1. Based on presenting symptoms and lab findings, what is most likely diagnosis that will be made for Mr. Y?

Gout – this illness results to an unexpected extreme pain, swelling or inflammation, warmth and redness episodes in some of the joints. Typically, Gout will affect one of the joints at a time. Mostly, it will affect the big joint of the person’s big toe. It could affect the ankle, wrist, knee, elbow and the foot joints as well.  This disease is an extreme type of arthritis which is referred to as crystal arthritis or other times called microcrystalline arthritis since the crystals are tiny. These crystals will appear in the joints and as the body tries to eliminate them, a throbbing swelling happens. In some unusual instances, it can later on affect the spine, shoulders and hip joints. Therefore, this would likely be the diagnosis that will be made for Mr. Y. an example of these symptoms that the patient experienced are his toe is red and had become swollen in the last day that he could not put on shoes.

2. What is the anticipated pharmacologic plan for managing Mr. Y’s acute pain? Provide a justification for the plan including a citation from a peer-reviewed source.

ULT or Urate Lowering Therapies would be the anticipated pharmacologic plan for managing Mr. Y’s acute pain. The reason for reducing the concentration of serum urate would be to inhibit tophi development and acute pain attacks. This therapies can be started during an attack of gouty as long as the effective management of anti-inflammatory has already been administered. Additionally, Prophylaxis would also be recommended for Mr. Y to lower the threat of gout attacks that are linked with the commencement of the Urate Lowering Therapies. Mr. Y will need to continue these Prophylaxis for about six months. An effective medication titration and subsequent monitoring of the urate medications, advert treatment effects and renal functions will be important. The result would be a lower serum urate concentration anticipation of less than 6mg/dl. For instance the three types of drugs that would be prescribed to Mr. Y may be uricase agents, xanthine oxidase inhibitors or uricosuric agents.

3. What is the anticipated pharmacologic plan for long-term management of Mr. Y’s diagnosis? Provide a justification for the plan including a citation from a peer-reviewed source.

The anticipated pharmacologic plan for long term management of Mr. Y’s diagnosis would be the administration of colchicine, corticosteroids and non-steroidal-inflammatories to be able to manage the inflammations and pain, prevent damage of joints, prevent future attacks as well as shorten the inflammation period. This medications may be administered to the patient for the rest of their lives to help them manage the acute pain and also prevent attacks that may occur in the future.

4. Identify the key elements of the education plan that would be appropriate for the patient about the acute and chronic pharmacologic plans you identified above.

Key elements that may be appropriate for the patient about the acute and chronic pharmacologic plans identified include emphasis on the modification of lifestyles and diet. These will include the management of weight, reducing drinking of alcohol and lowering seafood and meat takings. Mr. Y would also need to watch on his diet as a way of managing the acute pain. Mr. Y may be advised to avoid foods that may lead to the raise of uric acid completely. The education should also help the patient effectively adhere to the nonpharmacologic and pharmacologic therapies. It would also be important for the pharmacists to educate the patient about the gout medication, consisting of duration of therapy, drug interactions, contraindications, appropriate dosing and the adverse effects that relate to the disease. The information from the education would greatly assist the patient improve their management for the disease.

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