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Gulf Coast Community College - Associate Degree Nursing NUR 1260C – Gerontological Nursing Medication Cards Student Name: Name of Drug: Trade Name: Allopurinol Alloprim, Apo-Allopurinol, Lopurin, Zyloprim Classification: Xanthine oxidase inhibitors Usual Adult Dose: Initially 100mg/day ↑ at weekly intervals based on serum acid (not to exceed 800 mg/day Patient’s Dose: Action: Inhibits the production of uric acid by inhibiting the action of xanthine oxidase Adverse Effects: Hypotension, flushing, hypertension, bradycardia, heart failure (report w/IV administration), drowsiness, diarrhea, hepatitis, N/V, renal failure, hematuria, rash (discontinue drug at 1st sign of rash), urticaria, bone marrow depression, and hypersensitivity reactions. Drug Interactions: Use with mercaptopurine and azathioprine ↑ bone marrow depressant properties--doses of these drugs should be ↓. Use with ampicillin or amoxicillin ↑ risk of rash. Use with oral hypoglycemic agents and warfarin ↑ effects of these drugs. Use with thiazide diuretics or ACE inhibitors ↑ risk of hypersensitivity reactions. Large doses of allopurinol may ↑ risk of theophylline toxicity. May ↑ cyclosporine levels. Nursing Implications: Monitor intake and output ratios. Decreased kidney function can cause drug accumulation 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 Considerations: Serum and urine uric acid levels usually begin to ↓ 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 months. May cause ↑ serum alkaline phosphatase, bilirubin, AST, and ALT levels. ↓ CBC and platelets may indicate bone marrow depression. ↑ BUN, serum creatinine, and CCr may indicate nephrotoxicity. These are usually reversed with discontinuation of therapy.