Allopurinol 100mg/tab 1 tab BID

Inhibits the enzyme responsible for the conversion of purines to uric acid, thus reducing the production of uric acid with a decrease in serum and sometimes in urinary uric acid levels, relieving the signs and symptoms of gout

Indications: - Management of the signs and symptoms of primary and secondary gout - Management of patients with malignancies that result in elevations of serum and urinary uric acid - Management of patients with recurrent calcium oxalate calculi whose daily uric acid excretion exceeds 800 mg/day (males) or 750 mg/day (females) - Orphan drug use: Treatment of Chagas' disease; cutaneous and visceral leishmaniasis - Unlabeled uses: Amelioration of granulocyte suppression with fluorouracil; as a mouthwash to prevent fluorouracil-induced stomatitis Contraindications - allergy to allopurinol, blood dyscrasias, hypersensitivity.

CNS: Headache, drowsiness, peripheral neuropathy, neuritis, paresthesias Dermatologic: Rashes maculopapular, scaly or exfoliative sometimes fatal GI: Nausea, vomiting, diarrhea, abdominal pain, gastritis, hepatomegaly, hyperbilirubinemia, cholestatic jaundice GU: Exacerbation of gout and renal calculi, renal failure Hematologic: Anemia, leukopenia, agranulocytosis, thrombocytopenia, aplastic anemia, bone marrow depression

Reduce uric acid synthesis

- Assess for pain - Monitor uric acid levels q2 wk - Monitor CBC, AST, BUN, creatinine before starting treatment - Monitor nutritional status: discourage organ meat, sardines, salmon, legumes (high purine), gravies,alcohol Precautions: - Pregnancy C, lactation, renal disease, hepatic disease, children

Ibuprofen (200mg/5ml) 4ml q6h for T>/= 39oC

Inhibits prostaglandin synthesis by decreasing enzyme needed for biosynthesis; analgesic, antiinflammatory, antipyretic

Indications -Relief of signs and symptoms of rheumatoid arthritis and osteoarthritis -Relief of mild to moderate pain -Treatment of primary dysmenorrhea -Fever reduction -Unlabeled uses: Prophylactic for migraine; abortive treatment for migraine Contraindications -Contraindicated with allergy to ibuprofen, salicylates, or other NSAIDs (more common in patients with rhinitis, asthma, chronic urticaria, nasal polyps).

CNS: Headache, dizziness, somnolence, insomnia, fatigue, tiredness, dizziness, tinnitus, ophthalmologic effects CV: Hypertension, palpitations, arrhythmia Dermatologic: Rash, pruritus, sweating, dry mucous membranes, stomatitis GI: Nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence, GI bleeding GU: Dysuria, renal impairment, menorrhagia Hematologic: Bleeding, platelet inhibition with higher doses, neutropenia, eosinophilia, leukopenia, pancytopenia, aplastic anemia, decreased Hgb or Hct, bone marrow depression Respiratory: Dyspnea, hemoptysis, pharyngitis, bronchospasm, rhinitis Other: Peripheral edema, anaphylactoid reactions to

Fever reduction

- Assess pain - Assess musculoskeletal status: ROM before dose and 1 hr after. - Monitor liver function studies - Monitor renal function studies - Monitor blood studies: CBC, Hgb, Hct, protime if patient is on longterm therapy - Check I&O ratio - Assess hepatotoxicity - Assess for allergic reactions, visual changes and ototoxicity - Identify prior drug history - Identify fever: length of time in evidence and related symptoms Precautions: - Pregnancy B, lactation, children, bleeding disorders, GI disorders, cardiac disorders, hypersensitivity to other antiinflammatory agents, elderly, CHF

anaphylactic shock

1. Paracetamol (250mg/5ml) 3ml q4h for fever 2. Paracetamol 145mg IV q4h for T > 38oC

Antipyretic: Reduces fever by acting directly on the hypothalamic heatregulating center to cause vasodilation and sweating, which helps dissipate heat. Analgesic: Site and mechanism of action unclear

Indications - Analgesic-antipyretic in patients with aspirin allergy, hemostatic disturbances, bleeding diatheses, upper GI disease, gouty arthritis - Arthritis and rheumatic disorders involving musculoskeletal pain (but lacks clinically significant antirheumatic and antiinflammatory effects) - Common cold, flu, other viral and bacterial infections with pain and fever - Unlabeled use: Prophylactic for children receiving DPT vaccination to reduce incidence of fever and pain Contraindications - Contraindicated with allergy to acetaminophen. - Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation.

CNS: Headache CV: Chest pain, dyspnea, myocardial damage when doses of 5 8 g/day are ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr GI: Hepatic toxicity and failure, jaundice GU: Acute kidney failure, renal tubular necrosis Hematologic: Methemoglobinemia cyanosis; hemolytic anemia hematuria, anuria; neutropenia, leucopenia, pancytopenia, thrombocytopenia, hypoglycemia Hypersensitivity: Rash, fever

Fever reduction

- Monitor liver function studies; may cause hepatic toxicity at doses >4g/day - Monitor renal function studies; albumin indicates nephritis - Monitor blood studies, especially CBC and pro-time if patient is on longterm therapy. - Check I&O ratio; decreasing output may indicate renal failure. - Assess for fever and pain - Assess hepatotoxicity: dark urine, clay-colored stools - Assess allergic reactions: rash, urticaria