1533 Exam 2 Comfort, Metabolism, Acid/Base, Nutrition

DM Type 2

insulin resistance and impaired insulin secretion, No islet cell antibodies; declined B cell function Adult onset >30; obesity; poor diet; sedentary lifestyle. Can be reversed with diet and exercise (low carb diet)

Visceral Acute Pain

kidney stones opioids and NSAIDS (inhibit prostaglandin. vasoconstriction blocks inflammation)

Iron rich foods

lamb, peaches

Sequestrian Crisis

Results when other organs pool the sickle cells

Cimetidine

(Tagamet) H2 receptor antagonists Inhibits action of histamine on the H2 receptor site of parietal cells, decreasing gastric acid. Treatment- short term duodenal ulcer Give after hemodialysis - Diarrhea (look for black, tarry stools), N+V - Headache - Avoid ASA, NSAIDS - If taking another antacid, take one hour apart

Gestational Diabetes Management

Diet Insulin 1. Low/mid NPH 2. Short acting Humalin R

DASH diet

Dietary Approaches to Stop Hypertension, a dietary pattern designed to reduce blood pressure that emphasizes potassium-rich vegetables and fruits and low-fat dairy products; includes whole grains, poultry, fish and nuts and limits sodium, red meat, and added sugars. 4-5 servings fruit

Long Acting Insulin

Glargine Lantus Detemir NO PEAKS, NO MIXES draw up separately 24 hours

Peptic Ulcer Disease

A break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum result from infection with H. pylori, which may be acquired through ingestion of food and water

Fat soluble vitamins

A, D, E, K

Which would a nurse identify as an example of a sulfonylurea that increases insulin secretions from pancreatic beta cells?

Glipizide

Types of Crisis

Acute vaso-occlusive crisis Aplastic crisis Sequestrian

Respiratory Alkalosis Patho

hyperventilation, pain, fever, anxiety, excessive mechanical ventilation

A client informs the nurse that he plans on discontinuing the prescribed lorazepam (Ativan) he has been taking for the past four months. What is the nurse's best action in response to this client's statement?

Advise the client to contact his healthcare provider about tapering off the medication.

GERD meds

Antacids (calcium carbonate: Tums), Maalox, Tagamet, Zantac, Pepcid, Metoclopramide (Reglan), PPI's

Which drug influences or regulates functions such as the immune response and the anti-inflammatory response?

Dexamethasone

A nurse records a client's fingerstick blood glucose level and gives 2 units of regular insulin as ordered. At the next scheduled blood glucose assessment, the nurse realizes that the wrong client was tested and given insulin. What is the nurse's priority action related to this incident?

Assess both clients, and call the appropriate healthcare providers to notify them of the errors.

A nurse is assigned to administer glargine to a patient at a health care facility. What precaution should the nurse take when administering glargine?

Avoid mixing glargine with other insulin

Nutrition Labs

BMI A1C (carbs) Albumin (protein) Normal 3.5-5 Prealbumin 15-35 Liver Enzymes (AST,ALT) CMP LDL/HDL/Triglycerides

Acid examples

CO2 (lungs) lactic acid ketones HCl

Hypothyroidism Findings

COLD & SLOW - weight gain, cold intolerance, fatigue, depression, constipation, facial and eyelid edema, hair loss, muscle aches and weakness, dry skin, anorexia, brittle nails & hair Decreased: HR, BP, RR, temperature, glucose Decreased: T3 & T4; Increased: TSH & Calcium

Types of stones

Calcium Cystine Uric Acid Oxolate

DKA Priority Interventions

Can occur w/in hours Hydration (NS) Regular Insulin (IV) Check bs hourly HOB elevated VS hourly Oxygen Strict I's & O's Cardiac Monitor (K level) Labs every 2-4 hours Insulin can lead to hypokalemia NPO

Sucralfate

Carafate mucosal protective agent Forms a coating that acts locally to protect the gastric lining against peptic acid, pepsin and bile salts. Give on an EMPTY stomach. Short term treatment of duodenal ulcer Adverse: Constipation. Increase fluid and fiber intake

TPN/Enteral Feeding

Check gastric residual volume before each feeding or, in the case of continuous feedings, every 4 hours; return the aspirate to the stomach 1. Isotonic formulas are better tolerated than hypertonic formulas. 2. Always provide adequate free water. 3. Continuous feeding is better tolerated than bolus or Intermittent feeding. 4. Start rate slowly and build up kcaloric load gradually. 5. Always keep patient's head elevated at least 30 degrees to prevent aspiration. 6. Flush tube at intervals to prevent clogs. 7. Monitor labs closely when initiating feedings. 8. Only consider PEG placement if TF will be prolonged. 9. Always flush tube before and after administration of drugs. 10. Assess and reassess nutrient needs and nutritional status at regular intervals.

