gout

Question 1

colchicine

Answer 1

• Prevents tubulin polymerization & leads to inibition of leukocyte migration, phagocytosis, and release of cytokines
• used for acute gouty arthritis
• long term use can cause peripheral neuropathy and neutropenia

Question 2

NSAIDs

Answer 2

• inhibit eicosanoid-mediated pain and inflammation
• used for initial treatment of acute gouty arthritis

Question 3

Corticosterioids

Answer 3

• intraarticular injection good for acute monoarticular gout
• acute gouty arthritis
• good pain relief and used for those in whom colcichine and NSAIDs are ineffective or contraindicated

Question 4

Probenecid

Answer 4

• uricosuric agent – increases rate of uric acid excrteion
• Competes with urate at the anionic transport site of the renal tubule and inhibit urate reabsorption
• used for chronic tophaceous gout
• adverse side effects: reduced urate levels may cause urate crystal mobilization and acute gouty arthritis
• secretion of some weak acids (ie: PCN) is reduced

**Probenecid think PCN

Question 5

Allopurinol

Answer 5

• 1. Reduces uric acid synthesis by inhibiting xanthine oxidase (competitive inhibition) –> alloxanthine
     
     2. Alloxanthine is a non-competitive inhibitor of xanthine oxidase
• treat chronic tophaceous gout
• Acute attacks of gouty arthritis early in treatment due to mobilization of urate crystals

Question 6

Febuxostat

Answer 6

• non-purine, non-competitive antagonist of XO
• treat chronic tophaceous gout
• adverse effects: nausea, rash, arthralgias, expensive

Think X in name –> inhibitor of XO

Question 7

Clinical Manifestations of hyperuricemia

Answer 7

• acute gouty arthritis: deposits of uric acid in joint tissue –> inflammation, severe pain, swelling (podagra) –> usually subsides after a few days
• chronic tophaceous gout: deposits or urate (tophi) in tissues/bone –> destruction; hyperuricemia; recurrent attacks of acute gout

Question 8

drug tx for acute gouty arthritis

Answer 8

• NSAIDs
• Corticosteroids
• Colchicine

Question 9

drug tx for chronic tophaceous gout

Answer 9

• probenecid
• allopurinol
• febuxostat