Take this medicine, be careful that the patient's gout will not get better!

*For medical professionals to read and reference, and remind everyone to "avoid pits" Hyperuricemia and gout are common metabolic diseases, and the rational use of related drugs can make uric acid reach the standard as soon as possible and delay the progression of the disease
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What drug problems often exist in clinical use? How should we handle it? 1.
Overdose prescription: A 39-year-old male patient, diagnosed with gouty arthritis (acute phase), was prescribed colchicine tablets 2 mg three times a day, orally
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Analysis: During the acute attack of gout, it is recommended to use low-dose colchicine or non-steroidal anti-inflammatory drugs as soon as possible (sufficient dose, short course of treatment)
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For the acute stage of gout, the initial loading dose of colchicine is 1 mg orally, followed by an additional 0.
5 mg after 1 hour, and 0.
5 mg/time, 1-2 times/day after 12 hours until the symptoms are completely relieved
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The second indication is not suitable for prescription: a 42-year-old male patient, diagnosed with gout (acute attack), checked the serum uric acid 525µmol/L, and prescribed allopurinol tablets 100mg twice a day, orally
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Analysis: Allopurinol can not be used for acute gout attack, mainly for recurrent gout or chronic gout
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The use of allopurinol in the acute phase not only has no anti-inflammatory and analgesic effect, but also causes the rapid decrease of blood uric acid, which causes the acute attack of gouty arthritis
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Allopurinol must be started after the acute symptoms have disappeared (usually about 2 weeks after the onset)
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Drug prescription for three special groups: the patient female, 28 years old, 18 weeks of pregnancy, diagnosed with primary hyperuricemia
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Prescribe allopurinol tablets 50mg, twice a day, orally
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Analysis: Allopurinol is contraindicated in pregnant women and lactating women
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For pregnant women with hyperuricemia, febuxostat should be given priority only when the benefits outweigh the risks
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Four drug interaction prescriptions: The patient male, 39 years old, was diagnosed with rheumatoid arthritis and gout
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Prescribe azathioprine tablets 50mg once a day (qd) orally (po); Febuxostat tablets 40mg qd po
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Analysis: Febuxostat may inhibit the metabolism of azathioprine mediated by hepatic xanthine oxidase, the plasma concentration and pharmacological effects of azathioprine may increase, and bone marrow suppression (leukopenia, thrombocytopenia and anemia) may occur, so Combining the two is not recommended
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Five drug choices are not suitable for prescription: the patient is male, 45 years old, diagnosed with hyperuricemia and hypertension
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Prescribe febuxostat tablets 40mg qd po; hydrochlorothiazide tablets 25mg qd po
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Analysis: Hydrochlorothiazide tablets can affect the excretion of uric acid.
For hyperuricemia complicated with hypertension, losartan and/or calcium channel blockers are the first choice.
Thiazides and loop diuretics are not recommended for antihypertensive therapy alone
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Six contraindications prescription: male patient, 50 years old, diagnosed with hyperuricemia, renal insufficiency, examination showed renal function glomerular filtration rate (eGFR) 15ml·min-1·(1.
73m2)-1, prescribed phenyl bromide Malone tablets 50mg qd po
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Analysis: Benzbromarone is contraindicated in patients with moderate to severe renal impairment (glomerular filtration rate <20ml/min)
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According to the stage of renal function, the initial dose and maximum dose of the drug should be adjusted in time, eGFR<30ml•min-1•(1.
73 m2)-1, and febuxostat is the priority for uric acid-lowering drugs
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References: [1] Endocrinology Branch of Chinese Medical Association.
Guidelines for Diagnosis and Treatment of Hyperuricemia and Gout in China (2019) [J].
2020,36(1).