Ch. 78- Drug Therapy of Gout Flashcards
What is gout?
A painful recurrent inflammatory disorder mainly seen in men.
What is hyperuricemia?
Uric acid level > 7 mg/dL in men or > 6 mg/dL in women.
What are the typical symptoms of gout?
Episodes of severe joint pain, typically in the large toe.
What are the primary causes of gout?
- Excessive production of uric acid
- Impaired renal excretion of uric acid
What are the short-term drug therapy options for gout?
- NSAIDs (first-line)
- Glucocorticoids
- Colcrys
What is urate-lowering therapy (ULT)?
Long-term treatment to lower blood levels of uric acid.
Name some urate-lowering therapy options.
- Allopurinol (Zyloprim)
- Febuxostat (Uloric)
- Probenecid
- Pegloticase (Krystexxa)
What is the first-line agent for stopping pain in acute gouty attacks?
NSAIDs
What are common adverse effects of NSAIDs?
- GI ulceration
- Impaired renal function
- Fluid retention
- Increased risk of cardiovascular events
What glucocorticoids are commonly used for gout?
- Prednisone (oral)
- Triamcinolone acetate (IM)
What is the mechanism of action of colchicine?
Acts as an anti-inflammatory agent specific for gout.
True or False: Colchicine is effective for conditions other than gout.
False
What are the dosing guidelines for acute gout attack with colchicine?
1.2 mg at first sign of flare, followed by 0.6 mg one hour later.
What should be done if GI symptoms occur while taking colchicine?
Discontinue colchicine immediately.
What are the goals of drug therapy for hyperuricemia?
- Promote dissolution of urate crystals
- Prevent new crystal formation
- Prevent disease progression
- Reduce frequency of acute attacks
- Improve quality of life
What is the role of allopurinol in gout treatment?
Inhibits uric acid formation.
What is febuxostat used for?
Alternative to allopurinol that reduces blood levels of uric acid.
What does probenecid do?
Increases uric acid excretion.
What is pegloticase indicated for?
IV therapy of chronic gout in patients unresponsive to oral ULT.
What are common adverse effects of allopurinol?
- Hypersensitivity syndrome
- Gastrointestinal effects
- Neurologic effects
What must be monitored when using allopurinol with warfarin?
Decrease the dosage of warfarin.
What is a significant black box warning for febuxostat?
Cardiovascular death.
What should be done if a patient develops a rash while taking allopurinol?
Stop the medication and assess the patient for liver and kidney failure.
What is the treatment of last resort for chronic gout?
Pegloticase.
Fill in the blank: Probenecid acts on renal tubules to inhibit reabsorption of _______.
uric acid
What is a contraindication for pegloticase?
Inherited glucose-6-phosphate dehydrogenase (G6PD) deficiency.
