Question 1

A patient with chronic gout has an acute gouty episode and is admitted to the hospital. The patient has been taking nonsteroidal anti-inflammatory drugs for several months. The prescriber plans to begin therapy with probenecid. What will the nurse do?

A) Give the medication as ordered and observe the patient closely for gastrointestinal side effects.
B) Request an order to lower the dose of the nonsteroidal antiinflammatory drug.
C) Restrict the patient's fluid intake to minimize the risk of renal injury.
D) Suggest delaying the probenecid therapy until the acute episode has subsided.

Accepted Answer

Probenecid may exacerbate acute episodes of gout,so treatment with this drug should be delayed until the acute attack has passed. Probenecid has mild GI effects. Lowering the dose of the NSAID is not recommended. Patients should increase their fluid intake to minimize the risk of renal injury.

Question 2

A patient with gout who has increasingly frequent acute gouty attacks will begin receiving allopurinol [Zyloprim] and colchicine. The nurse will include which statement when teaching the patient about this drug regimen?

A) "Allopurinol helps reduce the gastrointestinal side effects of colchicine."
B) "Allopurinol reduces the likelihood of gouty episodes that usually occur with initial colchicine therapy."
C) "The colchicine is given to enhance the effects of the allopurinol."
D) "You will take both drugs initially and then stop taking the colchicine."

"You will take both drugs initially and then stop taking the colchicine."

Accepted Answer

Colchicine is used for prophylaxis when urate-lowering drugs,such as allopurinol,are initiated,because gouty episodes have a tendency to increase during this time. Patients start with both drugs,and ultimately the colchicine is withdrawn. Allopurinol does not affect the GI side effects caused by colchicine. Allopurinol may precipitate an acute gouty attack when treatment is begun; colchicine is given to prevent a gouty episode. Colchicine does not enhance the effects of allopurinol.

Question 3

A patient who will begin taking colchicine for gout reports taking nonsteroidal anti-inflammatory drugs,simvastatin,amoxicillin,and digoxin. What will the nurse do?&#10;A) Contact the provider to discuss using a different antibiotic while this patient is taking colchicine.&#10;B) Notify the provider about the potential risk of muscle injury when simvastatin is taken with colchicine.&#10;C) Request an order for cardiorespiratory monitoring, because the patient is taking digoxin.&#10;D) Suggest that the nonsteroidal anti-inflammatory drugs (NSAIDs) be withdrawn during colchicine therapy.

Accepted Answer

Colchicine can cause rhabdomyolysis,and this risk is increased in patients who also take simvastatin or other statin drugs. Amoxicillin does not interact with colchicine. The side effects of digoxin are not increased by concurrent use with colchicine. NSAIDs can safely be taken with colchicine.

Question 4

A patient is being treated with warfarin [Coumadin] to prevent thrombus. The patient develops hyperuricemia,and the provider orders allopurinol [Zyloprim]. The nurse will contact the provider to discuss ____ the ____ dose.

A) increasing; allopurinol
B) increasing; warfarin
C) reducing; allopurinol
D) reducing; warfarin

Accepted Answer

Allopurinol can inhibit hepatic drug-metabolizing enzymes and thus delay the inactivation of other drugs. This is a particular concern in patients taking warfarin; therefore,the warfarin dose should be reduced when allopurinol is also used. It is not correct to increase the allopurinol dose,increase the warfarin dose,or reduce the allopurinol dose.

Question 5

A patient who is hospitalized for an acute gout attack has received several doses of hourly oral colchicine but still reports moderate to severe pain. As the nurse prepares to administer the next dose,the patient begins vomiting. What will the nurse do?

A) Contact the provider to discuss giving a lower dose of colchicine.
B) Hold the medication and notify the prescriber.
C) Explain that this is a common side effect that will soon stop.
D) Request an order for an antiemetic so that the next dose of colchicine may be given.

Accepted Answer

Colchicine should be discontinued immediately,regardless of the status of the joint pain,if gastrointestinal (GI)symptoms occur. The patient's symptoms indicate injury to the GI endothelium. Once damage begins to occur,lowering the dose is not indicated. GI toxicity will not abate over time. An antiemetic may be useful for stopping the vomiting; however,continued administration of the drug can lead to further damage to the GI endothelium.

Question 6

A patient has had three gouty flare-ups in the past year. Which drug class will the nurse expect the provider to order for this patient?&#10;A) Colchicine&#10;B) Glucocorticoids&#10;C) Nonsteroidal anti-inflammatory drugs&#10;D) Urate-lowering drugs

Accepted Answer

The provider will order a urate-lowering drug for this patient. The medication should be diluted and administered with 20 mL of sterile sodium chloride and administered over 5 minutes or longer.

Question 7

A patient is admitted for treatment of gout that has been refractory to treatment with allopurinol and probenecid. The patient is taking colchicine,and the prescriber orders pegloticase [Krystexxa]. Before administering this drug,the nurse will expect to:

A) administer an antihistamine and a glucocorticoid.
B) discontinue the colchicine.
C) increase the dose of colchicine.
D) prepare to administer a bronchodilator if needed.

Accepted Answer

Because pegloticase poses a risk of triggering anaphylaxis,patients should be pretreated with an antihistamine and a glucocorticoid. Colchicine is indicated at the initiation of treatment with pegloticase to reduce the intensity of gout flare-ups. Bronchodilators are not indicated.

Question 8

A patient with chronic gout is admitted to the hospital for treatment for an infection. The patient is receiving allopurinol and ampicillin. The nurse is preparing to administer medications and notes that the patient has a temperature of 101°F and a rash. What will the nurse do?

A) Withhold the allopurinol and notify the prescriber of the drug reaction.
B) Withhold the ampicillin and contact the provider to request a different antibiotic.
C) Request an order for an antihistamine to minimize the drug side effects.
D) Suggest giving a lower dose of the allopurinol while giving ampicillin.

Accepted Answer

Allopurinol can cause a hypersensitivity syndrome,which is characterized by a rash and fever. If these occur,the drug should be discontinued immediately. The combination of ampicillin and allopurinol increases the risk of this reaction; if it occurs,the allopurinol,not the ampicillin,should be discontinued. Antihistamines are not indicated. Lowering the dose of allopurinol is not indicated.

Question 9

A patient who has gout will begin taking febuxostat [Uloric] and colchicine. What will the nurse include when teaching this patient about this drug regimen?&#10;A) &#34;You are taking both drugs in order to prevent hepatic side effects.&#34;&#10;B) &#34;You may stop taking the febuxostat after your uric acid levels decrease.&#34;&#10;C) &#34;You will have to take both drugs indefinitely to treat your symptoms.&#34;&#10;D) &#34;You will stop taking the colchicine within 6 months after starting therapy.&#34;

Accepted Answer

At the beginning of therapy with fevuxostat,symptoms of gout may flare,so colchicine or NSAIDS are given for up to 6 months to alleviate this. The combination does not prevent effects on the liver. The febuxostat will be given indefinitely.

Deck 74: Drug Therapy of Gout