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Pharmacology I > Gout > Flashcards

Gout Flashcards

1
Q

What is gout?

A

The deposition of uric acid crystals in the synovium

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2
Q

What is the end product of purines?

A

Uric acid

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3
Q

Where is the most likely place for crystal formation?

A

Peripheral joints

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4
Q

What is Gouty nephropathy?

A

kidney disorders caused by an increase in uric acid

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5
Q

What are the steps of acute gout attack?

A

Sodium urate crystals form in the join. Phagocytosis by neutrophils and macrophages. Neutrophils activation and release of inflammatory mediators.

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6
Q

Which drugs inhibit the formation of uric acid?

A

Allopurinol and Febuxostat

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7
Q

Which drugs increase the excretion of uric acid?

A

Probenecid

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8
Q

What NSAIDs are given for an acute gout attack?

A

Indomethacin and Ibuprofen

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9
Q

What is the mechanism of action of Indomethacin and Ibuprofen?

A

inhibition of prostaglandin synthesis

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10
Q

What are the side effects of Indomethacin?

A

GI irritation- the increase in acid causes a decrease in mucous in the stomach leading to irritation
Central Nervous System- headache, drowsiness

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11
Q

What drug is to be avoided in a gout attack?

A

Aspirin

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12
Q

Why is Aspirin avoided in a gout attack?

A

Due to its biphasic effect on uric acid excretion

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13
Q

What is an injectable NSAID that is mainly used for pain management?

A

Ketorolac (Toradol)

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14
Q

What is an alternative to opioids that is used in treating acute gout attacks?

A

Ketorolac (Toradol)

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15
Q

What are the side effects of Ketorolac (Toradol)?

A

GI irritation.

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16
Q

Where does Colchicine come from?

A

It is a naturally occurring alkaloid isolated from autumn crocus

17
Q

What is special about Colchicine?

A

It has a unique anti-inflammatory activity that is specific for gout only

18
Q

What is the mechanism of action for Colchicine?

A

it binds to tubulin and prevents it’s polymerization to microtubules. It also inhibits the production and release of pro inflammatory glycoproteins from neutrophils.

19
Q

What are the side effects of Colchicine?

A

Diarrhea, upset GI, nausea, and vomiting. (Side effects may be severe even at therapeutic levels)

20
Q

How is Colchicine administered?

A

It can be administered orally or given in IV for acute attacks

21
Q

What is the mechanism of action of Allopurinol?

A

It inhibits the enzyme xanthine oxidase and reduces the formation of uric acid

22
Q

Does Allopurinol stop an acute gout attack?

A

No it does not stop an acute gout attack however over time it reduces the potential of an attack in the future

23
Q

What are the side effects of Allopurinol?

A

Increases frequency of gout attack during early stages of therapy due to the breakdown of crystals as uric acid blood levels fall.
Elevation of liver enzymes
Allergic reactions

24
Q

What is Febuxostat?

A

A new xanthine oxidase inhibitor
(more effective than Allopurinol)

25
Q

How are Allopurinol and Febuxostat similar?

A

both decrease uric acid levels which increases dissociation of existing crystals

26
Q

what is the difference between Allopurinol and Febuxostat?

A

Febuxostat generally similar to allopurinol but it is more expensive. It also has less dermatologic and hepatic effects

27
Q

Which drug is not given to a patient with gouty neuropathy?

A

Probenecid

28
Q

What kind of drugs is given to a patient with gouty nephropathy?

A

Xanthine oxidase inhibitors

29
Q

What is the mechanism of action for Probenecid?

A

It inhibits both the secretion and reabsorption of organic acids.

30
Q

What are the side effects of Probenecid?

A

increase of stone formation in kidney
(not effective for treating acute attacks)

31
Q

What is the newest drug approved by the FDA for gout?

A

Pegloticase

32
Q

What is the mechanism of action of Pegloticase?

A

It is a recombinant rate oxidase that metabolizes rate to allantoin

33
Q

How is Pegloticase administered?

A

IV infusion due to it being a foreign protein to the body

34
Q

What is the first drug used to treat acute attacks?

A

Indomethacin, Ibuprofen or ketorolac
Add an oral corticosteroid in severe attacks (methylprednisolone)

35
Q

What drug is used as a last resort in an acute attack?

A

Colchicine

36
Q

What is the treatment of hyperuricemia of chronic gout?

A

Dietary modification
Uricosuric agent- probenecid

Pharmacology I (12 decks)

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