Drawing Up Inlsulin

Clear (Regular) 1st NPH (Cloudy) 2nd

Peptic Ulcer Treatment

Decrease/limit/stop - use of NSAIDs, such as ibuprofen and aspirin, caffeine, tobacco, beer, milk, foods containing peppermint or spearmint, and carbonated beverages. Treatment - Sucrolate 30 minutes to an hour before they eat (coats erosion). Administer proton pump inhibitors before breakfast and antacids 1 to 3 hours after meals. Avoid eating & drinking 2 hours before bed. Elevate head of bed 30 degrees

PVD

Deoxygenated blood; swelling, fluids pools. Edema dull, achy pain bc of pressure from fluid WARM to touch irregular wounds w/ drainage ELEVATE veins & compression hose brown/yellowish skin

The nurse is caring for a client with a brain tumor. What drug would the nurse expect to be prescribed to reduce the edema surrounding the tumor?

Dexamethasone

hyperglycemic hyperosmolar syndrome (HHS)

ER (happens over days) sugar goes into blood, making it very thick Decreased BP Decreased Urine output Increased HR Increased Creatinine Administer NS 1st to replace volume, then 1/2 NS Regular Insulin (IV)

Mediteranean diet

Eat: poultry, fish, eggs, vegetables, fruits, nuts, seeds, herbs, spices, healthy fats and oils. Avoid: red meats, Processed foods, sugar, soft drinks, grains, most dairy products, legumes, artificial sweeteners, vegetable oils, margarine and trans fats.

NG tube feeding

Elevate HOB 30 degrees X-ray for placement auscultate BS change tubing Q24hr irrigate 30ml normal water q4hr 200ml residual/aspiration bad hold if more than 250ml

The nurse admits a 26-year-old client with sickle cell anemia. Which drug is used to reduce pain and increase fetal hemoglobin?

Hydroxyurea

TPN

For malnourished patients electrolytes, sugar, fluid, vitamins, mineral and protein Requires a central line (which can lead to greater risk of infection)

The advance nurse practitioner, who is treating a client diagnosed with neuropathic pain, decides to start adjuvant analgesic agent therapy. Which medication is appropriate for the nurse practitioner to prescribe?

Gabapentin

A client and his spouse are in the client's hospital room. The spouse says to the nurse, "I looked up one of the new drugs on the Internet, gabapentin. It said it is for seizures. My husband has never had a seizure." Which would be a therapeutic response by the nurse?

Gabapentin can also be used for leg pain associated with diabetes.

Regular Insulin

Give IV only peak 2-4 hrs lasts 5-8 hrs

After hospital discharge, the parent of a child newly diagnosed with type 1 diabetes mellitus telephones the nurse because the child is acting confused and very sleepy. Which emergency measure would the nurse suggest the parent carry out before bringing the child to see the health care provider?

Give the child a glass of orange juice.

PUD/GERD meds

H2 blockers (Cimetidine, Famotidine) PPI's (Omeprazole, Pantoprazole) Antacids COAT (Calcium Carbonate, Tums, Maalox)

Kidneys regulate

HCO3 (base)

Hyperthyroidism Findings

HOT & FAST; exophthalmos (bulging eyes), tachycardia, hypertensive, weight loss, muscle wasting, localized edema, diarrhea, tremors, clubbing fingers, intolerant to heat, mood swings, anxiety

A nurse is preparing to administer an intermediate-acting insulin. Which medication would the nurse most likely administer?

Humulin N

A client is admitted to the emergency department in diabetic ketoacidosis (DKA) with a blood glucose level of 485 mg/dL. The client is prescribed an initial dose of 25 U insulin IV. Which type of insulin will be most likely to be administered?

Humulin R insulin

A client who has ingested too much sodium bicarbonate will have which of the following signs and symptoms?

