Gout is a recurrent inflammatory disorder caused by high uric acid levels in the blood (hyperuricemia) which can lead to severe joint pain. Drugs like NSAIDs, glucocorticoids, and colchicine are used to treat acute gout attacks by relieving symptoms. Allopurinol and probenecid are commonly used to manage hyperuricemia long-term by reducing uric acid production or increasing its excretion. Nurses play an important role in properly administering these drugs and educating patients on lifestyle factors that affect gout.

1. DRUG THERAPY OF
GOUT

2. Outline
 Pathophysiology of Gout
 Clinical manifestation
 Approach to Gout management
 Drugs for Acute Gouty Arthritis
 Drugs for Hyperuricemia
 Nursing responsibilities in Management of Gout
 Summary

3. Pathophysiology of Gout
Gout is a recurrent inflammatory disorder
characterized by hyperuricemia (high
blood levels of uric acid) and episodes of
severe joint pain, typically in the large
toe.

4. HYPERURICEMIA
HERIDITARY
OBESITY &
WEIGHT GAIN
ALCOHOL
INTAKE
ABNORMAL
KIDNEY
FUNCTION
DRUGS
CRYSTALLIZ
ATION OF
SODIUM
URATE
TOPHI
FORMATION
CLINICAL
MANIFESTATION
OF GOUT

5. Clinical Manifestation of Gout
 Severe joint pain
 Anorexia
 Nausea
 Fever
 Tenderness and swelling of affected joint

6. Approach to Gout Management
Hyperuricemia
 To reduce formation
of uric acid
 To increase excretion
of uric acid
Acute Gout
 To relieve symptoms
resulting from acute
gout attack

7. Drugs for Acute Gouty Arthritis
 Non-Steroidal Anti-inflammatory Drugs
(NSAIDs)
 Glucocorticoids
 Colchicine

8. NSAIDs
Drug of Choice: Indomethacin
Group: Non-steroid, Anti-inflammatory, Anti-rheumatic, Anti-gout,
Anti-dysmenorrheal, and Analgesic
Acts by inhibiting prostaglandin synthesis
Dosage: 50mg, 3 times daily
Route: Oral
Side effects: Gastrointestinal reactions, Headache, dizziness,
tinnitus, fatigue, confusion
Contraindications: history of hypersensitivity to aspirin or other
NSAIDs, peptic ulcer, proctitis, rectal bleeding, pregnancy and
lactation, hepatic disorders, coagulation effects, cerebrovascular
disease, heart failure, renal failure

9. Glucocorticoids
Drug of Choice: Prednisolone
Group: Corticosteroid
Acts by facilitating glucogenesis, depresses 17-ketosteroids, and
suppresses inflammation by decreasing the release of prostaglandin
Dosage: 20-50mg, maintenance dose is 5-25mg daily
Route: Oral, Suppository, IM, IV.
Side effects: Peptic ulcer, mild hirsutism, osteoporosis, delayed
wound healing, hypertension, dyspepsia
Contraindications: Corneal ulceration, tuberculosis, active peptic
ulcer, psychoses, osteoporosis, renal dysfunction, diabetes
mellitus, myasthenia gravis, pregnancy, congestive heart failure,
glaucoma, hypertension

10. Colchicine
Group: Uricosuric, Anti-inflammatory, and Analgesic
Acts by increasing urinary excretion of uric acid, and reduces
inflammatory response to urate crystals
Dosage: 1.2mg initially followed by 1.2mg every 1 to 2 hours. The
total dose should not exceed 8mg
Route: Oral
Side effects: Nausea, Vommiting, Diarrhoea, Abdominal pain
Contraindications: Known GIT disorders, renal disorders, cardiac
disorders, pregnancy and lactation

11. Drugs for Hyperuricemia
 Allopurinol
 Probenecid

12. Allopurinol
Group: Anti-gout
Acts by inhibiting xanthine oxidase (XO)
Dosage: Prophylaxis of gout, adult initially 100mg daily as a single
dose; usual maintenance dose in mild conditions 100 – 200mg daily, in
moderately severe conditions 300 – 600mg daily
Route: Oral
Side effects: Skin rashes, malaise, muscle ache, vertigo, headache,
impotence, fever, neuropathy, nausea, oedema, somnolence
Contraindications: Acute gout

13. Probenecid
Group: Uricosuric Agent
Acts by inhibiting reabsorption of uric acid, thereby increasing its
excretion by the Kidneys
Dosage: Initial adult those 250mg twice daily for 1 week, increased
after a week to 500mg twice daily
Route: Oral
Side effects: Skin rashes, malaise, constipation, vomiting, headache,
polyuria, nausea, pruritis
Contraindications: Renal uric acid calculi, blood dyscasia, initiation of
therapy during acute attack, known hypersensitivity

14. Nursing Responsibilities in Managing
Acute Gout
 Where there are gastrointestinal reactions as mentioned above,
give with food or milk to minimize such effects.
 Indomethacin should not be administered concomitantly with
aspirin.
 Must not be administered to group of persons contraindicated
 Avoid rectal administration of Indomethacin in proctitis or
haemorrhoid.
 Regular blood examination for bleeding time.
 Counsel patient on the possible effect on driving and performance
of other skilled tasks such as drowsiness and alteration in motor co-
ordination.

15.  Advice patient to discontinue medication promptly and to notify
physician if visual disturbances occur.
 Withdrawal of Prednisolone therapy must always be gradual.
 Administer Colchicin on an empty stomach to enhance absorption;
but for maintenance therapy, give with meals to reduce GI effects.
 Monitor fluid intake and output: teach patient to increase fluid
intake to about 3 – 4 litres daily.
 Tell patient to avoid alcohol and over the counter preparations
containing alcohol.
 Discontinue Colchicin if nausea or vomiting occurs, if used for acute
attack, discontinue as soon as pain resolves or if nausea, vomiting
or diarrhoea occurs.

16. Nursing Responsibilities in Managing
Hyperuricemia
 Administer after meals with plenty of water. Patient should
increase fluid intake to about 3 – 4 litres daily.
 Discontinue the drug and contact physician at first sight of rash,
painful urination, blood in urine, irritation of eyes, or swelling of
lips or mouth.
 Colchicines or NSAID (not aspirin or salicylates) maybe prescribed
to prevent acute gouty attacks which may occur in first 6 weeks of
therapy with Allupurinol.
 Do not initiate therapy until acute attack subsides.

17.  Tell patient with gout to avoid hazardous activities, alcohol
and aspirin or other salicylates because they increase urate
level and may precipitate gout. Paracetamol may be used for
pain.
 The frequency and severity of acute attacks may increase
during the first 6 – 12 months of therapy with Probenacid:
colchicines or another anti-inflammatory agent may be
prescribed during first 3 – 6 months of therapy to prevent such
attacks.
 Provide low purine diet, restricting liver, kidneys, sardines,
peas.
 Probenecid is preferred to sulphinpyrazone because it has
lower incidence of GI and haemotological adverse reactions.

18. Summary
 Gout is metabolic inflammatory disorder
characterized by hyperuricaemia and episode joint
pain, typically in the big toe.
 NSAIDs and glucocorticoids are preferred drugs for
treating acute gouty attacks.
 Allopurinol and Probenecid are preferred drugs for
long term control of hyperurecemia.

19. END