【病例学习第24期】Gout（痛风）

From Pharmacy Times(www.pharmacytimes.com)
Thanks to the author Craig I. Coleman, PharmD(Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.)

以下为正文(需要翻译的部分),欢迎会员认领并尽可能在48小时内翻译完毕并提交,将奖励50威望和50金钱.


Gout

GA is a 52-year-old man who limps into your pharmacy and hands the pharmacist a prescription for probenecid. GA has a past medical history significant for gout and a heart attack 3 years ago and takes metoprolol, atorvastatin, and aspirin. While entering the patient's insurance information into the computer, the pharmacist strikes up a conversation with GA about what he did last weekend. GA tells the pharmacist that he threw a big 40th birthday party for his wife and that he "had a few too many drinks." He then tells the pharmacist that the next day his gout flared up, resulting in a painfully inflamed big toe. At just that moment, the pharmacist realizes that the probenecid prescription is a few months old. Upon further questioning, GA admits to the pharmacist that this probenecid prescription was given to him along with a prescription for colchicine by his physician 2 months ago. He filled the colchicine prescription at that time and used it until his gouty attack subsided, but did not have the probenecid prescription filled. He thought he would save himself a trip to the physician and just take the probenecid to treat this attack.

Should the pharmacist fill this prescription?


ANSWER

Uric acid is typically excreted in the urine, but if blood uric acid levels become too high, it can be deposited in joints (most commonly the big toe), causing pain and inflammation. Probenecid increases the excretion of uric acid into the urine, preventing gouty attacks, but cannot be used to treat an ongoing attack. Furthermore, aspirin interferes with probenecid's ability to increase uric acid excretion, decreasing its efficacy. The pharmacist should instruct GA to see his physician to get another prescription for colchicine with instructions to take 0.6 to 1.2 mg every 2 hours until pain is relieved, gastrointestinal upset occurs, or a total daily dose of 8 mg is reached. Unlike probenecid, this will relieve the pain and inflammation of his gouty attack within hours. The pharmacist also should remind GA that too much alcohol could exacerbate his gout.

痛风
GA，男，52岁，一瘸一拐地步入药房，交给药师一张丙磺舒的处方。既往有痛风，三年前心脏病发作，平时服用美托洛尔、阿托伐他汀和阿司匹林。药师将病人的保险信息输入计算机时，询问病人上周都干了什么？GA告诉药师，他为妻子的40岁生日办了一场大型聚会，多喝了一点，第二天痛风就发作了，大脚趾疼。药师这才意识到，丙磺舒的处方是好几个月以前的。在药师的追问下，GA承认丙磺舒是在2个月前医生和秋水仙碱一起开的，当时他只配了秋水仙碱，后来痛风好了，就不吃了，但没有配丙磺舒。这次发作他是想直接服用丙磺舒，省的还要去看医生。请问，药师能不能为他配这张方？
答案：
尿酸一般分泌到尿液中，但若血尿酸过高，就会沉积到各关节（大脚趾最常见），引发疼痛和炎症。丙磺舒能够增加尿酸排到尿液中，预防痛风发作，但不能用于治疗急性发作。再说，阿司匹林干扰丙磺舒增加尿酸排泄的功能，使丙磺舒的效力下降。药师告诉GA，让他去找医生再开些秋水仙碱，每2小时口服0.6－1.2mg，直到疼痛缓解，或者出现胃肠道不适，或者日总剂量达8mg。秋水仙碱几个小时就能够缓解痛风引起的疼痛和炎症，这一点和丙磺舒不同。药师还应当提醒GA，过量酒精会加重痛风。

我已认领，48小时未完成，请其他战友继续认领。

GA，男，52岁，一瘸一拐地步入药房，交给药师一张丙磺舒的处方。既往有痛风，三年前心脏病发作，平时服用美托洛尔、阿托伐他汀和阿司匹林。药师将病人的保险信息输入计算机时，询问病人上周都干了什么？GA告诉药师，他为妻子的40岁生日办了一场大型聚会，多喝了一点，第二天痛风就发作了，大脚趾疼。药师这才意识到，丙磺舒的处方是好几个月以前的。在药师的追问下，GA承认丙磺舒是在2个月前医生和秋水仙碱一起开的，当时他只配了秋水仙碱，后来痛风好了，就不吃了，但没有配丙磺舒。这次发作他是想直接服用丙磺舒，省的还要去看医生。请问，药师能不能为他配这张方？
答案：
尿酸一般分泌到尿液中，但若血尿酸过高，就会沉积到各关节（大脚趾最常见），引发疼痛和炎症。丙磺舒能够增加尿酸排到尿液中，预防痛风发作，但不能用于治疗急性发作。再说，阿司匹林干扰丙磺舒增加尿酸排泄的功能，使丙磺舒的效力下降。药师告诉GA，让他去找医生再开些秋水仙碱，每2小时口服0.6－1.2mg，直到疼痛缓解，或者出现胃肠道不适，或者日总剂量达8mg。秋水仙碱几个小时就能够缓解痛风引起的疼痛和炎症，这一点和丙磺舒不同。药师还应当提醒GA，过量酒精会加重痛风。