NOTES

Colchicine: Used to prevent gout flares.

Allopurinol: Do not start during a gout attack. It will make it worse. If a patient starts it during an attack, tell them to stop and restart once the attack is over.

When should we use colchicine, NSAIDs, oral steroids, or injected steroids?

• NP boards want to ensure you assess the situation and the patient individually. 

• Oral steroids: giving too much will cause problems. Prescribe them if injected steroids or NSAIDs (gi bleed) are contraindicated. 

  • Examples of oral steroids: prednisone, prednisolone.

  • Warning: they can increase glucose levels in diabetic patients. You should avoid oral steroids if you tried them in the past and they were ineffective. 

  • They are not recommended with wound healing (diabetic ulcer).

• Injection steroids: Inject only once or twice in just ONE area. 

• NSAIDs: naproxen 500 mg bId, indomethacin 50 mg TID.

  • OK to give patients less than 60 years old.

  • Contraindicated if: renal, cardiac, or GI problems are present.

• Colchicine: less effective if taken less than 24 hours from the flare. But if it worked in the past, continue with it. Drug interaction is minimal and does well if the patient is on multiple drugs. OK for patients with kidney disease, hepatic problems, and if you are worried about P450 drug interaction.

*Asses the situation

*Past medical history: gi bleed? On multiple meds? One vs multiple joints affected? Have they used this med in the past? Has it worked?