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INTRODUCTION

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HIGH ALERT

colchicine (kol-chi-seen)

Classification

Therapeutic: antigout agents

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Indications
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Acute attacks of gouty arthritis (larger doses). Prevention of recurrences of gout (smaller doses). Unlabeled Use: Treatment of hepatic cirrhosis and familial Mediterranean fever.

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Action
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Interferes with the functions of WBCs in initiating and perpetuating the inflammatory response to monosodium urate crystals. Therapeutic Effects: Decreased pain and inflammation in acute attacks of gout. Prevention of recurrent attacks of gout.

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Adverse Reactions/Side Effects
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GI: diarrhea, nausea, vomiting, abdominal pain. GU: anuria, hematuria, renal damage. Derm: alopecia. Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, leukopenia, thrombocytopenia. Local: phlebitis at IV site. Neuro: peripheral neuritis.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor and report signs of agranulocytosis (fever, sore throat, mucosal lesions, signs of infection, bruising) or any unusual weakness and fatigue that might be due to aplastic anemia or other anemias. Also report signs of other blood dyscrasias such as thrombocytopenia (bruising, nose bleeds, bleeding gums). Periodic blood tests may be needed to monitor WBC and RBC counts.

  • Be alert for signs of kidney damage, including bloody urine (hematuria) and decreased or absent urine output. Report these signs to the physician immediately.

  • Periodically assess patient's impairments (pain, range of motion), functional ability, and disability to help determine if gout symptoms are reduced by drug therapy.

  • Be alert for signs of peripheral neuritis (numbness, tingling, decreased muscle strength). Establish baseline electroneuromyographic values at the beginning of drug treatment whenever possible, and reexamine these values periodically to document drug-induced changes in peripheral nerve function.

  • Assess injection site during and after IV administration, and report signs of phlebitis (local pain, swelling, inflammation).

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Interventions
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  • Implement appropriate manual therapy techniques, physical agents, therapeutic exercises, and orthotic/assistive devices to reduce pain, improve function, and augment the effects of antigout drug therapy.

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Patient/Client-Related Instruction
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  • Instruct patient to report other untoward side effects such as problems with hair loss (alopecia) or severe or prolonged GI reactions (nausea, vomiting, diarrhea, abdominal pain).

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Pharmacokinetics
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Absorption: Absorbed from the GI tract, then reenters GI tract from biliary secretions, when more absorption may occur.

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Distribution: Concentrates in WBCs.

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Metabolism and Excretion: Partially metabolized by the liver. Secreted in bile back into GI tract; eliminated in the feces. Small amount excreted in the urine.

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Half-life: 20 min (plasma), 60 hr (WBCs).

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TIME/ACTION PROFILE (anti-inflammatory activity)

ROUTE ONSET PEAK DURATION
PO 12 hr 24–72 hr unknown
IV within 6–12 hr unknown unknown

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Pregnancy; Severe renal (CCr <10 mL/min) or GI disease.

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