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 8ounce 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
anchovies Bacon Beer Codfish Goose Mackerel Organ meats Salmon Sardines Scallops Turkey Veal

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

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