Antigout and Uricosuric Agents

Question 1

Xanthine Oxidase Inhibitors

Answer 1

Allopurinol and febuxostat

Question 2

Xanthine Oxidase Inhibitors

Allopurinol and febuxostat Indication

Answer 2

chronic gout

Question 3

Xanthine Oxidase Inhibitors
Allopurinol and febuxostat
pharmacodynamics

Answer 3

decrease uric acid level by selevtively inhibiting xanthine oxidase wich is the enzyme responsible for the conversion of hypoxanthine to xanthine to uric acid. uric acid then decreased, reducing the risk of crystallization and therefor a gout attack

Question 4

FDA alert for febuxostat

Answer 4

can increase the risk for cardiac related deaths.

not first line

Question 5

Xanthine Oxidase Inhibitors
Allopurinol and febuxostat
Caution and contraindication

Answer 5

renal impiarment,
severe hepatic impairment
avoid with azathioprine, mercaptopurine, and theophylline,
avoid in pregnancy and lactation caution.

allopurinol: Peds >6 y/o r/t cancer therapy.

Question 6

Xanthine Oxidase Inhibitors
Allopurinol and febuxostat
adverse drug reactions

Answer 6

maculopapular skin rash, 
arthralgias, 
nausea, 
diarrhea, 
elevated transaminases, 
hypersensitivity(rare),
 hepatotoxicity (rare)

Question 7

Probenecid

indications, pharmacodynamics

Answer 7

chronic gout

increased the excretion of serum uric acid by competitively inhibiting the reabsorption of uric acid @ the proximal convoluted tubule

Question 8

probenecid ADRs

Answer 8

headache,
dizziness,
anorexia,
n/v,
gingival soreness,
urinary frequency,
dermatitis,
pruritus,
flushing,
fever,
gout exacerbation,
anaphylaxis,
blood discrasias.

Question 9

probenecid caution and contraindications

Answer 9

CrCl < 30 ml/min,
avoid combining with aspirin,
pts with G6PD deficiency,
avoid in sulfa allergy,
avoid in pregnancy and lactation ***
avoid in children < 2 y/o

Question 10

Colchicine

indication and pharmacodynamics

Answer 10

acute gout flare

inhibits activation, degranulation and migration of neutrophils to area of gout attack. then decreased inflammation and pain associated with attack

onset 18-24 hrs. full effect 48 hrs

Question 11

colchicine contraindications and caution

Answer 11

grapefruit juice
renal & hepatin impairment
elderly patients
pregnancy and lactations.

can use >16 y/o

Question 12

colchicine ADRs

Answer 12

nausea, diarrhea, GI disturbance, anemia, alopecia, abdominal pain.

Question 13

drug to drug interaction

Answer 13

CYP 450 system. many interactions

Question 14

Corticosteroids (prednisone)

indications and pharmacodynamics

Answer 14

acute gout, rheumatoid arthritis

decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

Question 15

corticosteroids (prednisone)

caution and contraindications

Answer 15

active infections,
caution in diabetic patients,
caution in active GI disease,
caution in renal and hepatic impairment,
caution in pregnancy and lactation,
approved in pediatrics.

Question 16

corticosteroids (prednisone) ADRs

Answer 16

HTN,
insomnia,
mood changes,
increased appettie,
glucose intolerance,
PUD,
glaucoma,
osteoporosis,
growth suppression,
Cushing syndrome with longterm use.
prolonged use may lead to adrenal suppression and immunosuppression.

Question 17

Corticosteroids pt education

Answer 17

take with calcium and vitamin D.