Gout Flashcards
What is gout?
The deposition of uric acid crystals in the synovium
What is the end product of purines?
Uric acid
Where is the most likely place for crystal formation?
Peripheral joints
What is Gouty nephropathy?
kidney disorders caused by an increase in uric acid
What are the steps of acute gout attack?
Sodium urate crystals form in the join. Phagocytosis by neutrophils and macrophages. Neutrophils activation and release of inflammatory mediators.
Which drugs inhibit the formation of uric acid?
Allopurinol and Febuxostat
Which drugs increase the excretion of uric acid?
Probenecid
What NSAIDs are given for an acute gout attack?
Indomethacin and Ibuprofen
What is the mechanism of action of Indomethacin and Ibuprofen?
inhibition of prostaglandin synthesis
What are the side effects of Indomethacin?
GI irritation- the increase in acid causes a decrease in mucous in the stomach leading to irritation
Central Nervous System- headache, drowsiness
What drug is to be avoided in a gout attack?
Aspirin
Why is Aspirin avoided in a gout attack?
Due to its biphasic effect on uric acid excretion
What is an injectable NSAID that is mainly used for pain management?
Ketorolac (Toradol)
What is an alternative to opioids that is used in treating acute gout attacks?
Ketorolac (Toradol)
What are the side effects of Ketorolac (Toradol)?
GI irritation.
Where does Colchicine come from?
It is a naturally occurring alkaloid isolated from autumn crocus
What is special about Colchicine?
It has a unique anti-inflammatory activity that is specific for gout only
What is the mechanism of action for Colchicine?
it binds to tubulin and prevents it’s polymerization to microtubules. It also inhibits the production and release of pro inflammatory glycoproteins from neutrophils.
What are the side effects of Colchicine?
Diarrhea, upset GI, nausea, and vomiting. (Side effects may be severe even at therapeutic levels)
How is Colchicine administered?
It can be administered orally or given in IV for acute attacks
What is the mechanism of action of Allopurinol?
It inhibits the enzyme xanthine oxidase and reduces the formation of uric acid
Does Allopurinol stop an acute gout attack?
No it does not stop an acute gout attack however over time it reduces the potential of an attack in the future
What are the side effects of Allopurinol?
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
What is Febuxostat?
A new xanthine oxidase inhibitor
(more effective than Allopurinol)
How are Allopurinol and Febuxostat similar?
both decrease uric acid levels which increases dissociation of existing crystals
what is the difference between Allopurinol and Febuxostat?
Febuxostat generally similar to allopurinol but it is more expensive. It also has less dermatologic and hepatic effects
Which drug is not given to a patient with gouty neuropathy?
Probenecid
What kind of drugs is given to a patient with gouty nephropathy?
Xanthine oxidase inhibitors
What is the mechanism of action for Probenecid?
It inhibits both the secretion and reabsorption of organic acids.
What are the side effects of Probenecid?
increase of stone formation in kidney
(not effective for treating acute attacks)
What is the newest drug approved by the FDA for gout?
Pegloticase
What is the mechanism of action of Pegloticase?
It is a recombinant rate oxidase that metabolizes rate to allantoin
How is Pegloticase administered?
IV infusion due to it being a foreign protein to the body
What is the first drug used to treat acute attacks?
Indomethacin, Ibuprofen or ketorolac
Add an oral corticosteroid in severe attacks (methylprednisolone)
What drug is used as a last resort in an acute attack?
Colchicine
What is the treatment of hyperuricemia of chronic gout?
Dietary modification
Uricosuric agent- probenecid
