Gout

A 30 yrs old female age of 45 years was admittedSudden and severe pain in a joint ,usually in the middle of the night or early morning since 3 mths was diagnosed as Gout

1. CASE PRESENTATION ON GOUT P.Asma Afreen 15EA1T0018 Pharm.D V Yr

2. PATIENT DETAILS Name :- Sravani Age :- 45 years Gender :- Female Ward :- Female medical ward

3. CHIEF COMPLAINTS Sudden and severe pain in a joint ,usually in the middle of the night or early morning since 3 months. Tenderness in the joint. Stiffness in the joint

4. ON EXAMINATION GC :- Fair BP :- 120/80mmHg RS :- NVBS PR :- 80 Bpm CVS :- S1 S2 Present P/A :- Soft

5. LAB INVESTIGATIONS CBP RESULT NORMAL VALUES HB 12 gm/dl 13.0-18.0gm/dl TC(WBC) 6000 cells/cumm 4000-11000cells/cumm Neutrophiles 57 % 40-70% Eosinophiles 04 % 0-6% Lymphocytes 30 % 20-45% Monocytes 03 % 02-10% Platelets 2.0 lakhs /cumm 1.5-4.0lakhs/cumm S. Creatinine 3 mg/dl 0.6-1.2mg\dl Uric acid 8.0 mg/dl 2.5 – 7.5 mg/dl

6. DIAGNOSIS GOUT

7. SOAP NOTES SUBJECTIVE A 30 yrs old female age of 45 years was admitted in female surgical ward of vishwa bharathi hospital with the chief complaints of following: Sudden and severe pain in a joint ,usually in the middle of the night or early morning since 3 mths. Tenderness in the joint. Stiffness in the joint

8. OBJECTIVE S.NO TEST RESULT NORMAL VALUES 1 HB 12 gm/dl 13.0-18.0gm/dl 2 S. Creatinine 3 mg/dl 0.6-1.2mg/dl 3 Uric acid 8.0 mg/dl 2.5 – 7.5 mg/dl Joint fluid analysis( aspiration ): Urate crystals was observed

9. ASSESSMENT Based on the subjective and objective finding the physician diagnosed that the patient was suffering from Gout

10. DEFINITION Gout is a form of inflammatory arthritis that develops in some people who have high levels of uric acid in the blood. The acid can form needle-like crystals in a joint and cause sudden, severe episodes of pain, tenderness, redness, warmth and swelling.

11. ETIOLOGY Mechanism to excrete the uric acid is defective. Over production of uric acid Medications Purine rich foods Hyperuricaemia may also be caused by blood conditions such as lymphoma, leukaemia and haemolytic anaemia (where blood cells are destroyed), and by other cancers or psoriasis Some foods may contribute to high blood levels of urate

12. PATHOPHYSIOLOGY

13. CLINICAL MANIFESTATIONS Intense joint pain. Lingering discomfort: After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Inflammation and redness: The affected joint or joints become swollen, tender, warm and red. Limited range of motion

14. DIAGNOSIS Joint fluid test.   Doctor may use a needle to draw fluid from your affected joint. Urate crystals may be visible when the fluid is examined under a microscope. Blood test.   Doctor may recommend a blood test to measure the levels of uric acid and creatinine in your blood. X-ray imaging.  Joint x-rays can be helpful to rule out other causes of joint inflammation. Ultrasound.  Musculoskeletal ultrasound can detect urate crystals in a joint or in a tophus.. Dual energy ct scan.  This type of imaging can detect the presence of urate crystals in a joint, even when it is not acutely inflamed..

15. STANDARD THERAPY Nonsteroidal anti-inflammatory drugs (NSAIDS).  Nsaids include over-the-counter options such as ibuprofen (advil, motrin IB, others) and naproxen sodium (aleve), as well as more-powerful prescription nsaids such as indomethacin (indocin) or celecoxib (celebrex). Colchicine.   Doctor may recommend colchicine (colcrys, mitigare), a type of pain reliever that effectively reduces gout pain. Corticosteroids.  Corticosteroid medications, such as the drug prednisone, may control gout inflammation and pain. Corticosteroids are generally used only in people with gout who can't take either nsaids or colchicine..

16. Medications to prevent gout complications : Medications that block uric acid production.  Drugs called xanthine oxidase inhibitors ( xois ), including allopurinol ( aloprim , lopurin , zyloprim ) and febuxostat ( uloric ), limit the amount of uric acid your body makes. This may lower your blood's uric acid level and reduce your risk of gout. Medication that improves uric acid removal.  These drugs, called uricosurics , include probenecid ( probalan ) and lesinurad ( zurampic ). Uricosuric drugs improve your kidneys' ability to remove uric acid from your body. This may lower your uric acid levels and reduce your risk of gout, but the level of uric acid in your urine is increased.

17. S.no Brand name Generic name Dose ROA Frequency 1 2 3 4 5 1. Colcrys Colchicine 1.2 g oral BD 2 Orudis Ketoprofen 100mg oral BD 3. Aleve Naproxen 200mg Oral BD 4. Ij. Rantac Ranitidine 150 mg IV BD PLAN

18. PHARMACIST INTERVENTIONS DRUG – DRUG INTERACTIONS Ketoprofen  naproxen Effect : Both increase anticoagulation & serum potassium. Management : By changing frequency or using alternative drug

19. PATIENT COUNSELLING Limiting alcoholic beverages and drinks sweetened with fruit sugar (fructose). Instead, drink plenty of nonalcoholic beverages, especially water. Limiting intake of foods high in purines, such as red meat, organ meats and seafood. Exercising regularly and losing weight. Keeping your body at a healthy weight reduces risk of gout. Certain foods have been studied for their potential to lower uric acid levels, including: Coffee Vitamin C. Supplements containing vitamin C may reduce the levels of uric acid in blood. Cherries. Cherries have been reported to lower levels of uric acid, as well as reduce the number of gout attacks. Eating more cherries and drinking cherry extract may be a safe way to supplement your gout treatment. Drink plenty of fluids. . Limit your intake of meat, fish and poultry.  Check uric acid levels twice a year

20. Thank you