GOUT Flashcards

1
Q

drugs that increase uric acid

A

aspirin, lower doses
calcineurin inhibitors (tacrolimus and cyclosporine)
Diuretics (Loops and thiazides)
Niacin
Pyrazinamide
select chemotherapy (w/ tumor lysis syndrome)
Select pancreatic enzyme products

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2
Q

tx basics for gout

A
  • tx acute pain with anti-inflammatory
    —> colchicine
    —> steroids (including intra-articular inj.)
    —> NSAIDs (often starting at high dose)
  • tx chronically to prevent future attacks
    —> Xanthine oxidase inhibitors (XOI): allopurinol (preferred), or febuxostat
    ——-> acute gout flair while on XOI can be tx w/ colchicine and NSAIDs

if XOI didn’t work and UA >6mg/dL:
- add on probenecide or lesinurad to daily XOI
- Replace the XOI w/ IV pegloticase (Krystexxa)

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3
Q

Colchicine

A

Colcrys

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4
Q

colchicine warning, notes

A

warning: myelosuppression, neuromuscular toxicity
do not use w/ cyclosporine, diltiazem, verapamil, gemfibrozil or statin (these drugs increase myopathy risk)

start w/in 36 hrs of symptom onset
wait 12 of tx dose before resuming prophylaxis dose

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5
Q

NSAIDs

A

Indomethacin (indocin)
Naproxen (Aleve)
Celecoxib (Celebrex)

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6
Q

Steroids

A

Prednisone/Prednisolone
Methylprednisolone (Medrol, solu-medrol)

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7
Q

Allopurinol

A

Zyloprim, Aloprime
- HLA-B*5801 testing prior to use- do not use if positive (hypersensitivity)
- hepatotoxicity, bone marrow suppression
Due to high rates of gout attacks when beginning, use w/ colchicine or NSAIDs

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8
Q

Febuxostat

A

Uloric
- limited to those who can not tolerate allopurinol, increased CV risk!
- do not use w/ mercaptopurine or azathioprine
- hepatotoxicity

Due to high rates of gout attacks when beginning, use w/ colchicine or NSAIDs

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9
Q

uricosurics:

A

inhibit reabsorption of UA in the kidney

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10
Q

Lesinurad

A

zurampic
warning: acute renal failure, more common if used alone, only use w/ XOI

keep hydrated

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11
Q

Probenecid

A

contra: Do not use w/ aspirin therapy, UA kidney stones
can increase beta-lactam levels

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12
Q

Pegloticase

A

Krystexxa
warning: anaphylactic reaction- monitor and pre medicate w/ antihistamines and steroids
contra: G6PD deficiency

DO NOT use in combo w/ allopurinol, febuxotant, or probenecide

recombinant Uricase: converts uric acid to allantoin, which is excreted

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13
Q

Rasburicase

A

Elitek
tx of TLS. contra in G6PD deficinecy

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