Hypoventilation, agitation, spasticity

A client is taking glyburide, 1.25 mg P.O. daily, to treat type 2 diabetes. Which statement indicates the need for further client teaching about managing this disease?

I skip lunch when I don't feel hungry.

Respiratory Acidosis Treatment

Increase RR, reposition client, maintain patent airway, mechanical ventilation

Metabolic Alkalosis Patho

hypokalemia (diuretic use), severe vomiting, NG/GI suctioning, too many antacids, mass on pyloric sphincter, hyperaldosteronism (cushing's, steroid, bicarbonate)

Hypothyroidism/Hashimoto's

Insufficient thyroid production

Hypothyroidism Medication

Levothyroxine (Synthroid); a synthetic form of T4; take 1 hour before meals with water. DO NOT TAKE WITH ANYTHING ELSE.

MLs per hour

ML/time in hrs

Drops per minute (gtts/min)

ML/time in mins X drop factor

A patient taking too much sodium bicarbonate for heart burn will have which type of acid base imbalance?

Metabolic Alkalosis

A client with obesity is diagnosed with type 2 diabetes. In order to promote weight loss in the client and aid in glucose management, which medication will the nurse anticipate the health care provider ordering?

Metformin

A group of students are reviewing information about oral diabetic agents. The students demonstrate understanding of these agents when they identify which agent as reducing glucose production from the liver?

Metformin

Intermediate Insulin

NPH peak 4-12 hours lasts 14 hours given 2x day

Metabolic Alkalosis Signs/Symptoms

NV, diarrhea, confusion, restlessness, tachycardia, hypoventilation

Which intravenous solution would be appropriate to treat metabolic acidosis?

NaHCO3

A client is experiencing significant respiratory depression and sedation related to morphine administration. The nurse would anticipate administering:

Naloxone

PAD

Narrow artery where oxygenated blood cant get to Causes Ischemia and necrosis of hands and feed round, irregular ulcers w/o drainage DON'T elevate legs--dangle Cap refil > 3 seconds COOL skin sharp pain weak, absent pulse Hairless

PUD/GERD diet

No acid, caffeine, alcohol, spicy foods No eating/drinking 2 hours before bed No NSAIDS

BMI is 18.5 to 24.9

Normal

Metoclopramide

Reglan Prokinetic/Antiemetic. Dopamine antagonists Blocks dopamine receptors at the chemoreceptor trigger zone Used to prevent NV from emetogenic cancer chemotherapy Give 30 mins before meals and at bedtime Avoid activities that require alertness

Neonate Bottle feeding

Only formulas that are fortified with iron should be used. Iron stores that the infant received prenatally are depleted by 4 to 6 months of age. To prevent iron deficiency anemia, poor growth patterns, and impaired development, iron-fortified formulas must be used.

Narcotics

Opioid; slows everything down. Causes constipation

A client is diagnosed with increased intracranial pressure. Mannitol IV is ordered to pull fluid from the brain. What type of diuretic is this drug?

Osmotic diuretic

Respiratory Acidosis

PCO2 > 45 & pH < 7.35

Respiratory Alkalosis

PaCO2 < 35 & pH > 7.45

Aplastic Crisis

Results from infection with human parvovirus

DM I signs/symptoms

Polydipsia, polyphagia, polyuria, diaphoresis, weight loss, blurred vision, mood changes

DM II Signs/symptoms

Polydipsia, polyphagia, polyuria, diaphoresis, weight loss, blurred vision, mood changes, frequent infections, slow healing wounds

Malnutrition/Malabsorption signs/symptoms

Positive Chvostek or Trousseau sign (from electrolyte disturbance), bulky stools, muscle wasting, orthostatic hypotension, hyperactive bowel sounds

Omeprazole

Prilosec PPI GERD Inhibits proton pump activity by binding to hydrogen-potassium adenosine triphosphates, located at secretory surface of gastric parietal cells, to suppress gastric acid secretion. Take calcium and Vitamin D to prevent bone loss Consume adequate fluids Hypomag can occur if taking 3+ months

Sickle Cell Crisis Interventions

Priority: Oxygenation & Perfusion Provide O2, IV hydration, pain meds

Pantroprazole

Protonix PPI GERD, erosive esophagitis Inhibits proton pump activity by binding to hydrogen-potassium adenosine triphosphatase, located at secretory surface of gastric parietal cells, to suppress gastric acid secretion. Delayed release- give w/ applejuice/sauce only May increase risk of sunburn

Which of the following oral diabetic agents block ATP potassium channels in beta islet cells, increasing intracellular calcium and stimulating insulin release?

