QuestionSBA
QuestionChoice
Patients with gout who are taking anti-uric acid medications should not discontinue their drugs during an acute flare as this can worsen symptoms
34054
e
Stop allopurinol and prescribe prednisolone 20mg PO for 7 days
QuestionChoice
Patients with gout who are taking anti-uric acid medications should not discontinue their drugs during an acute flare as this can worsen symptoms
34053
d
Stop allopurinol and prescribe naproxen sodium 500mg PO stat
QuestionChoice
Patients with gout who are taking anti-uric acid medications should not switch their drugs during an acute flare as this can worsen symptoms
34051
b
Change allopurinol to febuxostat 120mg PO OD
QuestionChoice
Patients with gout who are taking anti-uric acid medications should continue their drugs and receive treatment with anti-inflammatories. As NSAIDs should be avoided in this patient, colchicine can be given as an alternative
34050
a
Continue allopurinol and prescribe colchicine 500 micrograms PO BD for 3 days
QuestionChoice
Patients with gout who are taking anti-uric acid medications should continue their drugs and receive treatment with anti-inflammatories. NSAIDs are generally recommended first line but this patient has a history of GORD and hence they would not be suitable
34052
c
Continue allopurinol and prescribe diclofenac sodium 75mg PO BD for 7 days
QuestionComment
Why should NSAIDs be avoided in this patient?
37729
QuestionComment
GORD, increased GI bleeding
37927
User
subscriber
Kawasaki Syndrome
User
subscriber
Endoscope Hematoma
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2754
Gout
Topic
92
General Practice
6821
Case Presentation: A 48 year old man presents to his GP with a 48 hour history of pain in his right foot. **PH** type 2 diabetes, GORD, gout. **DH** metformin hydrochloride 500mg PO TDS, sitagliptin 100mg PO OD, esomeprazole 20mg PO OD, allopurinol 200mg PO OD, paracetamol 1g PO QDS.


**O/E**

Swollen, erythematous 1st metatarsophalangeal joint on right foot. No other joints involved. Left foot grossly normal.

Temperature 36.4°C.

Question: Select the most appropriate management at this stage.
a