CNS: Gout, Pain/Spasms, HA/Migraines Flashcards
Gout
- deposits of monosodium urate crystals in body tissue
Primary vs Secondary GOUT
primary = caused by an inborn error of purine metabolism
secondary = caused by hyperuricemia that results from other causes; disease states or drugs
Gout PATHO
- overproduction of uric acid
- under excretion of uric acid
Four phases of disease process:
1. asymptomatic hyperuricemia
2. acute gouty arthritis
3. intercritical period
4. development of chronic tophaceous deposits
Gout Hyperuricemia/Risk factors
serum urate level >7mg/dl in men and >6mg/dl in women
Risk factors: men, age >60yo, family hx, med, diet, alcohol consumption, obesity, co-existing medical conditions
Gout Treatment
- treatment - colchicine, corticosteroids, NSAIDs
- Prevention - allopurinol, colchicine, probenecid, pegloticase, febuxostat
patients resistant to conventional tx may require referral to rheumatology
GOAL is PREVENTION
Pretreatment lab
Gout TLC
weight loss
review of current meds
reduce, stop alcohol
dietary changes- low purine diet
significant lifestyle changes can reduce or eliminate need for med
Gout: Colchicine MOA/USES
Used in acute and post acute stages
MOA: reduces deposition of urate crystals
Gout: Colchicine CONTRA/Administration
CONTRA: hypersensitivity, severe renal/GI/hepatic/CV disorders
Onset 12-24 hrs
Dose: initial 0.6-1.2mg, followed by 0.6mg q2hrs until pain relief or diarrhea, max dose 6mg (traditional)
New guidelines: 1.2mg followed in 1hr by 0.6mg = effective and less toxic
Gout: Colchicine AE/INTERACTIONS
AE: GI (significant N/V/D, abd pain), alopecia, B12 malabsorption
Interactions: digoxin, antibiotics, antifungals, antiretrovirals, CCBs, fibrates, grapefruit juice, immunosuppressants, statins
All may INC toxicity
Gout: Colchicine Patient education
- do NOT exceed dose
- follow low purine diet
- NO ETOH
- NO ASA containing meds
- STOP and report: severe vomiting, muscle weakness, watery diarrhea, burning in throat, delirium, convulsions
Gout: Allopurinol USES/MOA
Used to PREVENT future attacks
MOA: inhibits enzyme that converts xanthine to uric acid
Gout: Allopurinol CAUTION/Administration
CAUTION: renal impairment, use of diuretics, ACE inhibitors
Onset 1-2 wks
Dose 200-600mg per day, usual 300mg/day
Adjust for renal clearance
Gout: Allopurinol MONITOR/Patient education
administer w/ large glass of water
MONITOR: start of therapy and during - CBC, serum uric acid, hepatic and renal function
- adequate hydration
- DEC ETOH use
- Low purine diet
- CAUTION w/ OTC meds and vitamins
REPORT signs of liver dysfunction, rash, hair loss, blood in urine
Gout: Probenecid MOA/USES
PREVENTION drug
MOA: inhibit reabsorption of uric acid, promotes excretion and reducing serum uric acid levels
Gout: Probenecid CAUTION/Administration
CAUTION: renal disease, high dose ASA therapy, hx PUD
Dosing: 250mg BID for one week, INC by 500mg per week based on serum uric acid levels
MONITOR: uric acid, renal function, CBC
May take 6 months to reach full effect
Gout: Probenecid AE/INTERACTIONS
AE: flushing, HA, rash, itching, GI, painful urination, anemia
INTERACTIONS: PCN, salicylates, methotrexate, quinolones, cephalosporins, sulfa, acyclovir, BDZ
Gout: Probenecid Patient education
- adequate hydration
- low purine levels
- take w/ food or milk
- AVOID NSAIDs, ASA
REPORT severe HA, rash, bruising, bleeding
Gout: Pegloticase (Krystexxa)
Newest drug for gout
would need to refer patient who require this drug
IV only
Patient must fail to reach normal uric acid levels w/ conventional therapy
CONTRA: patient w/ G6PD deficiency
AE: most common anaphylaxis, infusion reaction, gout flares
Gout: Febuxostat USES/MOA
Uloric
Newest drug for gout
CHRONIC management of gout
MOA: DEC serum uric acid levels
Gout: Febuxostat Administration/INTERACTIONS
Dosing: 40mg/day with goal to 80mg/day
INTERACTIONS: theophylline, mercaptopurine, azathioprine
Gout: Febuxostat CONTRA/AE
CONTRA: can INC initial gouty flares
CAUTION: Hx of CV disease, small # of MI experienced
AE: gouty flares, INC LFT, nausea, arthralgias, rash