BOF: 25
A sixty five year old male who is on treatment for
chronic heart failure with diuretics, angiotensin converting enzyme
inhibitors, beta-blockers and spironolactone presents with sudden onset of
pain and swelling of the metatarsophalangeal joint of his right big toe.
Aspiration of the joint demonstrates crystals of monosodium urate.
In this patient
a)
Moderate doses of aspirin would be beneficial
b)
Non-steroidal anti-inflammatory digs would be the drugs of first choice
c)
Highly selective cyclooxygenase 2 inhibitor should be used
d)
Colchicine would be the best choice
e)
Parenteral colchicine may be safely used to counter nausea and
diarrhoea
Answer:
d)
This patient has gout. Aspirin unless used in high doses
causes uric acid retention. Non-steroidal anti-inflammatory drugs would be
contraindicated in view of the heart failure. Highly selective COX 2
inhibitors may not be used with co-existing heart failure. Intravenous
colchicine is potentially hazardous.
Revision Tip
Revise gout KEYS to SUCCESS in
Medicine page 498-500
