Antigout Drugs
TERM
□ allopurinal (Zyloprim)
QUICK LOOK AT THE CHAPTER AHEAD
Gout is an inflammatory disorder that results in acute joint pain and is associated with impaired uric acid metabolism. This causes hyperuricemia, which can be a result of increased serum uric acid levels or impaired uric acid excretion. Uric acid is the end product of purine metabolism. Purines are found in certain foods such as organ meats; consequently, gout was once known as the “rich man’s disease.” When purines are metabolized, they are converted from hypoxanthine to xanthine and then to uric acid. When uric acid levels are elevated, this may cause the uric acid crystals to collect in the tissues and joints and cause pain.1
Nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids may also be used to treat gout. The NSAIDs are discussed in Chapter 36 and glucocorticoids in Chapter 51.
Table 38-1 Antigout Drugs | ||||||||||||
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ANTIGOUT DRUGS CLIENT TEACHING
Take medication exactly as prescribed.
If a dose is missed, remember to take as soon as remembered.
Increase fluid intake to at least 2000 mL/day to prevent urate stone formation.
Follow an alkaline diet if ordered to prevent urate stone formation.
Follow health care provider’s instructions regarding diet therapy and decreasing alcohol consumption.
Promptly report sore throats, bruising, petechiae, bleeding, fatigue, diarrhea, abdominal pain, and rash to the health care provider.
Do not take aspirin with probenecid (Benemid) or sulfinpyrazone (Anturane) as it decreases the effectiveness of probenecid and sulfinpyrazone.
Increase fluid intake to at least 2000 mL/day to prevent urate stone formation.
Promptly report sore throats, bruising, petechiae, bleeding, fatigue, diarrhea, abdominal pain, and rash to the health care provider.Allopurinal (Zyloprim)
May cause drowsiness and, thus, clients should not drive or operate heavy machinery until response to drug is known.
ACTIONAllopurinol (Zyloprim)
Inhibits uric acid production and lowers serum uric acid levels.
Colchicine
Not fully understood. Inhibits leukocyte migration.
Probenecid (Benemid) and Sulfinpyrazone (Anturane)
Increases the excretion of uric acid in urine. Note: sulfinpyrazone is chemically similar to phenylbutazone.
USEAllopurinol (Zyloprim)
Used orally to treat chronic gout, and orally or IV to treat secondary hyperuricemia related to malignancies
Colchicine
Used orally or IV to treat acute gout attacks and prophylactically for gout attacks
Probenecid (Benemid)
Used orally in prophylaxis of gout attacks. Can worsen an acute gout attack and should not be given until the attack subsides. Also used to prolong effects of penicillin and related anti-infectives
Sulfinpyrazone (Anturane)
Used orally to treat chronic gout. Also used to inhibit platelet aggregation
ADVERSE EFFECTS AND SIDE EFFECTSAllopurinol (Zyloprim)
Pregnancy category C
CNS: Occasional drowsiness, headache
Derm: Hypersensitivity, rash, fever, exfoliative dermatitis
GI: Nausea, vomiting, diarrhea, and hepatitis
Hematologic: Blood dyscrasias
Colchicine
Pregnancy category D
GI: Effects are most common and may cause nausea, vomiting, diarrhea, and abdominal pain
Hematologic: Agranulcytosis thrombocytopenia
Renal: Renal failure
Probenecid (Benemid)
Pregnancy category B
CNS: Headache
Derm: Rash
Hematologic: Aplastic anemia
Sulfinpyrazone (Anturane)
Pregnancy category C
CNS: Dizziness
Derm: Rash
GI: Effect most common and may include nausea, vomiting, abdominal pain, GI bleeding, and hepatic necrosis
Hematologic: Rare agranulocytosis
INTERACTIONS
