Gout

Question 1

Uric acid is a waste of?

Answer 1

Purine Metabolism

-Excreted by the kidneys

Question 2

Sources of Purine

Answer 2

Alcohol
Red meat
Organ Meat
Seafood/shellfish

Question 3

Predisposition to gout

Answer 3

Male
Genetics
Diet
Obesity
Diuretic therapy
Kidney insufficiency

Question 4

Gouty Arthritis S/S

Answer 4

PAIN

• intense
• Big toe
• Early morning

INFLAMMATION

• Edema
• Redness
• Tenderness

FEVER + MALAISE

Question 5

Pharm for Acute Gout

Answer 5

NSAID
Corticosteroids
Colchicine

Question 6

Gout: Prophylactic Pharm

Answer 6

Allopurinol
Colchicine
Probenecid

Question 7

Allopurinol

Answer 7

Allopurinol (Zyloprim)

Class: Antigout agent (Xanthine Oxidase Inhibitor)

MOA: inhibits production of uric acid

Indication: Prophylaxis

SE: Rash

Important interaction:

• Hypoglycemic agents
• Warfarin

Nursing Implications:
-take w/food or milk

Monitor:
Serum/urine uric acid
serum glucose (may cause hypoglycemia)
Takes 2-6 weeks to work

Question 8

Colchicine

Answer 8

Colchicine (Colcrys)

Class: anti-gout agent/anti-inflammatory

MOA: Mostly unknown
-inhibits leukocyte infiltration (disrupts cell division)
Indication: Gout flares and prophylaxis

SE:
-GI effects (stop drug TOXICITY)

Precaution:

• Usually given orally
• Contraindicated in renal disease

Nursing Implications:
Teach patient to avoid:
-Alcohol
-Grapefruit
-B12 vitamins

Interactions:

• CYP3A4 inhibitors: Clarithromycin
• Lanoxin (Digoxin)
• Statins
• others

Question 9

Probenecid

Answer 9

Probenecid (Benuryl)

Class: Uricosuric Agent

MOA: Inhibits reabsorption of uric acid in kidney, promoting excretion

Indication: Hyperuricemia with gout

Recommendations: Used alone or in combo with allopurinol when not effective alone

SE:

• GI upset
• Dizziness or h/a
• Kidney/Liver Impairment
• Lots of drug interactions