Probenecid should not be used if a patient has a creatinine clearance below 50 mL/min (Aung et al., 2017). A third-line of therapy is pegloticase, a urate-specific enzyme, which is an intravenous medication and should not be used with other chronic gout drugs (Arcangelo et al., 2017; Aung et al., 2017). Drug Therapy for Acute Gout AttackAcute gout attacks can be mild, moderate, or severe based off the pain scale and the provider needs to determine which the patient is experiencing before prescribing therapy (Arcangelo et al., 2017). First-line therapy for individuals with mild or moderate pain due to acute gout includes nonsteroidal anti-inflammatory drugs (NSAIDs), systemic corticosteroids, or colchicine (Arcangelo et at., 2017). NSAIDs such as naproxen, indomethacin, and sulindac needto be started at the beginning of an attack and continued 24 hours after the symptoms resolve (Arcangelo et al., 2017). Corticosteroids decrease inflammation during gout attacks and can be delivered systemically or orally; however, intra-articular doses can be given in one to two large joints (Arcangelo et al., 2017). Colchicine decreases pain and inflammation by reducing neutrophils that attack the affected joints. Colchicine should be given within 24 hours of the start
of the symptoms and should not be prescribed if it has been more than 36 hours (Arcangelo et al.,2017). Colchicine is also used as prophylaxis when chronic gout medication is started to avert acute gout attacks (Arcangelo et al., 2017). Patient Factor: AgeGout becomes more prevalent with age. Gout occurs more often in men between 35-39 years old and then decreased with age; however, younger women are diagnosed less frequently but post menopause the chances of developing gout increase (Abhiskek, 2017). Elderly people with gout often presents with more comorbidities which can present challenges when deciding on the appropriate therapy. Older individuals with peptic ulcer disease, CKD, and taking certain medications such as diuretics, ACE inhibitors, and ARBs need to be given NSAIDs, corticosteroids, and colchicine with caution to avoid dangerous adverse effects (Abhiskek, 2017).Congestive heart failure can become exacerbated with corticosteroids and medications that are inhibitors of cytochrome P4503A4 and P-glycoprotein such as clarithromycin, erythromycin, andcyclosporine should not be given with colchicine or the dose of colchicine should be reduced (Abhiskek, 2017). Oral prednisolone is the preferred choice of medications for acute gout flares over low-dose colchicine and NSAIDs (Abhiskek, 2017). Measure to Reduce Negative Side EffectsModifications to diet is the first step to decreasing acute gout flares along with smoking cessation, weight loss, and treating diabetes, coronary artery disease, obesity, hyperlipidemia, and hypertension (Arcangelo et al., 2017). Individualized care plans, explaining adverse effects and patient teaching help increase adherence and reduce negative outcomes.
- Summer '15