Gout Therapy

Therapeutic Function Xanthine oxidase inhibitor gout therapy Chemical Name 1 H-pyra2olo[3,4-d] pyrimidin4-ol Common Name —... 

Monitor the patient for pain relief and decreased swelling of the affected joints. Both parameters should be improved significantly within 48 hours of starting acute gout therapy. 

Therapeutic Function Xanthine oxidase inhibitor, Gout therapy... 

Gout is treated with diet and with several drugs. Dietary control (i.e., reduced consumption of food that is rich in nucleic acids such as liver and sardines) depresses uric acid synthesis in some individuals who are susceptible to primary gout. Allopurinol and colchicine are often used in gout therapy. Because allopurinol... 

In those with gout, the serum uric acid level is usually elevated. Sulfinpyrazone increases the excretion of uric acid by the kidneys, which lowers serum uric acid levels and consequently retards the deposit of urate crystals in the joints. Probenecid (Benemid) works in the same manner and may be given alone or with colchicine as combination therapy when there are frequent, recurrent attacks of gout. Probenecid also has been used to prolong the plasma levels of the penicillins and cephalosporins. 

For the physical assessment, the nurse generally appraises the patient s physical condition and limitations. If the patient has arthritis (any type), the nurse examines the affected joints in the extremities for appearance of the skin over the joint, evidence of joint deformity, and mobility of the affected joint. Fhtients with osteoporosis are assessed for pain particularly in the upper and lower back or hip. Vital signs and weight are taken to provide a baseline for comparison during therapy. If the patient has gout, the nurse examines the affected joints and notes the appearance of the skin over the joints and any joint enlargement. 

Promoting an Optimal Response to Therapy The patient with a musculoskeletal disorder may be in acute pain or have longstanding mild to moderate pain, which can be just as difficult to tolerate as severe pain. Along with pain, there may be skeletal deformities, such as the joint deformities seen with advanced rheumatoid arthritis. For many musculoskeletal conditions, drug therapy is a major treatment modality. Therapy with these drugs may keep the disorder under control (eg, therapy for gout), improve the patient s ability to carry out the activities of daily living, or make the pain and discomfort tolerable. 

Identify patients in whom maintenance therapy for gout and hyperuricemia is warranted. 

Gout is an episodic disease, and the number of attacks varies widely from patient to patient. Thus the benefit of long-term prophylaxis against acute gout flares must be weighed against the cost and potential toxicity of therapy that may not be necessary in all patients. Asymptomatic hyperuricemia usually does not require treatment. 

Allopurinol is well absorbed with a short half-life of 2 to 3 hours. The half-life of oxypurinol approaches 24 hours, allowing allopurinol to be dosed once daily. Oxypurinol is cleared primarily renally and can accumulate in patients with reduced kidney function. Allopurinol should not be started during an acute gout attack because sudden shifts in serum uric acid levels may precipitate or exacerbate gouty arthritis. Rapid shifts in serum uric acid can change the concentration of monosodium urate crystals in synovial fluid, causing more crystals to precipitate. Thus some clinicians advocate a prophylactic dose of colchicine (0.6 mg/day) during initiation of antihyperuricemic therapy. Acute episodes should be treated appropriately before maintenance treatment is started. 

Initiate therapy to treat the acute gout attack without delay. Develop a plan to assess this therapy after 24 and 48 hours. 

Therapy should be initiated with maximum recommended doses for gout at the onset of symptoms and continued for 24 hours after complete resolution of an acute attack, then tapered quickly over 2 to 3 days. Acute attacks generally resolve within 5 to 8 days after initiating therapy. 

Allopurinol is the antihyperuricemic drug of choice in patients with a history of urinary stones or impaired renal function, in patients who have lymphoproliferative or myeloproliferative disorders and need pretreatment with a xanthine oxidase inhibitor before initiation of cytotoxic therapy to protect against acute uric acid nephropathy, and in patients with gout who are overproducers of uric acid. 

Patients with acute gout should be monitored for symptomatic relief of joint pain as well as potential adverse effects and drug interactions related to drug therapy. The acute pain of an initial attack of gouty arthritis should begin to ease within about 8 hours of treatment initiation. Complete resolution of pain, erythema, and inflammation usually occurs within 48 to 72 hours. 

Potentially important laboratory abnormalities occurring with niacin therapy include elevated liver function tests, hyperuricemia, and hyperglycemia. Niacin-associated hepatitis is more common with sustained-release preparations, and their use should be restricted to patients intolerant of regular-release products. Niacin is contraindicated in patients with active liver disease, and it may exacerbate preexisting gout and diabetes. 

Colchicine (6) is used in the treatment of a broad range of diseases including acute gout and Mediterranean fever [28] and induces depolymerization of tubulin. This compound (6) distorts the tubulin/microtubule equilibrium by binding to the tubulin dimer and halting mitosis in the metaphase. The reason this approach is such a successful target in cancer therapy is that... 

Gout Do not start therapy until an acute gouty attack has subsided. However, if an acute attack is precipitated during therapy, probenecid may be continued. Give full therapeutic doses of colchicine or other appropriate therapy to control the acute... 

Exacerbation of gout Exacerbation of gout following therapy with probenecid may occur in such cases, colchicine or other appropriate therapy is advisable. Salicylates Use of salicylates is contraindicated in patients on probenecid therapy. Salicylates antagonize probenecid s uricosuric action. 

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