Chapter 48: Gout

Question 1

Colchicine MOA

Answer 1

Inhibits microtubule formation by binding to tubulin

Interrupts cell motility and other things needed for inflamm process

Limits inflamm by blocking neutrophil activation

Question 2

What type of joint disease are glucocorticoids steroids) used for?

Answer 2

acute polyarticular gout - can be injected directly into the joint

Question 3

What NSAID is used most frequently to treat the pain associated with Gout?

Answer 3

indomethacin (ibuprofen runner up)

Question 4

Allopurinol MOA

Answer 4

Inhibits xanthine oxidase

Decreases breakdown of GMP and AMP into uric acid….this way uric acid does not build up in the blood

Question 5

Oxypurinol MOA

Answer 5

basically “freezes” xanthine oxidase

Question 6

Inhibiting xanthine oxidase leads to a build up of what in the blood? Is this an issue?

Answer 6

Buildup of xanthine and hypoxanthine

not an issue because these are pretty soluble in the blood! they can be filtered by the kidney without crystal deposition

Question 7

What would you administer in the case of acute gouty attack?

Answer 7

Colchicine or NSAID

NOT ALLOPURINOL!!!! this could potentially worsen gout at this time

Question 8

During the first 4-6 months of allopurinol therapy, what should you administer along with it?

Answer 8

Colchicine or NSAID to reduce risk of precipitating an attack

Question 9

What skin issue is a potential adverse effect of allopurinol?

Answer 9

A rash that can progress to the nastyass Stevens Johnson syndrome

= if you get rash, DISCONTINUE!

Question 10

Febuxostat MOA

Answer 10

nonpurine inhibitor of xanthine oxidase - recently approved

Chronic gout tx

Question 11

Febuxostat is metabolized where?

Answer 11

In the liver. So if pt has renal issue, you may not have to adjust dose.

Question 12

Which 2 drugs inhibit URAT1, leading to increased excretion of uric acid? Which is more potent?

Answer 12

Probenecid

Sulfinpyrazone (more potent)

Question 13

Losartan

Answer 13

MOA: angiotensin II receptor antagonist
TX: pts with hypertension&gout

Question 14

What is tumor lysis syndrome and what medications can be used to treat it?

Answer 14

Chemo –> rapid lysis of tumors –> liberate nucleotides and increase plasma urate –> massive renal injury

Rasburicase!
Allopurinol actually can help too

Raspberries have little nubs that look like tumors all over it

Question 15

Urate is LESS soluble at lower or higher temepratures?

Answer 15

lower

Question 16

Why would patients not adhere to colchicine therapy? (i.e. what is a common adverse effect?)

Answer 16

diarrhea