Question 1

A patient who is taking colchicine for gout is in the clinic 1 week after beginning the medication.The patient reports decreased appetite and nausea.The primary care NP should:&#10;A) suspect worsening of gouty arthritis.&#10;B) order vitamin B12 levels to assess for vitamin deficiency.&#10;C) discontinue the colchicine for 48 hours until symptoms subside.&#10;D) reassure the patient that these are common, temporary side effects.

Accepted Answer

Colchicine toxicity causes nausea,vomiting,and anorexia.When toxicity is suspected,the medication should be temporarily discontinued and restarted after symptoms subside.

Question 2

A patient comes to the clinic reporting sudden pain and swelling of one knee joint.The primary care NP suspects gout.When preparing to order diagnostic tests,the most important initial test the primary care NP should order is:

A) renal function tests.
B) serum uric acid levels.
C) 24-hour urine collection.
D) synovial fluid aspirate for Gram stain and culture.

Accepted Answer

Although the other tests are part of the diagnostic process,the most important differential diagnosis to be made in a patient with gout is the exclusion of a septic joint.

Question 3

A patient who has a previous history of renal stones will begin taking probenecid for gout.The primary care NP should:&#10;A) add colchicine to the patient's drug regimen.&#10;B) counsel the patient to use high-dose aspirin for pain.&#10;C) teach the patient to drink plenty of acidic fluids such as juice.&#10;D) tell the patient to stop taking the medication when symptoms subside.

Accepted Answer

Patients at risk for urinary stones may take colchicine along with probenecid to reduce the risk caused by probenecid.Salicylates and acidic urine increase the risk.The medication must be tapered 6 months after the last acute attack.

Question 4

A patient with a history of gouty arthritis comes to the clinic with acute pain and swelling of the great toe.The patient is not currently taking any medications.The primary care NP should prescribe:&#10;A) naproxen.&#10;B) colchicine.&#10;C) probenecid.&#10;D) allopurinol.

Accepted Answer

Naproxen is the first medication given for an attack of acute gouty arthritis to stop the inflammatory response.Pharmacologic treatment for hyperuricemia must be started after the acute attack has subsided.

Question 5

A patient who has hypertension is taking a thiazide diuretic.The patient has a serum uric acid level of 8 mg/dL.The primary care nurse practitioner (NP)caring for this patient should:&#10;A) prescribe colchicine.&#10;B) discontinue the thiazide diuretic.&#10;C) order a 24-hour urine collection.&#10;D) refer the patient to a rheumatologist.

Accepted Answer

Patients who have hypertension or who take thiazide diuretics are at increased risk for gout.An elevated uric acid level alone is not diagnostic,and a 24-hour urine collection should be ordered.Colchicine should not be prescribed until the diagnosis is confirmed.It is not necessary to discontinue the thiazide diuretic.A referral to a specialist is not indicated.

Question 6

A patient who is obese and has hypertension is taking a thiazide diuretic and develops gouty arthritis,which is treated with probenecid.At a follow-up visit,the patient's serum uric acid level is 7 mg/dL,and the patient denies any current symptoms.The primary care NP should discontinue the probenecid and:

A) prescribe colchicine.
B) prescribe febuxostat.
C) tell the patient to use an NSAID if symptoms recur.
D) counsel the patient to report recurrence of symptoms.

Accepted Answer

Colchicine is a first-line drug for preventing acute attacks.Because this patient has three risk factors,a preventive medication should be used.Febuxostat is a second-line preventive medication.The patient should not be treated on an as-needed basis.

Question 7

A primary care NP prescribes probenecid to treat a patient who has gout.The patient comes to the clinic 2 weeks later with severe flank pain.The NP should:&#10;A) ask the patient about fluid intake.&#10;B) order a urinalysis and urine culture.&#10;C) change the medication to allopurinol.&#10;D) recommend nonsteroidal antiinflammatory drugs (NSAIDs) to treat flank pain.

Accepted Answer

Uricosuric agents are tubular blocking agents and decrease serum uric acid levels by increasing urinary excretion of uric acid.During this process,high concentrations of uric acid develop in the proximal renal tubules and may predispose the patient to the development of urinary stones.Patients should be encouraged to drink plenty of fluids.The patient who presents with flank pain should be questioned about fluid intake.If fluid intake is sufficient and renal stones are ruled out,a urinary tract infection may be considered.Allopurinol is not indicated.NSAIDs are not indicated.

Question 8

Gout is diagnosed in a patient,and tests show the cause to be an underexcretion of uric acid.The primary care NP should prescribe:&#10;A) febuxostat (Uloric).&#10;B) colchicine (Colcrys).&#10;C) allopurinol (Zyloprim).&#10;D) probenecid (Benemid).

Accepted Answer

A uricosuric agent is indicated to increase the excretion of uric acid.Probenecid is a uricosuric medication.Febuxostat and allopurinol are xanthine oxidase inhibitors.Colchicine is not a uricosuric agent.

Deck 38: Gout Medications