Repaglinide

The nurse is to administer a dose of naloxone. Which would be the highest priority problem to be addressed when caring for a client who is to receive a dose of naloxone?

Respiratory depression

Acute vaso-occlusive crisis

Results from entrapment of erythrocytes and leukocytes in the microcirculation, causing tissue hypoxia, inflammation. And necrosis due to inadequate blood flow to a specific region of tissue or organ.

Sickle Cell complications

Stroke, DVT, hematuria, bone infractions, heart failure

Thyroid regulates

T3, T4 and calcitonin

Pituitary regulates

TSH

While assessing a client receiving morphine for pain management, what finding would alert the nurse and require healthcare provider notification?

The client with a pulse of 118, a respiratory rate of 8, and a BP of 80/60

Heart Healthy Diet

This diet may help you lower your blood cholesterol level, manage your blood pressure, and lower your risk for heart problems. b. Avoid sodium < 2300 mg/day c. Limit cholesterol < 200 mg/day (meats, eggs, and dairy products) d. Unsaturated fats (in fish, nuts, and olive oil) e. Fiber 20-30 g/day f. Complex carbs 50-60% of total daily calories (grains, especially whole grains, fruits, and vegetables) Fruits, veggies, whole grains, plant proteins, fish, olive oil, limit alcohol, low fat/fat free dairy

Metabolic Acidosis Treatment

Treat the underlying cause (DKA, diarrhea, renal failure); Improve oxygenation

The nurse administers morphine to a client. What is the most effective way for the nurse to evaluate the pain response following administration?

Using a pain scale, ask the client to describe the pain.

Micros

Vitamins and Minerals

The nurse administers IV morphine to a client at 6 PM for pain documented as 6 on a scale of 0 to 10. At 6:30 PM, the client states that the pain level is 3 on a scale of 0 to 10, and that level is acceptable to him. The client asks the nurse why another assessment was necessary after the administration of the pain medication. What is the nurse's best response to this client about proper pain management?

We assess every client in relation to pain, initially to determine appropriate interventions and later to determine whether the interventions were effective in preventing or relieving pain

Sickle Cell Anemia (Chronic)

a genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape

visceral pain

a poorly localized, dull, or diffuse pain that arises from the abdominal organs, or viscera

PVD (neuropathic pain)

a slow and progressive circulation disorder. Narrowing, blockage, or spasms in a blood vessel can cause this disease. May affect any blood vessel outside of the heart including the arteries, veins, or lymphatic vessels.

Post Op pain

a. Assess patient comfort b. Control of environment: quiet, low lights, noise level c. Administer analgesics as indicated; usually short-acting opioids IV d. Family visit, dealing with family anxiety e. Review pertinent information, baseline assessment upon admission to unit f. Assess airway, respiratory function, cardiovascular function, skin color, level of consciousness, and ability to respond to commands g. Reassess VS, patient status every 15 minutes or more frequently as needed h. Administration of postoperative analgesia

Malnutrition/Malabsorption

a. Low serum albumin and prealbumin levels are most often used as measures of protein deficit in adults b. Failure of the mucosa of the small intestine to absorb or normally digest single or multiple nutrients efficiently c. May impair absorption of amino acids, fat, sugar, or vitamins d. Results in inadequate movement of nutrients from the small intestine to the bloodstream or lymphatic system e. Manifestations dependent on the specific nutrients not being absorbed, but typically include diarrhea

Sickle Cell Crisis

a. Spleen is primary site of sickling i. Decreased hematocrit ii. (+) sickle cells on smear iii. Increased WBC (normal 4,500-11000) iv. Increased platelet (150,000-450,000) v. Diagnosis is confirmed by Hgb electrophoresis vi. Pt with SCD are usually diagnosed in childhood because they become anemic in infancy and begin to have sickle cell crises at age 1 or 2 years.

