Patient Care and Monitoring

1. Assess the patient's symptoms to determine the time of attack onset, which joints are affected, the level of pain, and other symptoms.

2. Review the patient history for contributing lifestyle factors and other disease states that may help guide therapy.

3. Obtain a thorough medication history for prescription drug, nonprescription drug, and dietary supplement use. Determine if any of these products may be contributing to hyperuricemia.

4. Educate the patient on lifestyle modifications that will improve symptoms, including weight loss, if appropriate, and avoidance of ethanol.

5. If the diagnosis of gout has not been confirmed previously, consider aspiration of an affected joint to identify uric acid crystals.

6. Initiate therapy to treat the acute gout attack without delay. Develop a plan to assess this therapy after 24 and 48 hours.

7. Select therapy based on comorbidities and potential for adverse effects. In patients with no other disease states, NSAIDs are the preferred drug class.

8. Assess the need for continuous antihyperuricemic therapy. Use patient factors such as comorbidities to select an agent. Allopurinol is the standard prophylactic agent used in the United States.

9. Do not start antihyperuricemic therapy within 4 weeks of an acute attack.

10. Evaluate the patient for the presence of adverse drug reactions, drug allergies, and drug interactions.

11. Stress the importance of adherence with the therapeutic regimen, including lifestyle modifications, to prevent future gout attacks and long-term complications.

12. Provide patient education about the disease state, lifestyle modifications, and drug therapy.

• Assess patients receiving systemic corticosteroids for mental status changes, fluid retention, increased blood glucose, muscle weakness, or development of new infections.

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