5.1 Gout Flashcards
Which drugs are used for acute attacks of gout? (4)
1) Indomethacin
2) NSAIDs
3) Colchicine
4) Glucocorticoids
What is the mechanism by which drugs used to treat acute attacks of gout act?
Supress leukocyte recruitment and activation
What is the Colchicine act on tubulin?
Binds tubulin, inhibiting it’s polymerization and preventing formation of microtubules, which disrupts mobility of granulocytes, decreasing their migration into the affected area.
Besides acting on tubulin, how else does Colchicine act? (2)
1) Blocks cell division by disrupting the mitotic spindle
2) Inhibits synthesis and release of leukotrienes
What is the DOC for acute gout attacks?
Indomethacin
What are the adverse affects of Indomethacin?
1) Bleeding
2) Na and H20 retention
3) Renal insufficiency
What drug is contraindicated with Indomethacin?
Aspirin
Why is Aspirin contraindicated with Indomethacin?
(low dose) competes with uric acid for secretion at the PT and causes hyperuricemia.
What is the most troublesome adverse affect of Colchicine therapy which has caused NSAIDs to replace them?
Diarrhea
What are the adverse affects related to chronic administration of Colchicine? (4)
1) Myopathy
2) Neutropenia
3) Aplastic anemia
4) Alopecia
What are the contraindications of Colchicine therapy?
Use with caution in patients with:
- hepatic
- renal
- CV disease
Which drugs are used to treat chronic gout? (4)
1) Allopurinol
2) Probenecid
3) Sulfinpyrazone
4) Rasburicase
What is the MOA of Allopurinol?
Purine analog which inhibits xanthine oxidase facilitating dissolution of tophi
What is Allopurinol indicated for? (2)
1) Decrease uric acid synthesis
2) Prevent renal damage during cancer chemotherapy
What is the adverse affects of Allopurinol?
Hypersensitivity skin rash may progress to Steven-Johnson syndrome (toxic epidermal necrosis)
