Gout

Question 1

What is used to treat acute gout?

Answer 1

Colchicine

Question 2

What is used to treat chronic gout?

Answer 2

• Drugs that decrease Uric Acid Productions (Xanthine Oxidase Inhibitors)
  ~ Allopurinol/Febuxostat

Question 3

What is hyperuricemia? List some disease examples.

Answer 3

• Elevated uric acid in the body either due to increase uric acid production or decreased excretion
  ~ Gout disease (Kings Disease)
  ~ Tumor Lysis Syndrome (oncological emergency)

Question 4

How to treat acute gout flare up?

Answer 4

• NSAIDS and/or Colchicine and/or Glucocorticoids (ideally within 24 hours)

Question 5

What is Colchicine used to treat?

Answer 5

• Acute Gout (Gout Flare Ups) (Loading dose, followed by maintenance)
• Gout prophylaxis during initiation of urate-lowering therapy (maintenance dosing)

Question 6

Colchicine adverse effects?

Answer 6

• Narrow Therapeutic Index!
  ~ Based on understanding of cellular microtubule disruption > colchicine is toxic to rapidly proliferating cells
  ~ Patients have developed multi-organ failure resulting in death
• Rhabdomyolysis

Question 7

How is Colchicine administered?

Answer 7

• Uric acid can crystallize in urine= kidney injury or kidney stones
  ~ Encourage ~3 Liters/day of fluid

Question 8

Colchicine nursing considerations?

Answer 8

Monitor uric acid, renal function, hepatic function, and CBC

Question 9

Colchicine patient education?

Answer 9

• Take on empty stomach (w/ food if GI symptoms)
• Stay hydrated while on medication
• Avoid grapefruit juice

Question 10

List examples of Xanthine Oxidase Inhibitors.

Answer 10

• Allopurinol
• Febuxostat (RARELY USED due to BOXED WARNING FOR DEATH)

Question 11

What are Xanthine Oxidase Inhibitors used to treat?

Answer 11

• Hyperuricemia (Chronic gout therapy/Urate Lowering Therapy )
• Prevention of Tumor Lysis Syndrome

Question 12

Xanthine Oxidase Inhibitors adverse effects?

Answer 12

• Severe Cutaneous Adverse Reactions (SCAR)=
  ~ Stevens Johnson Sydrome (SJS) or Toxic Epidermal Necrolysis (TEN)

Question 13

Other Xanthine Oxidase Inhibitors adverse effects?

Answer 13

• Hepatoxicity
• Uric acid can crystallize in urine= kidney injury or kidney stones
  ~ Encourage ~3 Liters/day of fluid

Question 14

Allopurinol nursing implications?

Answer 14

MONITORING:
~ Baseline CBC, Liver, Renal Function
~ HLA-B*5801
~ General uric acid target < 6 mg/dL