Gout Management

Gout: - Acute therapy: - NSAIDS (naproxen 750-1000mg daily x day!" then 500-750 daily x #-7 day!$ (indomethacin 150-%00mg x day!" then 100mg daily x #-7 day!$ - can u!e &'(-% in patient! )ith GI contraindication! (celecoxi* #00mg on day 1" then %00mg daily x +-10 day!$ - can al!o u!e opioid!" may*e ice" may*e ,o-ran - intraarticular !teroid! '. corticotropin '. high-do!e predni!one (#0-+0mg daily x day!" then taper *y 10-15mg daily$ *ut *e !ure to exclude in-ection - can gi/e patient! .x -or oral colchicine 00+mg e/ery hour x -or a*orting acute attac1! - impaired renal -unction: 00+mg *id i- &r&l 2503 00+ 4d i- &r&l 5-503 00+ 4od i- &r&l 5 5 - elderly: reduce do!e *y hal- &hronic therapy - )hen to u!e long-term uric acid-lo)ering therapy: tophi" or more attac1! per year" cyclo!porine u!e" uric acid o/erproduction - can u!ually !1ip %#-hr urine urate and treat empirically )ith allopurinol once daily in A6 - Allopurinol renal do!ing: 00mg 4d i- &r&l 2703 %00mg 4d i- &r&l +0-703 100mg 4d i&r &l 0-+03 50mg 4d i- &r&l 5 0 - chronic therapy: can u!e lo)-do!e colchicine *ut lot! o- !ide e--ect! and med interaction!