Allopurinol

INTRODUCTION

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.

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.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Be especially alert for skin rash, and notify physician or nursing staff immediately of any signs of hypersensitivity.

• Monitor signs of renal failure, including decreased urine output, bloody urine, increased blood pressure (BP), muscle cramps/twitching, edema/weight gain from fluid retention, yellowish brown skin, and confusion that progresses to seizures and coma. Report these signs to the physician immediately.

• Assess BP and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Assess signs of congestive heart failure (dyspnea, rales/crackles, peripheral edema, jugular venous distention, exercise intolerance). Report these signs to the physician immediately.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report an abnormally slow heart rate (bradycardia) or symptoms of other arrhythmias such as including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Monitor signs of bone marrow depression including fatigue, dizziness, fever, chills, sore throat, shortness of breath, chest pain, pallor, and unusual bruising or bleeding. Report these signs to the physician.

• If treating gouty arthritis, periodically assess impairments (pain, range of motion), functional ability, and disability to help document whether drug therapy is successful.

Interventions

• If treating arthritic conditions, implement appropriate manual therapy techniques, physical agents, therapeutic exercises, and orthotic/assistive devices to reduce pain, improve function, and augment the effects of drug therapy.

• Because of the risk of arrhythmias, heart failure, and abnormal BP responses, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

Patient/Client-Related Instruction

• Advise patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.

  ...