Arthritis Gout (2) Flashcards
5 drugs that can elevate serum urate and precipitate gout
thiazies loop diuretics niacin calcineurin inhibitors asprin
What class of drugs is first line urate-lowering therapy in gout? 2 examples?
Xanthine Oxidase Inhibitors (XOI)
allopurinol or febuxostat
allopurinol MOA and indications
reduces uric acid synthesis by inhibiting xo(converts purines to uric acid)
for hyperuricemia of gout or recurrent kidney stones
allopurinol considerations
starting dose no greater than 100mg/day
gradually titrate up
starting dose must be less than 100 in pts with kidney disease
Pts started on allopurinol should be warned…
an acute gout flare could occur upon starting therapy
HA and somnolence can occur as well as jaundice
Hypersensitivity to allopurinol can occur in those of ______ descent with HLA______
asian descent
HLA-B*5801
Febuxostat MOA and indications
selectively inhibits XO
for hyperuricemia
Febuxostat monitoring
LFT(liver), serum uric acid, and s/s of stroke, MI or hypersensitivity
Febuxostat is recommended to be taken with ______ or ______ to prevent acute flares
NSAID or Colchicine
If XOI drugs contraindicated what 3 drugs are the alternative
probencid
fenofibrate
losartan
Probencid is not recommended as a monotherapy in
gout pts with low creatinine clearance (~50ml/min)
Hx of ______ contraindicates probencid monotherapy
urolithiasis (stone forming)
Probencid MOA
inhibits reabsorption of urate in prox convoluted tubule (which inc excretion of uric acid)
DONT START UNTIL ACUTE ATTACK HAS SUBSIDED
(may want alkalize urine and drink plenty of H2O to avoid stones)
7 ADR of probencid
HA dizzy anemia flushing sore gums, nausea, stones
Probencid levels are inc by _____
asprin and other salicylates
______ and ______ are appropriate 1st line prophylaxis therapy
colchicine (1st line) and NSAIDs
Pegloticase
approp for pts with severe gout and intolerance to oral ULT
Pegloticase MOA
recomb urate-oxidase enzyme which converts uric acid to allantoin
discontinue other oral antihyperuricemic agent 1st
premedicate with antihist and corticosteroids
Pegloticase monitoring and ADRs
serum uric acid levels s/b less than 6mg
antibody formation
acute gout flare
3 therapies that you should treat acute gout with 1st
NSAIDs (or COX-2 inhibitor)
systemic corticosteroids
colchicine
_________ are contraindicated in acute gout
Asprin and other salicyclates (bc inhibit uric acid excretion)
Colchicine MOA and ADRs
moa: prevents leukocyte chemotaxis and phagocytosis
(NO effect on uric acid levels or analgesic effect
adr: N/v/d bone marrow dep with chronic use
with gout you may consider _________ if large joints are involved
intraart injection of corticosteroids
__________, ________, and ________ are all FDA approved NSAIDs for acute gout
indomethacin
naproxen
sulindac
________ is the cox 2 inhib approved for acute gout
celecoxib
Indomethacin adr
may aggravate depression or other cns disterbances such as epilepsy and parkinsonism
______ and _______ are oral steroids you might give for gout.
predinsone and methylprednisone
________ is an IM steroid for gout
triamcinolone
