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 metatarso-phalangeal 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.
