2- Gout and Migraines Flashcards
Are NSAIDs and Colchicine used in the acute or chronic tx of gout?
Acute
Are Uricosuric Agents, Xanthine Oxidase Inhibitors and enzymes that convert uric acid to allantoin used in the tx of acute or chronic gout?
Chronic
What is the use of NSAIDs in the tx of gout?
Inflammation due to acute attack of gouty arthritis
What is the primary NSAID used in the tx of gout?
Indomethacin
(can also use naproxen and sulindac)
What NSAIDs are contraindicated in the tx of gout because they decrease urate excretion?
ASA and Salicylates
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)?
Colchicine
(oral admin, increased toxicity with IV)
What are the SEs of colchicine?
Diarrhea, N/V, abd pain
What drugs are uricosuric agents (block active reabsorption of uric acid) and used in the tx of gout?
Probenecid
Lesinurad (Zurampic)
What is a SE of uricosuric agents?
(Probenecid, Lesinurad (Zurampic))
GI irritation
When using uricosuric agents, what should be maintained in order to minimize the possibility of kidney stone formation?
A large urine volume
What is the caution with uricosuric agents and what should be done to help prevent this?
May trigger gouty attack
Prophylactic colchicine
What drug should be started 2-3 weeks AFTER acute gouty attack and is given orally?
Probenecid
What are the SEs of Probenecid?
Decrease excretion of acidic compounds (ex. Penicillin, MTX)
What drug is a URAT1 inhibitor and can be combined with a xanthine oxidase inhibitor in the tx of gout?
Lesinurad (Zurampic)
What is the SE of Lesinurad (Zurampic)?
Renal failure
(more common when used as monotherapy or at higher doses)
What drugs are xanthine oxidase inhibitors (inhibit synthesis of uric acid) and are effective in both primary and secondary forms of gout?
Allopurinol, Febuxostat
What are the SEs of Allopurinol and Febuxostat?
Vasculitis, agranulocytosis, hypersensitivity
What can be used to decrease the possibility of an acute gouty attack with initial Allopurinol or Febuxostat therapy?
Colchicine prophylaxis
What drug interactions should you be aware of for Allopurinol and Febuxostat?
(increased effect, elimination, metabolism, activation)
Increases:
- Effect of mercaptopurines
- Elimination of cyclophosphamide
- Metabolism of warfarin, probenecid
- Activation of 5-FU
Aluminum Hydroxide decreases the absorption of what drug used in the tx of gout?
Allopurinol
What drugs are enzymes that convert uric acid to allantoin?
Rasburicase (Fasturtec)
Pegloticase (Krystexxa)
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)
Rasburicase (Fasturtec)
Aside from GI issues, what is a concerning SE a/w Rasburicase (Fasturtec)?
Anaphylactic shock
What drug is a recombinant mammalian urate oxidase enzyme that is easily excreted in the urine and used in the tx of gout?
Pegloticase (Krystexxa)
What drug class is first line for treating acute migraine sxs?
“Triptans”
All 5-HT1D agonists, cause vasoconstriction
(Sumatriptan, Rizatriptan, Naratriptan, Zolmitriptan, Eletriptan, Frovatriptan)
If a “triptan” is used in the tx of an acute migraine, and a HA recurs within 24-48 hours, what should you do?
2nd dose required
What are the SEs of the “triptans”?
(tx of acute migraine sxs)
Vasoconstrictive effects
CV (arrhythmias, angina, MI, cardiac arrest, stroke, PVD, hemorrhage)
GI (bowel ischemia, bloody diarrhea)
What are the contraindications to use of a “triptan” for acute migraine sxs?
Due to vasoconstriction risk (CV, CAD, HTN)
Breastfeeding/ pregnancy, DM, tobacco smoking, renal impairment
What drugs are used in the tx of acute migraine sxs?
Triptans, Ergotamine, Dihydroergotamine
What drug is a 5-HT agonist (but less specific than “triptans”), results in STRONG vasoconstriction and is most effective if administered early?
Ergotamine (Ergomar)
What increases the absorption (and therefore potentiates the effect) of Ergotamine?
Caffeine
What are the SEs of Ergotamine?
Acute (GI effects, CV toxicity)
Chronic (ergotism, vasoconstriction + CNS)
What drug is similar to Ergotamine but less vasoconstriction and has a SE of nausea?
Dihydroergotamine (Migranal)
What analgesics are used to treat the pain a/w migraines?
Aspirin, acetaminophen, naproxen, propoxyphene
What BB is used for chronic prevention (prophylaxis) of migraines?
Propranolol
What CCB is used for chronic prevention (prophylaxis) of migraines?
Verapamil
What antidepressants are used for chronic prevention (prophylaxis) of migraines?
Amitriptyline, Fluoxetine
What anticonvulsants are used for chronic prevention (prophylaxis) of migraines?
Valproic Acid, Topiramate
The following drugs are all used prophylactically for tx of what?
Clonidine, Botox, ARBs & ACE-Is
Migraines
What drug is used for migraine prophylaxis and is an IgG2 monoclonal Ab that binds CGRP?
Erenumab (Aimovig)
