Anti-gout agents

ANTIGOUT DRUGS GOUT metabolic disease of unknown cause Inflammation attacks joints, tendons & tissues defect in purine( shellfish, organs, meat) metabolism HYPERURICEMIA (hallmark if gout)

Treatment Goals 1. End acute gouty attack ASAP 2. Prevent recurrence of acute gouty arthritis 3. Prevent formation of uric acid stone in kidney 4. Decrease or prevent disease complications that result from Na urate deposit in joints( tophi), kidneys Gouty arthritis Anti-gout agents Uric acid inhibitors Uricosurics Others Anti gout drugs:

Colchicine For acute gouty attacks Exact action mechanism not known motility of leukocytes, phagocytosis Inhibits migration of WBC to inflamed joints thus inhibiting uric acid deposition Side effects : n/v ,diarrhea, gastric distress NURSING RESPONSIBILITIES (Colchicine)

1. with food/ milk if given po 2. Up fluids 3. Avoid alcoholic beverages Up GI s/s, up UA

4. If given per IV administer over a period of 2-5 mins Avoid extravasation Incompatible with D5 solution

5. Call MD if diarrhea occurs 6. Avoid Caffeine ( decrease med absorption) Anti gout drugs: Uric acid inhibitors

ALLOPURINOL (ZYLOPRIM) Inhibit xanthine oxidase >= production of UA Drug interaction Amoxicillin or ampicillin >= risk of rash effect of coumadin ,oral hypoglycemics, theophyline ACE inhibitors >=up hypersensitivity Mgt : Up fluids Anti-gout drugs: Uricosurics Reduces reabsorption of UA at PCT Common Drugs: Probenecid Sulfinpyrazone

URICOSURICS (Probenecid)

 Drug Interaction Ketoprofen - renal excretion of ketoprofen Antineoplastic agents UA, nephropathy ASA - renal excretion of ASA Heparin prolonged effect of heparin Nitrofurantoin ( Macrodantin) - toxic effect of nitrofurantoin Adverse Effects + MGT UA stone formation Headache N/V GI pain Bleeding Hypoglycemia Anti Gout Agents

Adverse Reactions + MGT: Rash Bone marrow depression N/V with Abdominal pain Nursing Care for Clients taking Anti Gout Medications Up fluid intake Monitor renal function (BUN,Creatinine) Give with milk or food Limit intake of Purine rich foods (shellfish, organs, meat) Avoid Alcohol & Caffeine

In Summary

Anti Inflammatory Agents Nonsteroidal anti-inflammatory drugs ( NSAIDS) Acetic acids Carboxylic acids / Salicylates Propionic acids Enolic acids Fenamic acid/ Fenamates Nonacidic compounds

Disease modifying anti- rheumatic drugs (DMARD) Gold Compounds Etanercept Leflunomide Penicillamine Sodium Hyaluronate

Corticosteroids (glucocorticoids,mineralocorticoids) Other related drugs Acetaminophen Other Antiarthritis (antimalarials, immunosuppressives drugs) Antigout (uric acid inhibitors, uricosurics, colchicine)