ACUTE GOUT Flashcards
TASK
477
explanation
-it is a condition problem with urate metabolism
-accumilation of urate as a result of imbalance of intake of urate/urate production and excretion by kidney and GIT>excretion influenced by genetics
TRIGGERS
-DRUGS: HCT
-following minor trauma toe
-following surgical operation
-diet high in purines : meat, tin fish, game meat
-commonly occurs great toe but can occur in any jt
ASSOCIATED WITH
-IHD, kidney disease, DM, HTN
MX
ACUTE FLARE UP
-stop diretic and salicylate
-start early as possible
1.indomethacin 75mg stat>50mg 2hrs later>25mg 8hry 48 hrs>25mg bd 1 week
2.colchicine 1.2mg stat>0.6mg 6 hrs later>0.6mgbd 3 days
NOT tolerating
-prednisolone 0.5mg/kg 10 days with tapering
start allopurinol early
-increase fluid intake
-elevate foot end 24-48hr
-suggest alternative bp: ace inhibitor
-pcm for additional pain relief
-return to work after pain subsides withing 48hrs
-indo pred can increase BP
TREAT TARGET URATE
-it is essential to reduce gout flares and reduce tophi
-with tophi urate level<0.3
-without tophi <0.36
-flare may occur up to 12-18months>but decrease frequency
-if maintained>will stop eventually
-100mg day kidney/50mg with kidney for 3 weeks>200mg 2 weeks>300mg daily 2 weeks> check serum urate maintain
-max dose up to 900
PROPHYLAXIS
-start on naproxen or colchicine 0.5mg daily, while on allopurinol
-ct for 6/12
MONITOR URATE
-every 6/12 once target urate reached
