NUR 641 Topic 1 DQ 2

Sample Answer for NUR 641 Topic 1 DQ 2 Included After Question

Description:

Select a medication used in evidence-based treatment guidelines for the condition chosen in the first discussion question. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions of which one should be aware. Make sure that you select a different medication than your peers. Include the name of the medication in the subject line so that the medications can be followed. Include your references in APA style.

A Sample Answer For the Assignment: NUR 641 Topic 1 DQ 2

Title: NUR 641 Topic 1 DQ 2

The management of gout is two-fold in the sense that it involves both reducing the serum concentration of urate and upregulating its production in instances wherein undersecretion exists. The American College of Rheumatology produced a management guideline for the treatment of gout entitled American College of Rheumatology Updated Guideline for the Management of Gout ( Qaseem, Harris, & Forciea, 2017). According to this guideline, Allopurinol ≤150 mg/day has received backing from studies regarding its role in the management of gout. Wright et al. (2015) in their study Predicting Allopurinol Response In Patients With Gout, also concluded that Allopurinol is effective in the management of gout in consistence with several clinical guidelines concerning the same matter.

Mechanism of Action

The mechanism of action of Allopurinol is similar to most purines as it is an analog of the same. Allopurinol is an isomer of a purine that occurs naturally in the body known as hypoxanthine and it works to lower urate levels by inhibiting the enzyme xanthine oxidase. The above enzyme plays a role of successively oxidizing hypoxanthine and xanthine, which leads to uric acid production by the body, which is a product of the purine metabolism process. In addition to its basic function of blocking the production of uric acid, the inhibition of the xanthine oxidase enzyme leads to the existence of elevated levels of xanthine and hypoxanthine. Whereas it is impossible to change xanthine to purine ribotides, hypoxanthine can undergo conversion to these ribotides namely guanosine monophosphates and ribosides adenosine. Increased concentration of the two ribosides may lead to the inhibition of the amidophosphoribosyl transferase feedback mechanism, which is the first as well as rate-limiting enzyme in the process of purine biosynthesis. To this end, it is evident that allopurinol works by reducing the formation of uric acid as well as inhibiting the synthesis of purine.

Monitoring, Sid Effects and Drug Interactions

During the initiation of the dosage, gout flares may occur as a result of the altering levels of the serum uric acid concentration leading to mobilization of urate from locations such as tissue deposits. However, this occurrence should not influence discontinuation that should only be considered in instances of serious rash and renal abnormalities. Allopurinol needs to be discontinued immediately at the occurrence of rashes and appropriate medical interventions taken. Also, as regards patients with renal impairment, dosage adjustments should be considered as BUN levels have increased in such patients (Clarkson et al., 2017). Further, the drug has also demonstrated some adverse reactions in patients that have been categorized as either severe, moderate or mild side-effects. Concerning severe reactions, patients should be examined for renal failure, exfoliative dermatitis, and erythema multiforme and so on.

The moderate side-effects comprise delayed eosinophilia, early bullous rash, edema, bleeding, and hypotension among others. Other important side-effects include vomiting, nausea, urticarial, fever among others (Singh et al., 2017). Lastly, Allopuinol prescription should also be made with cognizance of its interactive capacity with other drugs. According to information from manufacturers of some brand names such as Zyloprim, Allopurinol interacts with the following drugs: Aluminum Hydroxide, Aluminum Hydroxide; Magnesium Carbonate, Aluminum Hydroxide; Magnesium Hydroxide, Aluminum Hydroxide; Magnesium Hydroxide; Simethicone, Aluminum Hydroxide; Magnesium Trisilicate, Amoxicillin, Amoxicillin; Clarithromycin; Lansoprazole and many more (Clarkson et al., 2017). Therefore, whereas Allopurinol is effective when it comes to the management of gout, its prescriptions needs to be done carefully by considering the above information.

References

Clarson, L. E., Hider, S. L., Belcher, J., Roddy, E., & Mallen, C. D. (2017). Factors Influencing Allopurinol Initiation in Primary Care. Annals of Family Medicine, 15(6), 557–560. https://doi.org/10.1370/afm.2137

Singh, N., Parashar, P., Tripathi, C. B., Kanoujia, J., Kaithwas, G., & Saraf, S. A. (2017). Oral delivery of allopurinol niosomes in treatment of gout in animal model. Journal of Liposome Research, 27(2), 130–138. https://doi.org/10.1080/08982104.2016.1174943

Wright, D. F., Duffull, S. B., Merriman, T. R., Dalbeth, N., Barclay, M. L., & Stamp, L. K. (2015). Predicting allopurinol response in patients with gout. British journal of clinical pharmacology, 81(2), 277-89.

Qaseem, A., Harris, R. P., & Forciea, M. A. (2017). Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine, 166(1), 58–68. https://doi.org/10.7326/M16-0570