Gout Flashcards
MOA: COX inhibition: reduced prostaglandin synthesis. Inhibit urate crystal phagocytosis. Decreased leukocyte migration
NSAIDs
indication: Acute gout attack within 24 hours of symptom onset and continue until pain absent for 24 hrs
NSAIDs
should aspirin be used for gout
no
MOA: down regulation of multiple inflammatory pathways. Interferes w/ function of mitotic spindles in neutrophils. Impedes leukocyte migration and phagocytosis
colchicine
indications: Acute gout attack START within 12-24 hours of symptom onset for max effect. Calcium Phosphate Crystal Arthritis, pericarditis, Behcet’s, Familial Mediterranean Fever, PREVENTION of gout attacks in certain patients
colchicine
AEs: GI – severe diarrhea (23%),nausea, vomiting, abdominal pain. Myopathy, Bone marrow suppression
colchicine
colchicine interactions
It is a CYP3A4 substrate- so avoid use with strong CYP3A4 inhibitors (diltiazem, verapamil,clarithromycin, grapefruit). Statins are substrates and therefore DO interact so consider stopping the statin for a few days
colchicine special pop concerns
Adjust dose or avoid in severe renal dysfunction (CrCl<30)
PO steroids for gout for minimum of ___ days
10
indications: For pts w/ contras to NSAIDs and cochicine. Polyarticular attacks, systemic for widespread
corticosteroids
MOA: Stimulates production of cortisol by adrenal corte
Corticotropin
anakinra, canakinumab
IL-1 inhibitors
indications for urate lowering therapy
2+ attacks / yr, tophus, stage 2 CKD or worse, past urolithiasis (uric acid kidney stones)
AE: can cause acute attack
urate lowering therapies
“Allopurinol (Zyloprim®, Aloprim®)
Febuxostat (Uloric®)”
class
Xanthine Oxidase Inhibitors
turns off the facet - reduces uric acid production. Inhibits xanthine oxidase
“Allopurinol (Zyloprim®, Aloprim®)
Febuxostat (Uloric®)”
1st line urate lowering agents for gout
allopurinol
AEs: diarrhea, nausea, rash, pruritis, urticaria
allopurinol
AEs: transaminitis, nausea, arthralgia, rash
Febuxostat (Uloric®)
interactions of allopurinol
A: increases warfarin, theophylline
allopurinol adjust dose for whom
renal impaired
monitoring: “Allopurinol (Zyloprim®, Aloprim®)
monitor uric acid Q2-5 wks, then Q6 mo after target is reached
co-prescribe w/ allopurinol
NSAID or colchicine
MOA: empties the tub with a bucket. Decreases reabsorption in Proximal tubule. Reduces uric acid retention. Tophaceous deposits may be reabsorbed
“Probenecid
indication: Patients intolerant to or ineffective use of xanthine oxidase inhibitors
“Probenecid
“Probenecid
class
Uricosurics
AEs: “Headache, N/V, aplastic anemia (rare)
Precipitate kidney stone formation “
Probenecid
Probenecid
interactions
Aspirin, penicillins, methotrexate
Probenecid pt counseling
encourage hydration to prevent kidney stones
drains the tub. Metabolises uric acid. IV infusion Q2 wks
Pegloticase (Krystexxa®)
indication: Refractory chronic gout
Pegloticase (Krystexxa®)
Pegloticase (Krystexxa®)
contra
Contraindication: G6PD deficiency
AEs: anaphylaxis, infusion reactions, possible gout flares
Pegloticase (Krystexxa®)
MOA: Uric acid transporter 1 (URAT1) inhibitor. Increases renal secretion of uric acid
Lesinurad (Zurampic®)
FDA approved for co-administration with Xanthine Oxidase Inhibitor (if serum uric acid levels not achieved)
Lesinurad (Zurampic®)
BBW and AEs for Lesinurad (Zurampic®)
“BBW: Risk of renal failure when administered as monotherapy
Headache, influenza, SCr increase, GERD”
