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