Urate-lowering Therapy: Lifespan Considerations (Nursing)

00:00 Now we're going to discuss the lifespan considerations for urate-lowering therapies in the treatment of gout. When it comes to our pediatric populations, know that gout is pretty rare in children, but when urate lowering therapy is needed, there's obviously some special considerations.

00:16 Raspicurase is used for tumor lysis syndrome in pediatric oncology patients. Now, if allopurinol is used, dosing is based on weight rather than the fixed adult doses. Now, because children's renal function can differ from adults, close monitoring of their renal function is essential.

00:34 Now, when it comes to patients who are pregnant or lactating, these are women of childbearing potential, so medication safety is always a key concern. But under the FDA's current pregnancy and lactation labeling rule, the PLLR, which is what replaced the former letter categories, medications are now labeled with detailed risk summaries rather than categories.

00:56 Allopurinol has limited human pregnancy data and animal studies have shown potential developmental risks. So allopurinol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Similarly, Fabectostat also has insufficient human pregnancy data to establish its safety, so it's generally avoided when possible. Colchicine requires careful risk-benefit assessment during pregnancy. If treatment is necessary during pregnancy, Probenecid may be considered, but here's a special note. Probenecid was previously categorized as having lower fetal risk compared to the other options. The current labeling still notes the limited human pregnancy data. The relative safety of probenicid is based primarily on observational experience rather than robust evidence. Ideally, all urate-lowering therapies should be avoided during pregnancy unless both of these criteria are met. One, the benefits clearly outweigh the potential risk to the fetus, and two, this decision should be made in conjunction with both rheumatology and obstetric care. Older adults may have reduced renal function, and that's going to affect the drug clearance and it increases the risk of adverse effects. So it's important for you to keep in mind that older adults may have unrecognized renal impairment even with normal creatinine levels because this is due to their decreased muscle mass. Therefore, calculating the E, the estimated GFR, using the formulas that account for age is essential to help with appropriate and safe dosing.

02:32 Now, older adults also commonly take multiple medications, which always raises the potential for drug interactions. For these patients, we typically follow a start low, go slow approach with careful dose titration and more frequent monitoring. You also have to consider the comorbidities, particularly cardiovascular disease, which could influence the choice of therapy. Older adults typically have a higher risk of adverse drug reactions and could experience atypical presentations of these reactions. So keep that in mind when you're completing your assessments.