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