CCC Colchicine For Acute Gout Discussion

PLEASE ANSWER QUESTION “What role does colchicine play in acute gout?” AS A FOLLOW UP QUESTION IN THE DISCUSSION BELOW:

• What treatment should this patient receive to relieve symptoms during an asthma attack?
• In the case of a 12-year-old boy experiencing occasional asthma attacks during soccer, immediate relief from symptoms during an asthma attack should involve administering a short-acting beta-agonist (SABA) such as Levalbuterol. As stated by McGurran et al. (2019), Levalbuterol, available in inhaler form, offers a rapid response with a recommended dose of two inhalations as needed, not exceeding every 4-6 hours. The mechanism of Levalbuterol involves bronchodilation, relaxing the smooth muscles in the airways to alleviate bronchoconstriction.

Q2. If the patient’s asthma attacks occur more frequently, what changes in therapy might be appropriate?

When asthma attacks become more frequent, it is vital to consider stepping up the therapeutic approach to maintain optimal asthma control. One effective strategy is a low to moderate-dose inhaled corticosteroid (ICS), such as mometasone or beclomethasone. This approach is highly recommended for children with persistent asthma symptoms. It is also important to tailor this medication to the severity of the patient’s asthma symptoms. 

Q3. What will you assess to determine if this patient is a good candidate for contraceptives, and what will you prescribe? (Include brand and generic name, route, frequency, and dose). What is the mechanism of action of the contraceptive you prescribed and the adverse effects?

It is crucial to evaluate the patient’s medical history and lifestyle when assessing her for contraceptives. A combination oral contraceptive (COC) may be prescribed for this patient. An alternative COC brand is “Loestrin 24 Fe” (trade name: ferrous fumarate), containing ethinyl estradiol and norethindrone (Fischer et al., 2021). The dosing regimen for this medication involves taking one pill daily at the same time each day. The specific brand and regimen can vary based on individual patient factors. The mechanism of action of Loestrin 24 Fe involves suppressing ovulation by inhibiting the release of gonadotropins and thickening cervical mucus to impede sperm penetration. Adverse effects can include breakthrough bleeding, breast tenderness, and, rarely, more severe complications like blood clots or cardiovascular events.

Q4.  The patient states she heard a pill can help her acne. What would you prescribe and what is your rationale? (Include brand and generic name, dose, route, and frequency).

A prescription for COC like “Yaz” (ethinyl estradiol and drospirenone) can be effective for the patient’s acne treatment. The dosage for Yaz involves taking one active tablet once daily for a 28-day cycle. It works by promoting skin cell turnover and preventing clogged pores, ultimately reducing acne (Shields & Barbieri, 2023). It is essential to clarify that noticeable improvements may take a few weeks to manifest. While the primary purpose of the medication is acne management, it can also improve skin texture and tone.

Q5. The patient is concerned because her mother and sister developed fractures in their legs and vertebra after menopause. She wants to know what medication and other advice will prevent osteoporosis. You discuss bisphosphonates. How are they used in the prevention and treatment of osteoporosis?

Bisphosphonates are an effective treatment for osteoporosis. For this patient, a comprehensive evaluation should assess her risk factors. These include her family history of fractures, calcium and vitamin D intake, physical activity, and smoking status. If she emerges as a high-risk candidate, the consideration of bisphosphonate therapy becomes pertinent. The selection of a suitable bisphosphonate, the prescribed dosage, and the recommended dosing frequency should be meticulously tailored in accordance with her specific risk factors and bone density measurements. Emphasizing the significance of lifestyle modifications remains pivotal. These encompass embracing weight-bearing exercises, adopting a diet rich in calcium, incorporating vitamin D supplementation, and pursuing efforts toward smoking cessation. 

Q6. How would you treat this patient’s acute gout attack? Please list the trade and generic name and the dose of therapy. What is the mechanism of action of your choice of prescription?

Nonsteroidal anti-inflammatory medicines (NSAIDs) are frequently the first option of treatment to treat a patient’s acute gout attack. Indomethacin (trade name: Indocin) is one NSAID for gout that is regularly administered (Patel & Gaffo, 2022). The dosage for this medication is a 50 mg dose, administered three times per day. As symptoms improve, this should be followed by a progressive dosage reduction. This medication works by preventing the production of prostaglandins, which reduces inflammation and eases pain. 

References:

Fischer, J. A., Sasai, C. S., & Karakochuk, C. D. (2021). Iron-containing oral contraceptives and their effect on hemoglobin and biomarkers of iron status: a narrative review. Nutrients, 13(7), 2340. https://doi.org/10.3390/nu13072340

McGurran, M. A., Richter, L. M., Leedahl, N. D., & Leedahl, D. D. (2019). Impact of a comprehensive COPD therapeutic interchange program on 30-day readmission rates in hospitalized patients. Pharmacy and Therapeutics, 44(4), 185.

Patel, A. V., & Gaffo, A. L. (2022). Managing gout in women: current perspectives. Journal of Inflammation Research, 1591-1598. https://doi.org/10.2147/JIR.S284759

Shields, A., & Barbieri, J. S. (2023). From breakouts to bargains: Strategies for patient-centered, cost-effective acne care. Cutis, 112, E24-E29.