– 48 hr before start of chemotherapy known to cause tumor cell lysis. Rate of infusion depends on volume of
infusate (100– 300 mg doses may be infused over 30 minutes). May be administered as a single infusion or equally divided infusions at 6-, 8-, or 12-hr intervals.
● Y-Site Compatibility: acyclovir, aminophylline, amphotericin B lipid complex,
anidulafungin, argatroban, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, carboplatin, caspofungin, cefazolin, cefotetan, ceftazidime, ceftriaxone, cefuroxime, cisplatin, cyclophosphamide,
dactinomycin, dexamethasone sodium phosphate, dexmedetomidine, docetaxel,
doxorubicin liposome, enalaprilat, etoposide, famotidine, fenoldopam, filgrastim,
fluconazole, fludarabine, fluorouracil, furosemide, ganciclovir, gemcitabine,
granisetron, heparin, hetastarch, hydrocortisone, hydromorphone, ifosfamide,
leucovorin calcium, linezolid, lorazepam, mannitol, mesna, methotrexate, metronidazole, milrinone, mitoxandrone, morphine, nesiritide, octreotide, oxytocin,
paclitaxel, pamidronate, pantoprazole, pemetrexed, piperacillin/tazobactam, potassium chloride, ranitidine, sodium acetate, teniposide, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, trimethoprim/sulfamethoxazole, vancomycin,
vasopressin, vinblastine, vincristine, voriconazole, zidovudine, zoledronic acid.
● Y-Site Incompatibility: alemtuzumab, amikacin, amphotericin B colloidal, carmustine, cefotaxime, chlorpromazine, clindamycin, cytarabine, dacarbazine, daptomycin, daunorubicin, dexrazoxane, diltiazem, diphenhydramine, doxorubicin,
doxycycline, droperidol, epirubicin, ertapenem, etoposide phosphate, floxuridine, foscarnet, gentamicin, haloperidol, hydroxyzine, idarubicin, imipenem/cilastatin, irinotecan, mechlorethamine, meperidine, methylprednisolone sodium
succinate, metoprolol, moxifloxacin, mycophenolate, nalbuphine, ondansetron,
palonosetron, pancuronium, potassium acetate, prochlorperazine, promethazine, sodium bicarbonate, streptozocin, tacrolimus, tobramycin, vecuronium, vinorelbine.
Patient/Family Teaching
● Instruct patient to take allopurinol as directed. Take missed doses as soon as re-
membered. If dosing schedule is once daily, do not take if remembered the next
䉷 2015 F.A. Davis Company
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CONTINUED
allopurinol
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day. If dosing schedule is more than once a day, take up to 300 mg for the next
dose.
Instruct patient to continue taking allopurinol along with an NSAID or colchicine
during an acute attack of gout. Allopurinol helps prevent, but does not relieve,
acute gout attacks.
Alkaline diet may be ordered. Urinary acidification with large doses of vitamin C or
other acids may increase kidney stone formation. Advise patient of need for increased fluid intake.
May occasionally cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to drug is known.
Instruct patient to report skin rash, blood in urine, or influenza symptoms (chills,
fever, muscle aches and pains, nausea, or vomiting) to health care professional
immediately; skin rash may indicate hypersensitivity.
Advise patient that large amounts of alcohol increase uric acid concentrations and
may decrease the effectiveness of allopurinol.
Emphasize the importance of follow-up exams to monitor effectiveness and side
effects.
Evaluation/Desired Outcomes
● Decreased serum and urinary uric acid levels. May take 2– 6 wk to observe clini-
cal improvement in patients treated for gout.
Why was this drug prescribed for your patient?
⫽ Canadian drug name.
⫽ Genetic Implication.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.