AGENTS USED TO TREAT HYPERURICEMIA AND

GOUT

GOUT -a chronic metabollic disease associated

with the development of hyperuricemia, the

presence of abnormally elevated

amounts of uric acid in the blood

HYPERURICEMIA -may arise because of a reduction in the renal elimination of uric acid, an increase in uric acid production, or a

combination of these two factors

URIC ACID is an agent formed in the body by protein breakdown

-either be derived from dietary protein sources or from the breakdown of body

tissues

-not metabolized by the body

-it is generally excreted in the urine

In GOUT, uric acid precipitates from saturated body fluids as crystals

(TOPHI) which deposits in tissues and joints

This may cause GOUTY

ARTHRITIS, a condition

characterized by inflammation at the

site of crystal deposition and acute joint pain

MANAGEMENT OF ACUTE GOUTY ARTHRITIS

COLCHICINE

-drug of choice for acute attack of gout-particularly beneficial in clients who are hypersensitive to aspirin and NSAIDs

-Colchicine relieves pain and confirms the diagnosis of gout

CONTROL OF HYPERURICEMIA

-aimed at reducing serum urate levels to below 6mg/dl

-at this level, tophi do not form within the joints and tissues of the body

CONTROL OF HYPERURICEMIA

URICOSURIC AGENTS (Probenecid, Sulfinpyrazone) – increase the urinary

excretion of uric acid

XANTHINE OXIDASE INHIBITORS (Allopurinol) – preventing the formation

of uric acid in the body

URICOSURIC AGENTS

Example: Probenecid (Benemid), Sulfinpyrazone (Anturane)

-these agents increase uric acid excretion by preventing the

reabsorption of uric acid in the renal tubules

NURSING IMPLICATIONS:

-encourage client to drink large volumes of water (10-12 8-ounce glasses) daily to prevent increase UA concentration in the urine

NURSING IMPLICATIONS:

-Sulfinpyrazone (Anturane) is capable of affecting platelet function

XANTHINE OXIDASE INHIBITORS

Example: Allopurinol (Zyloprim)

-interferes with the conversion of purines to uric acid by inhibiting the

enzyme xanthine oxidase

NURSING IMPLICATIONS:

-May cause skin rashes and/or hepatotoxicty in some clients

-Avoid foods that are rich in purine

SOME FOODS HIGH IN PURINES

anchoviesBaconBeer

CodfishGoose

Mackerel Organ meats

SalmonSardinesScallopsTurkeyVeal

KEY NURSING IMPLICATIONS IN THE USE OF HYPERURICEMIA

Assess the client taking colchicine for nausea and loose stools

Local tissue reactions can occur with infiltration of colchicine

Treatment should be initiated at the first sign of an attack of gout

KEY NURSING IMPLICATIONS IN THE USE OF HYPERURICEMIA

Factors that may produce attacks include a high fat diet, purine rich foods, thiazide diuretics, liver extracts, penicillin, levodopa, ethambutol

Aspirin is avoided when probenecid or sulfinpyrazone is used

KEY NURSING IMPLICATIONS IN THE USE OF HYPERURICEMIA

Fluid intake is encouraged during probenecid, sulfinpyrazone, and allopurinol therapy

Notify the prescriber promptly if skin rash occurs during allopurinol