NURS 615 Exam 3 kylie (1)-Gout Treatment.
Gout treatment.
Decrease alcohol and organ meat, dish and bacon in diet
Antigout Drugs: allopurinol
... [Show More] (Zyloprim), colchicine, and febuxostat (Uloric)
• allopurinol
• inhibit synthesis of uric acid by inhibiting xanthine oxidase conversion of
hypoxanthine & xanthine to uric acid
• prevent flares
• monitor renal and liver function tests before treatment
• drowsiness/dizziness may occur
• Febuxostat:
• inhibit synthesis of uric acid by inhibiting xanthine oxidase conversion of
hypoxanthine & xanthine to uric acid
• prevents flares
• risk of gout flare up when starting febuxostat; patient should be concurrently
taking NSAID or colchicine for up to 6 months
• monitor liver
o colchicine
decreases inflammatory response to urate crystal deposits
For acute attacks
Low dose vs. High dose—low dose has better efficacy with less
s/e
1.2 mg followed by 0.6mg 1hour later vs 1.3mg followed by 0.6
mg every 4-6 hours 4.8mg total
Colchicine always causes diarrhea, other GI symptoms (upset
stomach, nausea, abdominal pain) can be decreased if taken
with food
Do not stop abruptly
Decrease dose with hepatic dysfunction
Patient should be educated to recognize and report proximal
muscle weakness, myalgia, and neuropathy if taking colchicine.
Contact doctor These can be an adverse effect of colchicine and
usually resolve within 3-4 weeks of stopping the medication.
• Labs to monitor with gout treatment:
Uric acid levels
Allopurinol, colchicine, probenecid, sulfinpyrazone-liver and
renal function before and during therapy, BUN, creatinine, &
creatinine clearance
Monitor acid-base balance in patients whose urine is being
alkalinized
Uricosuric agents: probenecid (Benemid) & Sulfinpyrazone (Anturane)
• probenecid & sulfinpyrazone inhibit renal tubular reabsorption of urate and
therefor increase excretion of uric acid via the kidneys and decrease serum uric
acid
• sulfinpyrazone also competitively inhibits platelet aggregation, multiple drug
interactions
• not anti-inflammatory
• not for use in acute attacks
• Probenecid-CBC-watch for blood dycrasias; patient education re s/s of blood
dyscrasia that should be reported *fever, sore throat, fatigue, bruising easily
Corticosteroids: Chapter 25, p. 808-817
• End in ”sone”
• Used to treat many conditions
• Used short-term for self-limiting conditions; Long-term reserved for lifethreatening conditions or severely disabling symptoms (COPD)
• If used over 6 months: Increase blood glucose, impair immune function (get
vaccines) , impair wound healing, GI complaints (report black tarry stools) ,
osteoporosis (decreases calcium), anxiety/insomnia, sodium & fluid retention
9monitor weight and fluid retention)
• If on 1gram or more also prescribe PPI (omeprazole) to prevent PUD
• Feedback activity on HPA axis suppresses secretion and production of ACTH and
suppresses prostaglandin E production of insulin-like growth hormone, hence
skeletal muscle wasting occur.
• Adrenal suppression occurs with long-term therapy
• abrupt withdrawal causes withdrawal syndrome: malaise, myalgia, nausea, HA,
fever, relapse of symptoms, hypotension
• Taper is necessary to avoid this unless therapy is very short term or burst
therapy
• Prednisone is contraindicated with active infection and hypersensitivity
NSAIDS: Chapter 25, p. 817-834
• 1
st line for mild to moderate pain
• Inhibit cyclo-oxygenase (COX) activity and prostaglandin synthesis
• COX-1: systemic, present in all tissues at all times; especially in platelets,
endothelial cells; GI tract; and renal microvasculature, glomeruli, and collecting
ducts; regulates platelet aggregation, blood flow to kidney and stomach, and
stomach acid secretion and production of protective mucus in the stomach
*blocking these explains adverse reactions and serious s/e like GI bleed, renal
failure, edema, fluid retention
• COX-2: inducible enzyme produced in response to pain and inflammation
• BB warning for CV issues/events (stroke, MI, thrombus, CV disease) and GI
issues (bleed, ulcer, performation). Increased risk for elderly and with increased
dose
• Non-spelective NSAIDs inhibit both COX 1 & 2
• ASA, ketoprofen, flurbiprofen, indomethacin, piroxican, sulindac are mostly
selective to COX-1
• Ibuprofen slightly selective to COX-2. Decreases prostaglandins (decrease
pain), also antipyretic due to action on hypothalamus. Inhibiting cox 1 gives
GI side effects. NSAID of choice for children over 6 months
• COX-2 selective drugs: celecoxib (Celebrex)
• do not inhibit COX-1, less GI effects
• Black box warning regarding cardiovascular events & GI bleeding
• Many drug interactions- warfarin
• Cautious use in CHF, HTN, PUD, Renal dysfunction, advanced age, avoid in
pregnancy. [Show Less]