Q@Q time ③ - cardio69

[ArchivalUser]

A 58 y/o M is evaluated for a 6mon of base on http://www.positivehealth.com/img/image-...9d/22b.jpg He was doing well on colchicine and allopurinol but developed hyperdensity to allopurinol, which resolved with cessation of the agent. He then began have more frequent disorder flares; 2 flares occurred in the past 25 days and treated with steroid. Pat history is also significant for HTN, chronic kidney dz and dyslipidemia. Current med are lisinopril, metoprolol, simvastatin and colchicine. On PE, Temp: 37.3/99 F, BP: 142/86, PR: 64/min, RR: 12/min and BMI of 30. The remainder of exam is norm.

Lab serum reveal;
Urate: 9.2mg/dL
Cr: 2.3 mg/dL
Live chem studies ~norm
GFR: 48mL/min/1.72m^2

Most appropriate next step?

a) Start recombinant form of the enzyme uricase that convert uric acid -> allantoin
b) Stop Colchicine
c) Start drug that base on weak organic acid by inhibit urate in PCT
d) Start drug that unrelated to allopurinol, block xanthine oxidase



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[ArchivalUser]

Times UP.

[ArchivalUser]

Ok so i will start the pat on uloric , febuxostat and c if he gets better with that ... his uric acid has to come down and colchicine is not a good choice specially having CKF
Colchicine should b used only for acute attacks and not as a long term med in this case

[ArchivalUser]

*D* correct.
Febuxostat

@morticia GJ, don't forget the time.