Gout (Module 5) Flashcards
Gout Patho
purine is a by product of protein metabolism; breaks down into uric acid
acid accumulates and deposits in joints causing inflammation and pain
primary (most common; inherited, middle age, older men and post menopausal women)
secondary (hyperuricemia caused by another disease or condition-renal insufficiency, diuretics, crash diets)
Asymptomatic Stage Gout
elevated serum uric acid lvl
Acute Stage Gout
excruciating pain, usually metatarsophalangeal joint of the great toe, called podagra
Tophaceous Stage Gout
repeated episodes (between 3-40 yrs after first symptoms appear) result in urate crystals under the skin and within major organs, often kidneys
kidney stones are common
Gout Labs and Diagnostics
serum uric acid
urinary uric acid
kidney function tests (BUN/Creat)
synovial fluid aspiration (arthrocentesis)
Gout Xanthine Oxidase Inhibitors (Allopurinol)
prevent conversion of xanthine to uric acid
promotes uric acid secretion and its production
take with/without food
can cause liver dysfunction and bone marrow suppression
Gout Antigout Anti-Inflammatory (Colchicine)
with/without food
avoid grapefruit juice
can be given for acute attacks
no longer a first line drug
Gout Uricosuric Agents (Probenecid)
with food to avoid GI issues
increases excretion of uric acid
not to be used at beginning of the attack
avoid aspirin
Gout Uric Acid Oxidase (Pegloticase)
IV therapy for chronic gout if pt didn’t respond to PO (last resort)
monitor for anaphylaxis and infusion reactions (chest pain, dyspnea, urticaria, erythema, pruritus)
NSAIDs
except aspirin; often first line drugs with quick response
adverse effects include GI ulceration, impaired renal function, fluid retention, and increased risk for CV events
Glucocorticoids (Prednisone)
can be used if NSAIDs are ineffective or CI
Gout Nursing Care
DIET LOW IN PURINE
no organ meats, shellfish, or oily fish with bones (sardines)
no excessive alcohol or fad diets
no aspirin or diuretics
avoid stress
drink adequate water to protect kidneys
