Pharmacology, part 30: Musculoskeletal Medications for Gout

by Cathy Parkes March 30, 2021 Updated: September 23, 2021

In this article, we cover the most important medications you need to know for gout, including colchicine for an acute gout attack, probenecid to excrete uric acid, and allopurinol to prevent uric acid production. We'll start with some background on gout, including the difference between acute and chronic gout. BONUS: Learn where our Cool Chicken hints got started!

The Nursing Pharmacology video series follows along with our Pharmacology Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Cool Chicken When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!

Gout

Gout is a metabolic disease that causes hyperuricemia and uric acid crystals to be deposited in the joints, which can lead to pain, inflammation, and acute arthritis. The signs and symptoms of gout include joint pain, redness, swelling, and tophi (a nodular mass) in the big toe.

If you'd like to learn more about gout, check out our Medical-Surgical flashcards for nursing students — gout is one of the musculoskeletal disorders covered, along with its pathophysiology, risk factors, signs/symptoms, diagnostics, treatment, and patient teaching; as well as an A&P refresher on the musculoskeletal system.

Hyperuricemia

Hyperuricemia is an excess of uric acid buildup in the blood. One of the kidneys' key functions is to eliminate waste products from the body, and uric acid is one of those waste products. Uric acid crystals can provoke an inflammatory immune response.

Acute gout attack

An acute gout attack is a painful episode of gout, usually only affecting only one joint. Often this happens in the big toe.

Why does gout often affect the big toe?

Gout often affects the big toe because of its cool temperature compared to the rest of the body (uric acid crystallizes more at lower temperatures), the foot/toe's increased susceptibility to trauma/stress (e.g. stubbing the toe), and the prevalence of osteoarthritis at this joint.

Chronic gout

Chronic gout is repeated episodes of gout pain and inflammation, potentially affecting more than one joint.

Acute gout attack - Colchicine (Colcrys)

Colchicine is a medication used to decrease pain and inflammation in an acute gout attack. It is in a class of medications known as anti-gout agents.

Cool Chicken Colchicine: “Hey man, cool chicken. OUCH! That chicken just pecked my gouty toe.”

This is the original Cool Chicken tip that spawned all of the other Cool Chicken tips that we love here at Level Up RN!

Mode of action

Colchicine's mode of action is to interfere with white blood cells' initiation of the body's inflammatory immune response.

Side effects

Side effects of colchicine include GI upset and thrombocytopenia, which is a low platelet count that can make it hard for blood to clot.

Patient teaching

It's important to remember that patients taking colchicine should avoid grapefruit juice. When grapefruit juice is contraindicated for a drug, it's usually because it interferes with how the drug is metabolized and could cause an inappropriate amount of the drug in the body.

Uricosuric agent - Probenecid (Probalan)

Probenecid is a uricosuric agent used to treat hyperuricemia with chronic gout.

Cool Chicken Your chronic gout would benefit from probenecid.

Mode of action

Probenecid's (and other uricosurics') mode of action is to inhibit renal reabsorption of uric acid, which means that it increases renal excretion of uric acid. Increasing excretion through urine means that it decreases the concentration in blood.

Side effects

Side effects of probenecid can include GI upset and renal calculi.

What are renal calculi?

Renal calculi is another way to say kidney stones.

If you are an etymology nerd, you might guess that the calc- in calculi is for calcium, like a calcium deposit, but you'd be wrong! Calculi is from Latin meaning little stones, like you might find on an abacus (which, at the time, was used for calculating).

We created our Medical Terminology flashcards to make breaking down words into their parts easy, so you never have to be confused by an unfamiliar word on an exam!

Nursing care & patient teaching

If you have a patient taking probenecid for chronic gout, make sure to monitor uric acid levels and renal function during therapy. Encourage this patient to increase their fluid intake to prevent kidney stone formation.

Xanthine oxidase inhibitor - Allopurinol (Zyloprim)

Allopurinol is a xanthine oxidase inhibitor used to treat hyperuricemia with chronic gout.

Mode of action

Allopurinol's mode of action is to inhibit uric acid production. The difference between probenecid and allopurinol is that probenecid increases excretion of uric acid that has already appeared in the body, while allopurinol inhibits uric acid production in the first place.

Cool Chicken Allopurinol: Purify and get rid of allof that uric acid.

Side effects

Common side effects seen with allopurinol are GI upset, rash (Stevens-Johnson syndrome), hepatotoxicity (liver damage), and nephrotoxicity (kidney damage).

Nursing care & patient teaching

If you have a patient taking allopurinol for chronic gout, you will need to monitor their renal and liver function during therapy, and encourage them to increase their fluid intake to help prevent formation of a kidney stone. Patients should be made aware that allopurinol takes 2-6 weeks before they will see an improvement in their chronic gout symptoms.


Full Transcript

Alright. In this video, we are going to wrap up our coverage of musculoskeletal medications. Specifically, I will be covering medications that are used for gout.

So the first medication I want to talk about is a med that is used for an acute gout attack, and that is colchicine.

So colchicine can help reduce the pain and inflammation in an acute gout attack by interfering with the white blood cells' initiation of the inflammatory response in the body.

Side effects can include GI upset as well as thrombocytopenia.

In terms of patient teaching, we want to encourage our patient to increase their fluid intake and also let them know that they should not consume grapefruit juice while taking colchicine.

So the way I remember this medication is that colchicine looks like cool chicken, and my little tip for this is actually what kicked off the whole cool chicken icon and cool chicken craze.

So if a guy, he's got his chicken, and he sees his friend, and his friend's like, "Hey, man. Cool chicken," and the guy is like, "Thanks," but then the chicken pecks the friend's gouty toe. And the guy is like, "Oh, my gouty toe. Your chicken just pecked it." And so that just helps me to remember that when I see cool chicken or colchicine, I think about that chicken pecking somebody's gouty toe, and it helps me to remember that colchicine is used for an acute gout attack.

Alright. Let's now talk about a uricosuric agent which is used to treat chronic gout. This is Probenecid. Probenecid helps to treat hyperuricemia with chronic gout by inhibiting renal reabsorption of uric acid. So it basically helps to improve excretion of that uric acid.

Side effects can include GI upset as well as renal calculi, which is a fancy name for a kidney stone.

So when your patient is on this medication, you want to encourage them to increase their fluid intake to help prevent formation of a kidney stone.

In addition, we're going to want to monitor their uric acid levels as well as their renal function during therapy. In terms of how I remember this, if you look at the drug name, Probenecid, that "-bene-" helps to remind me of benefit, so I think, "Your chronic gout would benefit from Probenecid."

Alright. Let's now talk about a xanthine oxidase inhibitor, which is allopurinol.

So just like with Probenecid, allopurinol helps to treat hyperuricemia with chronic gout.

However, its mode of action is different. So instead of promoting excretion of uric acid, allopurinol helps to inhibit uric acid production in the first place.

In terms of side effects, there are some more serious side effects with this medication. This includes GI upset, a rash, as well as hepatotoxicity, and nephrotoxicity.

So patient teaching. We're going to definitely encourage our patient to increase their fluid intake. We also need to really monitor their liver and renal function during therapy, and we should also let our patient know that it takes about two to six weeks before they see an improvement in symptoms.

In terms of how I remember what this medication is for, when I look at the drug name allopurinol, it makes me think, "Purify and get rid of all of that uric acid." So, hopefully, that's helpful for you.

That wraps up our coverage of gout medications and our coverage of musculoskeletal medications! So next up, I will be talking about endocrine medications. If you have found value in this video, be sure to like and subscribe to us here at Level Up RN, and tell your friends in nursing school and your classmates about our channel as well!


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