2- Gout and Migraines

Question 1

Are NSAIDs and Colchicine used in the acute or chronic tx of gout?

Answer 1

Acute

Question 2

Are Uricosuric Agents, Xanthine Oxidase Inhibitors and enzymes that convert uric acid to allantoin used in the tx of acute or chronic gout?

Answer 2

Chronic

Question 3

What is the use of NSAIDs in the tx of gout?

Answer 3

Inflammation due to acute attack of gouty arthritis

Question 4

What is the primary NSAID used in the tx of gout?

Answer 4

Indomethacin

(can also use naproxen and sulindac)

Question 5

What NSAIDs are contraindicated in the tx of gout because they decrease urate excretion?

Answer 5

ASA and Salicylates

Question 6

What drug binds tubulin to inhibit leukocyte migration and phagocytosis, has NO analgesic effect, no effect on urate excretion, and is used to treat acute attack of gouty arthritis (12-24 hrs)?

Answer 6

Colchicine

(oral admin, increased toxicity with IV)

Question 7

What are the SEs of colchicine?

Answer 7

Diarrhea, N/V, abd pain

Question 8

What drugs are uricosuric agents (block active reabsorption of uric acid) and used in the tx of gout?

Answer 8

Probenecid

Lesinurad (Zurampic)

Question 9

What is a SE of uricosuric agents?

(Probenecid, Lesinurad (Zurampic))

Answer 9

GI irritation

Question 10

When using uricosuric agents, what should be maintained in order to minimize the possibility of kidney stone formation?

Answer 10

A large urine volume

Question 11

What is the caution with uricosuric agents and what should be done to help prevent this?

Answer 11

May trigger gouty attack

Prophylactic colchicine

Question 12

What drug should be started 2-3 weeks AFTER acute gouty attack and is given orally?

Answer 12

Probenecid

Question 13

What are the SEs of Probenecid?

Answer 13

Decrease excretion of acidic compounds (ex. Penicillin, MTX)

Question 14

What drug is a URAT1 inhibitor and can be combined with a xanthine oxidase inhibitor in the tx of gout?

Answer 14

Lesinurad (Zurampic)

Question 15

What is the SE of Lesinurad (Zurampic)?

Answer 15

Renal failure

(more common when used as monotherapy or at higher doses)

Question 16

What drugs are xanthine oxidase inhibitors (inhibit synthesis of uric acid) and are effective in both primary and secondary forms of gout?

Answer 16

Allopurinol, Febuxostat

Question 17

What are the SEs of Allopurinol and Febuxostat?

Answer 17

Vasculitis, agranulocytosis, hypersensitivity

Question 18

What can be used to decrease the possibility of an acute gouty attack with initial Allopurinol or Febuxostat therapy?

Answer 18

Colchicine prophylaxis

Question 19

What drug interactions should you be aware of for Allopurinol and Febuxostat?

(increased effect, elimination, metabolism, activation)

Answer 19

Increases:

• Effect of mercaptopurines
• Elimination of cyclophosphamide
• Metabolism of warfarin, probenecid
• Activation of 5-FU

Question 20

Aluminum Hydroxide decreases the absorption of what drug used in the tx of gout?

Answer 20

Allopurinol

Question 21

What drugs are enzymes that convert uric acid to allantoin?

Answer 21

Rasburicase (Fasturtec)

Pegloticase (Krystexxa)

Question 22

What drug is a recombinant form of urate oxidase, given IV, and can be used in the tx of gout as well as to decrease risk of tumor lysis syndrome (TLS) in patients with hematological malignancies or solid tumors (especially after chemo initiation?

(urate oxidase is NOT endogenous in humans)

Answer 22

Rasburicase (Fasturtec)

Question 23

Aside from GI issues, what is a concerning SE a/w Rasburicase (Fasturtec)?

Answer 23

Anaphylactic shock

Question 24

What drug is a recombinant mammalian urate oxidase enzyme that is easily excreted in the urine and used in the tx of gout?

Answer 24

Pegloticase (Krystexxa)

Question 25

What drug class is first line for treating acute migraine sxs?

Answer 25

“Triptans”

All 5-HT1D agonists, cause vasoconstriction

(Sumatriptan, Rizatriptan, Naratriptan, Zolmitriptan, Eletriptan, Frovatriptan)

Question 26

If a “triptan” is used in the tx of an acute migraine, and a HA recurs within 24-48 hours, what should you do?

Answer 26

2nd dose required

Question 27

What are the SEs of the “triptans”?

(tx of acute migraine sxs)

Answer 27

Vasoconstrictive effects

CV (arrhythmias, angina, MI, cardiac arrest, stroke, PVD, hemorrhage)

GI (bowel ischemia, bloody diarrhea)

Question 28

What are the contraindications to use of a “triptan” for acute migraine sxs?

Answer 28

Due to vasoconstriction risk (CV, CAD, HTN)

Breastfeeding/ pregnancy, DM, tobacco smoking, renal impairment

Question 29

What drugs are used in the tx of acute migraine sxs?

Answer 29

Triptans, Ergotamine, Dihydroergotamine

Question 30

What drug is a 5-HT agonist (but less specific than “triptans”), results in STRONG vasoconstriction and is most effective if administered early?

Answer 30

Ergotamine (Ergomar)

Question 31

What increases the absorption (and therefore potentiates the effect) of Ergotamine?

Answer 31

Caffeine

Question 32

What are the SEs of Ergotamine?

Answer 32

Acute (GI effects, CV toxicity)

Chronic (ergotism, vasoconstriction + CNS)

Question 33

What drug is similar to Ergotamine but less vasoconstriction and has a SE of nausea?

Answer 33

Dihydroergotamine (Migranal)

Question 34

What analgesics are used to treat the pain a/w migraines?

Answer 34

Aspirin, acetaminophen, naproxen, propoxyphene

Question 35

What BB is used for chronic prevention (prophylaxis) of migraines?

Answer 35

Propranolol

Question 36

What CCB is used for chronic prevention (prophylaxis) of migraines?

Answer 36

Verapamil

Question 37

What antidepressants are used for chronic prevention (prophylaxis) of migraines?

Answer 37

Amitriptyline, Fluoxetine

Question 38

What anticonvulsants are used for chronic prevention (prophylaxis) of migraines?

Answer 38

Valproic Acid, Topiramate

Question 39

The following drugs are all used prophylactically for tx of what?

Clonidine, Botox, ARBs & ACE-Is

Answer 39

Migraines

Question 40

What drug is used for migraine prophylaxis and is an IgG2 monoclonal Ab that binds CGRP?

Answer 40

Erenumab (Aimovig)