GOUT Flashcards
drugs that increase uric acid
aspirin, lower doses
calcineurin inhibitors (tacrolimus and cyclosporine)
Diuretics (Loops and thiazides)
Niacin
Pyrazinamide
select chemotherapy (w/ tumor lysis syndrome)
Select pancreatic enzyme products
tx basics for gout
- 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)
Colchicine
Colcrys
colchicine warning, notes
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
NSAIDs
Indomethacin (indocin)
Naproxen (Aleve)
Celecoxib (Celebrex)
Steroids
Prednisone/Prednisolone
Methylprednisolone (Medrol, solu-medrol)
Allopurinol
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
Febuxostat
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
uricosurics:
inhibit reabsorption of UA in the kidney
Lesinurad
zurampic
warning: acute renal failure, more common if used alone, only use w/ XOI
keep hydrated
Probenecid
contra: Do not use w/ aspirin therapy, UA kidney stones
can increase beta-lactam levels
Pegloticase
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
Rasburicase
Elitek
tx of TLS. contra in G6PD deficinecy