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MSK 2 > Drugs for Gout: Fitz > Flashcards

Drugs for Gout: Fitz Flashcards

1
Q

re absorption in kidneys of urate by what transporter?

A

URAT1

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2
Q

what are factors that contribute to gout attacks in first metatarsal-phalangeal joint?

A
  • joint has lower temp
  • physical trauma can cause acidosis
  • nocturnal intraarticular dehydration may caused nocturnal crtyallization and nocturnal onset of pain
  • presence of altered matrix proteins, exposed cartilage fragments, and nucleating debris . . OA or elderly pts
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3
Q

what is the gout specific anti inflammatory drug

A

colchicine

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4
Q

how does colchicine work?

A
  • binds to tubulin and depolymerizes microtubules

- Disrupts granulocyte function (phagocytosis, migration); inhibits LTB4 formation

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5
Q

what do you tell your gout patient about taking over the counter ibuprofen to help

A

the recommended dose is not sufficient

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6
Q

what is appropriate choice for first line gout attack prophylaxis?

A

NSAID unless lack of tolerance or medical contraindication

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7
Q

when should colchicine dose be decreased

A

if renal or hepatic dysfunction

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8
Q

is colchicine an analgesic?

does it modify uric acid levels?

A
  • No not directly but reduces swelling so secondary

- No

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9
Q

Corticosteroid use and gout?

A
  • long term risk such as osteoporosis and infection
  • short term (3-7 days) risk low
  • adverse effect on BP and blood sugar can be a concern for HTN and uncontrolled DM pts
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10
Q

Drugs for hyperuricemica and Tophaceous gout?

mechanism of action?

A
  • Allopurinol and Febuxostat: Xanthine oxidase inhibitors, inhibit urate biosynthesis
  • Probenecid* and sulfinpyrazone: Uricosuric agents (URAT1 inhibitors), enhance urate excretion
  • Pegloticase and Rasburicase: Recombinant urate oxidase enzyme, enhance urate metabolism
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11
Q

1st line urate lowering therapy (ULT)

A

XOIs

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12
Q

2nd line ULT?

A

oral XOI with oral uricosuric agent (probenecid)

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13
Q

what is serum urate target

A

<6 mg/dl

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14
Q

what accumulates when giving a XOI

A

hypoxanthine

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15
Q

dosing for allopurinol

A

once daily P.O.

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16
Q

Febuxostat vs allopurinol

A
  • not purine analog
  • as effective as allopurinol at reaching <6 mg/dL
  • better and different adverse effect profile (liver function) vs allopurinol
  • Can be used in pts with renal disease
17
Q

what happens in initial phase of ULT

A

-early increase in acute gout attacks . . . contributes to non compliance

18
Q

what is recommended to add to initial ULT

A

-oral colchicine or NSAID to decrease acute gout

19
Q

clinical complications of allopurinol and Febuxostat

A
  • inhibit metabolism of Xanthine drugs used in cancer chemo, immunosuppression, asthma conferring risk of overexposure and require dose adjustments
  • 6-mercaptopurine
  • Azathioprine
  • Theophylline
20
Q

Black box warning specific for Allopurinol

A
  • not for asymptomatic hyperuricemia

- discontinue at first appearance of skin rash or other allergic signs

21
Q

what is the genotype that confers risk for hypersensitivity reaction to allopurinol

A

HLA-B*5801

22
Q

what part of tubule mediates urate reabsorption

A

proximal

23
Q

Probenecid blocks URAT1 on what membrane

A

apical

24
Q

Uricosuric agents should be avoided in who

A

-pts with risk/history of nephrolithiasis or uric acid nephropathy

25
Q

ULT and acute gout?

A

no benefit and should general not be initiated during an acute attack

26
Q

paradox of Aspirin administration for acute gout

A
  • do not used standard dose
  • it blocks tubular secretion more than tubular absorption so it aggravates hyperuricemia
  • need very high dose. >3 g/day
27
Q

when is pegloticase appropriate for ULT

A

severe disease, failure, or intolerance to others

28
Q

Pegloticase and Rasburicase augment metabolic degradation of uric acid into what

A

Allantoin

29
Q

Pegloticase indicated for hyperuricemia associated with what

A

malignancy . . tumor lysis syndrome

30
Q

dosing for Pegloticase?

A

IV . . Q 2 weeks

31
Q

Black box warning for both Pegloticase and Rasburicase?

A

-hypersenstivity

32
Q

Black box warning for only Rasburicase?

A
  • hemolysis

- contraindicated in pts with G6PD deficiency

MSK 2 (16 decks)

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