Gout

Question 1

Gout Overview

Answer 1

Painful inflam from deposition of uric acid crystals in joints.
Big toe first.
Recurrent

Question 2

Acute Gout Flares

Answer 2

NSAIDS (first line) including Indomethacin
Glucocorticoids (2nd)
Colchicine (pts tolerant or unresponsive to 1/2 line options)

Question 3

Indomethacin

Answer 3

IND: Gout
MOA: NSAID
BOX: CV and GI of NSAIDs
CON: CABG
ADR: HA, bleeding, vomiting

Question 4

Colchicine

Answer 4

IND: Gout
MOA: Inhibits Beta-tubulin polymerization. Prevents activation, degranulation, and migration of PMNs
BOX: n/a
CON: Use with P-glycoprotein inhibitor or strong CYP 3A4 inhibitor
ADR: DIARRHEA

Question 5

Allopurinol

Answer 5

IND: Gout, MC agent and cheapest
MOA: Xanthine Oxidase Inhibitor (enzyme that makes uric acid)
BOX: n/a
CON: n/a
ADR: Acute gout attacks early in therapy, co-prescribe anti-inflamm for 3-6 months. Hepatotoxicity; DRESS. Delayed Hypersensitivity rxn; SJS/TEN

Question 6

Febuxostat

Answer 6

IND: Gout
MOA: Xanthine Oxidase Inhibitor
BOX: Cardiovascular death. Only use when Allopurinol is no good
CON: Use with Azathioprine or Mercaptopurine; both potentially fatal
ADR: n/a

Question 7

Probenecid

Answer 7

IND: Gout, older agent
MOA: Inhibits Uric acid at proximal tubule; promotes excretion of uric acid
BOX:
CON: Use with ASN, blood dyscrasias, kidney stones, INITIATION DURING ACUTE GOUT ATTACK
ADR: n/a

Question 8

Pegloticase

Answer 8

IND: Gout. Very expensive. Uncontrolled gout, last line.
MOA: Converts uric acid to an inactive form (allantoin)
BOX: Anaphylaxis and infusion rxns; premedicate.
G6PD deficiency
CON: G6PD deficiency
ADR: Infusion rxn, gout flare, AB development

Question 9

Rasburicase

Answer 9

IND: Hyperuricemia a/w malignancy
MOA: Recombinant urate-oxidase enzyme; converts uric acid to allantoin
BOX: Fatal hypersensitivity.
G6PD def.
Interferes with uric acid measurements
CON: Hx of hemolysis, G6PD
ADR: Peripheral edema, fever, increased bilirubin and ALTs