Chapter 9 anti inflammatory and immunomodulating agents -- gout and uric acid lowering drugs

Question 1

NSAIDS
colchicine
corticosteroids

Answer 1

• pain and inflammation relievers
• NSAIDS (ibuprofen, indomethacine)
• low dose colchicine ( relieve pain and inflammation associated with gout) [often used with NSAIDS]
• corticosteroids (prednisone, methylprednisone) — for sx relief

Question 2

allopurinol (zyloprim)
febuxostat (uloric)

Answer 2

sxanthine oxidase inhibitors

• decrase uric acid levels by inhibiting xanthine oxidase (enzyme that converts hypoxanthine to xanthine and xanthine to uric acid

indication
* gout
* eliminate uric acid release from leukemia cells during initial chemotherapy (leukemia cancer patients)

Question 3

Foods that cause gout

Answer 3

Red meat and seafood. Meat (especially organ meats like liver and sweetbreads) and seafood (like fish and shellfish) can be high in chemicals called purines. When your body breaks them down, your level of uric acid goes up. —- purines?…

Instead, go forprotein from low-fat dairy products, like skim milk, cheese, and yogurt. You can also eat more beans, soy, and other plant-based forms of protein.

Sweetened drinks. Sodas and juices flavored with fruit sugars, like high-fructose corn syrup, can trigger gout flares.

For a sweet substitute, switch to flavored water or diet soda, which won’t raise your odds of an attack. In general, make sure to drink a lot of fluids. Aim for at least eight glasses a day, with at least half being water.

Alcohol. Liquor and especially beer can make you more likely to have gout. You don’t have to give up on cocktail hour forever, but your best bet is to limit how much you drink. Your doctor can help you figure out how much is OK.

Question 4

probenecid

Answer 4

• renal reabsorption of uric acid inhibitor
• competes with uric acid for renal reabsorption (less uric acid reabsorbed!) at the proximal convoluted tubule
• IMPORTANT — maintain good fluid intake sufficent to achieve 2-3 L of urine output per day

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administer prophylatic dose of colchicine for first 3-6 months b/c probenecid can induce GOUT flares

Question 5

lesinurad (zurampic)

Answer 5

• uric acid transporter 1 (URAT1) and organic anion transporter-4 (OAT4) inhibitors
• reduces acitity of both transporters to block reabsorption of uric acid by kidneys
• USUALLY — used in combination with allopurinol or febuxostat

note
* important to assess renal fx during tx as renal failure may occur

Question 6

pegloticase (krystexxa)

Answer 6

recombinant modified urate oxidase (uricase) enzyme

• catalyzes oxidation of uric acid to allantoin (which is readily excreted by kidney)

SUBQ – pegylated ( attaching polyethylene glycol (PEG) chains to polypeptides or other) to inc duration of action

effects
* anaphylaxis
* infusion rxn b/c immune sys recognizes protein as foreign