Ch 65 – Gout – Collaborative Care/Nursing Management – Flashcards
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Goal of treatment of patient with Gout
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termination of an acute attack by using an antiinflammatory agent like colchicine NSAIDs prescribed for pain management
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Future attacks of Gout prevented by
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allopuinol (Zyloprim, Aloprim) weight reduction avoidance of alcohol avoidance of foods high in purine (red and organ meats)
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Gout - drug therapy - acute gouty arthritis
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colchicine NSAIDs - because colchicine has no analgesic properties, only antiinflammatory
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Colchicine - how administered - how long before relief
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PO 24-48 hours
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Colchicine - how is it used diagnostically
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because good response to this drug is further evidence of diagnosis of gout
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How to prevent recurrent Gout
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combination of colchicine & a xanthine oxidase inhibitor (allopurinol) or combined with a uricosuric drug (Benemid, Uloric)
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What is used for long-term management of hyperuricemia w/chronic Gout
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selective inhibitor of xanthine oxidase
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If not responding to drugs that lower uric acid in blood - what else can be given
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pegloticase (Krystexxa)
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What is pegloticase (Krytexxa)
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an enzyme that metabolized uric acid into a harmless chemical that's excreted in urine
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pegloticase (Krytexxa) - how given
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IV
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What other drug is helpful with acute attacks
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corticosteroids orally or intraarticular injection
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When are systemic corticosteroids only used
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if routine therapies contraindicated or ineffective
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What else can be used to treat Gout - acute attack
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ACTH
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What's been used in the past for hyperuricemia caused by urate underexcretion
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uricosuric drugs (probenecid)
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uricosuric drugs - MOA
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inhibit renal tubular reabsorption of urates
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uricosuric drugs - when is this drug sometimes ineffective
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when creatinine clearance is reduced like with patients >60
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what inactivates the effects of uricosurics
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aspirin results in urate retention should be avoided if taking uricosuric drugs acetaminophen can be used safely
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what needs to be maintained to prevent precipitation of uric acid in renal tubules
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adequate urine volume with normal renal function (2-3 L/day)
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allopurinol - benefits
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blocks production of uric acid useful w/patients that have uric acid stones or renal impairment (in whom uricosuric drugs may be ineffective or dangerous)
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if allopurinol can't be tolerated
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oxypurinol
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what is oxypurinol
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an active metabolite of allopurinol
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for elderly patients w/both gout & hypertension
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angiotensin II receptor antagonist losartan (Cozaar)
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losartan (Cozaar)
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promotes urate diuresis & may normalize serum urate levels combo of losartan & allopurinol may be given
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Gout - what needs to monitored regularly
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serum uric acid elvels
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Gout - nutritional therapy
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limit alcohol & foods high in purine drugs can control this w/o having to make changes instruct obese people in weight control program
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nursing intervention w/acute gouty arthritis
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supportive care of inflammed joints avoid causing pain by careless handling bed rest joints properly immobilized lower extremity involvement - use of a cradle or footboard (protects painful area from weight of bedclothes)
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nursing intervention - assess
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limitation of motion degree of pain
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explain to patient precipitating factors that may cause an attack
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excessive caloric intake too much in purine-containing foods too much alcohol starvation (fasting0 drug use (niacin, aspirin, diuretics) major medical events (surgery, myocardial infarction)
