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MSDN Week 7 - Coggle Diagram
MSDN Week 7
allopurinol (Zyloprim)
common ADRs: none
rare ADRs: SJS/TENs, agranulocytosis, aplastic anemia, thrombocytopenia, granulomatous hepatitis, hepatotoxicity, immune hypersensitivity reaction, renal failure
interactions: didanosine (increased didanosine bioavailability), azathioprine (XO needed to eliminate azathioprine metabolite, mercaptopurine; when XO is inhibited by allopurinol, increases azathioprine effect and toxicity), cyclophosphamide (unknown; increased cyclophosphamide toxicity; bone marrow suppression)
efficacy: resolution of clinical signs of gout, serum UA concentrations measured after 48 h of therapy
indications: gout (mild/moderate/severe), hyperuricemia (tumor lysis syndrome)
toxicity: LFTs, renal function, CBC
class: xanthin oxidase inhibitor; antigout
counseling: take after meals to lessen gastric irritation; maintain adequate hydration during therapy to prevent kidney stones; patient should avoid alcohol and caffeine when taking allopurinol; seek medical attention if s/s of myelosuppression, agranulocytosis, or SJS occur
febuxostat (Uloric)
common ADRs: none
rare ADRs: ECG abnormalities, hypersensitivity, stroke, mood changes, drug reaction rash with eosinophilia and systemic symptoms
indications: hyperuricemia in patients not adequately treated with, or having adverse effects from, allopurinol
efficacy: reduction in uric acid levels to < 6 mg/dL, decrease in gout attacks
class: xanthine oxidase inhibitor
toxicity: baseline and periodic LFTs
counseling: take with food; weight loss and limiting alcohol consumption will reduce gout attacks and should be recommended to all patients; seek medical attention for severe mood swings, rashes, or abnormal heartbeat
interactions: substrates for XO like azathioprine, didanosine, mercaptopurine, theophylline (decreased metabolism of XO substrates and increased toxicity)
hydroxychloroquine (Plaquenil)
common ADRs: none
rare ADRs: arrhythmias, cardiomyopathy, SJS, agranulocytosis, seizures, retinopathy, psychosis
interactions: aurothioglucose (increased risk of blood dycrasias), digoxin (increased digoxin levels), vibrates (increased risk of cholelithiasis), metoprolol (decreased metabolism and increased toxicity of metoprolol)
efficacy: decreased pain and improved ROM (RA); decreased joint pain, decrease in butterfly rash, improved energy (Lupus)
indications: lupus, malaria, rehumathoid arthritis
toxicity: seek medical attention if heart palpitations, severe rash, unusual bruising or bleeding, or difficulty seeing or changes in sisal fields; baseline and periodic eye exams
class: aminoquinolone
counseling: if taking weekly, take on same day each week; take with food or milk
colchicine (Colcrys, Gloperba, Mitigare)
common ADRs: diarrhea, nausea
rare ADRs: agranulocytosis, rhabdomyolysis
interactions: CYP3A4/5 inhibitors/inducers, P-gp inhibitors/inducers, lipid lowering agents (coadministration of colchicine and lipid-lowering agents may result in myopathy and rhabdomyolysis)
indications: acute gout, gout prophylaxis, familial Mediterranean fever
efficacy: resolution of clinical s/s of gout
class: antigout
toxicity: CBC, alkaline phosphate at baseline and periodically during treatment; instruct patients to D/C the medication immediately and seek medical attention if s/s of agranulocytosis, or myotoxicity; monitor renal and hepatic function
counseling: instruct patient on appropriate dosing strategy for gout flares
azathioprine (Azzamun, Imuran)
common ADRs: nausea, leukopenia, infection
rare ADRs: neoplasia, pancreatitis
interactions: allopurinol/febuxostat (decreased metabolism of azathioprine by XO), immunosuppressants (additive immunosuppression), vaccines (decreased vaccine efficacy, increased Acs of live vaccines)
efficacy: absence of rejection, improvement in symptoms of disease being treated
indications: renal transplantation, RA
toxicity: CBC, TPMT genotyping, LFTs, monitor for development of cancer
class: immunosuppressant agent
counseling: take with food; long-term use may increase risk of cancer, including lymphoma; be aware of symptoms of lymphoma and report to HCP; requires regular blood tests to assess for lowered blood counts; may increase risk of infections