Renal Calculi (Acute Pain)

a. Stones are formed in the urinary tract when urinary concentrations of substances such as calcium oxalate, calcium phosphate, and uric acid increase b. Infection, urinary stasis, and periods of immobility increases the risk of real calculi c. Severe pain is treated with opioid analgesics, NSAIDS and fluid intake d. Mild pain is treated with warm baths, warm heat to the flank, and NSAIDS e. Increase fluid intake; avoid coffee

The nurse is educating a newly diagnosed diabetic who must learn how to give himself insulin injections. The nurse tells the client that insulin is absorbed fastest from which area of injection?

abdomen

nociceptive pain

acute pain; a pain sensation that results abruptly

Thyroid Storm

an emergency (Increased: HR, BP, Glucose and Temperature)

Triglycerides

an energy-rich compound <150

Respiratory Alkalosis Treatment

decrease RR, administer sedatives, breath into a paper bag, rebreather mask

Hypothyroidism Causes

atrophy of thyroid gland w/ aging; iodine deficiency (needed to synthesize thyroid hormone)

Diabetes Type I

autoimmune disease that leads to the destruction of insulin-producing pancreatic beta cells.

Cardiac Diet

avoid sodium eat complex carbs (whole grains, fruits, veggies) avoid caffeine

Oxolate

avoid spinach, strawberries, rhubarb, chocolate, tea, peanuts, wheat bran

GERD

backflow of gastric or duodenal contents into the esophagus that causes troublesome symptoms and/or mucosal injury to the esophagus. Excessive reflux may occur because of an incompetent lower esophageal sphincter, pyloric stenosis, hiatal hernia, or a motility disorder. The incidence of GERD seems to increase with aging and is seen in patients with irritable bowel syndrome and obstructive airway disorder exacerbations (e.g., asthma, COPD, cystic fibrosis)

LDL

bad cholesterol <100

NSAIDS

can cause GI bleeds/ulcers Take in the morning w/food

Steroids

can cause hyperglycemia

Gestational Diabetes

condition in which a hormone made by the placenta prevents the body from using insulin effectively. resistance of insulin in the body. Beta-cell dysfunction and tissue insulin resistance

Metabolic Acidosis Signs/Symptoms

confusion, tachycardia, hypotensive, headache, fatigue, vomiting, twitching, tachypnea

Acid

depresses CNS

neuropathic pain examples

diabetes PAD gabapentin

Respiratory Acidosis Signs/Symptoms

dizziness, drowsiness, apnea (< 10 shallow breaths), snoring, wheezing, cyanosis, altered mental status, muscle weakness, decreased BP w/ vasodilation, dysrhythmias

GERD signs/symptoms

dyspepsia (indigestion), dysphagia or odynophagia, hypersalivation, and esophagitis

DM I medications

i. 4 oz oj for hypoglycemia ii. Fast acting: Lispro - 15-30 mins; peak in .5 to 2.5 hours iii. Regular: 30-60 mins; peak in 1-5 hours iv. NPH 60-120 mins; peak in 6-14 hours v. Long acting: Lantus - 70 mins; no peak vi. Insulin (Humalin R IV only)

PVD treatment

elastic support stockings or leggings sequential pneumatic compression devices Adjuvant analgesic agents, such as antidepressants, anticonvulsants, and local anesthetics Gabapentin- anticonvulsant and nerve pain medication, treats seizures and pain caused by shingles.

B12

energy and production of RBC's

Hyperthyroid/Grave's Disease

excess thyroid hormones Decreased Calcium. Increased T3 & T4 & Blood sugar

Base

excites CNS

Myxedema coma

extreme hypothyroidism(abrupt med cessation), rare with a high mortality rate = decreased cardiac output leads to decreased tissue perfusion which leads to brain and organ depletion leading to multi-organ failure

DM I Labs

fasting blood sugar level less than 100 mg/dL is healthy. 126 mg/dL (7 mmol/L) or higher on two separate tests, you have it. A1C average blood sugar over the past 2-3 months

Macros

fats - stored as triglycerides proteins carbs - energy

DM II Labs

i. A1C 6.5% or higher on two separate tests indicates diabetes. ii. Cholesterol above 200 mg/dl iii. Check blood sugar before and after exercising

A diabetic client is brought to the emergency department with a blood glucose level of 30 mg/dL. His wife says he took his NPH insulin this morning but skipped his lunch. What drug should the nurse prepare to administer intravenously?

glucagon intravenous injection

HDL

good cholesterol >40

When educating a client about glargine, the nurse should explain that this medication:

has a prolonged absorption rate and provides a relatively constant concentration for 12-24 hours.

