Gout

Uric acid >7.5mg/dL, normal in up to 25%, acute attack (increase ESR and WBC), sodium urate crystals in joint fluid

Asymptomatic Hyperuricemia (DONT TREAT), NSAIDs treatment of choice (Naproxen 500mg/Indomethacin 25-50mg)

Used for attack less than 36 hr, loading dose 1.2 mg then .6 1 hour later

Symptomatic relief, used when NSAID contraindicated, IV, PO, intra-articular

If monoarticular use injection, joint aspiration w/culture and gram stain recommended with intra-articular corticosteroids

Minimize urate deposition in tissue, reduce requency and severity of recurrences

Avoid hyperuricemia, medications (thiazides, loop diuretics, low dose ASA), ETOH, high purine foods (meat, seafood, lentils)

Prevent attacks in mild hyperuricemia, suppress attacks when urate-lowering therapy is initiated

Rapidly lowers plasma urate and urinary uric acid concentrations, tophus mobilization, uric acid renal calculi, unresponsive to uricosurics

Initiated at 300mg/dL, then 300-400mg daily, can be increased in a week (max 800),

Can cause hypersensitivity in w/ampicillin, increase half-life of probenecid, probeneacid increases secretion of allopurinol. CKD use ok

Given without does adjustment in mild to moderate kidney disease, abnormal LFTs, initial does 40 mg/dl po max dose of 80 mg

Decrease uric acid levels, block tubular reabsorptionof filtered urate, prevent new tophi, reduces size of tophi

Hypersensitvity with fever and rash, GI disterbance, Do not use in pt w/ hx uric acid nepholithiasis. Atleast 2L/day urine output