1. Agents Used to Treat Hyperuricemia and Gout
Chapter 13
Agents Used to Treat Hyperuricemia and Gout

2. Gout metabolic dx: hyperuricemia, arthritis
metabolic defect - not caused by meat, alcohol, though diets limit
Affects approximately 2.1 million people in the US

3. Gout
Possibly d/t decreased elimination of uric acid from the kidneys or an increase in uric acid production
More men than women
Starts in middle age

4. Uric Acid Uric acid is formed from the breakdown of purines
The accumulation of uric acid causes deposits in the joints and kidneys:
Kidney stones
Kidney failure
Gouty arthritis
Hyperuricemia

5. Acute Attacks
Acute attacks:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Corticosteroids
Colchicine: intravenously or orally

6. Agents Used Corticosteroids and NSAIDs
Produce anti-inflammatory effects
Produce analgesic effects
Colchicine’s action is unclear
Reduces leukocyte production of lactic acid

7. Colchicine Major adverse effects: Nausea, vomiting, and diarrhea
Gastrointestinal bleeding
Neuritis
Myopathy
Alopecia
Bone marrow depression
Not first-line drug

8. Long-term Control Most commonly used agent for gout:
Allopurinol: prevents formation of uric acid
Adverse effects: hepatotoxicity and skin rash

9. Gouty Arthritis
Most commonly used agent
NSAIDs
Indomethacin (Indocin)
Naproxen (Aleve)
Sulindac (Clinoril)

10. Uricosuric Agents
Increase excretion of uric acid
Probenecid (Benemid)
Side effects
Headaches
Dizziness

11. Sulfinpyrazone (Anturane) Side effects Nausea and vomiting Diarrhea
Uricosuric Agents
Sulfinpyrazone (Anturane)
Side effects
Nausea and vomiting
Diarrhea

12. Therapeutic Effects Monitor for: Decreased inflammation Decreased pain
Ease of movement
Monitor lab values of uric acid
Monitor urine output

13. Nursing Considerations
Kidney stones
Encourage water intake
Blood levels of certain drugs may be elevated (i.e. antibiotics)
Aspirin may negate the effects of probenecid

14. Nursing Considerations
Educate patients on foods high in purines
Assess patients knowledge of disease process and medication management
Assess effectiveness of treatment
Assess pain and address pain management