Metabolic Acidosis Patho

hyperkalemia, DKA, severe diarrhea, renal failure, shock, Kussmaul respirations build up of acid in the body due to kidney disease or kidney failure

Renal Calculi Signs/Symptoms

i. Assessed for pain/discomfort ii. Nausea/Vomiting iii. Diarrhea iv. Abdominal distention v. Observe for signs/symptoms of UTI (chills, fever, frequency, hesitancy, obstruction) vi. Urine is inspected for blood and is strained for stones or gravel. vii. Non-contrast CT scan viii. Blood chemistries and 24-hr urine test for o Ca, uric acid, creatinine, sodium, pH, and total volume ix. Dietary and medication history / family history x. Chemical analysis of recovered kidney stones

DM II Medications

i. Insulin ii. Metformin - to help w/ weight loss and help control blood sugar iii. Glyburide - oral anti-diabetic

DM I complications

i. Microvascular - neuropathy, poor wound healing, retinopathy ii. Macrovascular - MI, CVA, CKD iii. DKA - ketones indicate acid

DM II complications

i. Microvascular - neuropathy, poor wound healing, retinopathy ii. Macrovascular - MI, CVA, CKD iii. Ketosis -uncommon unless stress/infections

Sickle Cell Interventions

i. Pain medication - opioids ii. O2 for lack of perfusion iii. Heat iv. IV fluids v. Hydroxyurea

Neonate Breastfeeding

i. This may be as often as every 1½ to 3 hours in the neonate. ii. Infants may feed for 10 to 20 minutes on each breast at each feeding, or longer on just one breast, alternating the breast at each feeding. Both methods are acceptable. iii. The breastfeeding infant does not need supplementation with water or formula even in the first few days of life as long as the newborn continues to wet six to eight diapers per day.

Rapid Insulin

lispro, aspart, glulisine 15 min onset 30-90 min peak Give meals right away or within 10 mins Monitor for hypoglycemia

Kidney Disease Diet

low protein

Cystine

low protein diet, uric acid is alkalized

Uric Acid

low purine diet (avoid shellfish, anchovies, asparagus, mushrooms, organ meats)

Statins

lower cholesterol and triglycerides

Liver

makes bile and cholesterol

Diabetic Diet

my plate a. Carbohydrates makes up 50-60% of daily calories b. Fats makes up 20-30% of total daily calories c. Protein makes up 10-20% of total daily calories

BMI is 30.0 or higher

obese

Gestational Diabetes Risk Factors

obesity, age >30 years, family history of diabetes, previous large babies (>9 lb)

Respiratory Acidosis Patho

occurs when this respiratory depression renders the lungs ineffective in the exchange of oxygen and carbon dioxide. CO2 builds up in the bloodstream. Serum levels show hypercapnia and hypoxemia drug overdose (opioids), COPD, atelectasis, pneumonia, hypoventilation, Guillain Barre, spinal cord injury

BMI is 25.0 to 29.9

overweight

Metabolic Acidosis

pH < 7.35 & HCO3 <22

Metabolic Alkalosis

pH > 7.45 & HCO3 >26

PPN

peripheral line

Hyperthyroidism Treatment

radioactive iodine Beta Blocker (propranolol) helps ease the heart thyroidectomy

Hypothyroidism Foods to Avoid

soy, broccoli, spinach, kale, caffeine, alcohol, peaches, pears, strawberries

central pain

spinal cord injuries migraines

Respiratory Alkalosis Signs/Symptoms

tachycardia, palpitations, anxiety, diaphoresis, seizures

GERD management

tobacco cessation, limiting alcohol, weight loss, elevating the head of the bed, avoiding eating before bed, and altering the diet

When a client with cancer, who has been taking morphine, becomes less sensitive to the drug's analgesic properties, that client is said to have developed a(n)

tolerance

BMI is less than 18.5

underweight

A client prescribed allopurinol denies any current symptoms of gout. What response should the nurse provide when the client asks why the medication has been prescribed?

used to prevent or treat hyperuricemia, which commonly occurs with gout.