Gout Flashcards
What is the enzyme related to the rate-limiting step of uric acid formation?
Xanthine oxidase
What are the main reasons for primary gouty attacks?
Defect in uric acid excretion, Or uric acid overproduction
where is uric acid made?
produced as an end product of purine metabolism (DNA)
How is uric acid excreted?
2/3Renally and 1/3 GI
What drugs may cause hyperuricemia
ASA, Diuretics (EXCEPT spironolactone), Pyrazinamide, Niacin
what are risk factors for getting gout?
male
overweight
drinks too much beer or etoh
high blood pressure
problems with kidney
older or meds that increase uric acid
when do you start treatment with meds for gout?
only if the patient has an elevated uric acid level AND HAS A GOUT ATTACK
Colcrys
colchicine
What are the three treatments available for acute gouty attacks?
Colchicine, NSAIDS (indomethacin), Corticosteroids
typical colchicine regimen for gout attack?
two 0.6 tabs then one hour later another tablet
Indocin
indomethacin
When should a pt stop taking Colchicine
Abdominal cramping or diarrhea
Colchicine dosing limit
Three tablets within the first hour
Colchicine ADEs
Common: n/v/abdomian pain, Diarrhea (GI), Rare w/ high doses: Bone marrow suppression and neuromyopathy
When should you avoid NSAIDS with patients w/ gout?
if the patient has severe renal insufficiency
what is the DOC NSAID for Gout? What is the dose?
indomethacin 50mg TID until pain is tolerable and then taper down to avoid rebound
Is the IV form of colchicine available?
No - taken off the market for bad reactions
what four NSAIDS are tyicall used for gout?
indomethacin, naproxen , sulindac or celecoxib
Who should not take colchicine?
Pts with PUD
What is the max dose of colchicine?
1.8 mg
When is colchicine most effective?
12-36 hours after the attack
Indomethacin (Indocin) gout information. When is it effective?
Most studied NSAID. Effective at any point of a gouty attack.
with colchicine, when can you take a second course of therapy for a gout attach again?
3 days after the initial first course of therapy
Corticosteroid treatment for acute gout
Prednisone intra-articularly, IV, IM or orally, or via ACTH. Use limited to colchicine and NSAID failures.
Zyloprim
Allopurinol
When is gout prophylaxis given?
After an actual gouty arthritis attack
Pegloticase (Krystexxa) MoA / place in therapy
IV tx for chronic gout in pts refractory to conventional therapy.
Probenecid (Benemid) MoA
Uricosuric agent that promotes the excretion of uric acid by blocking it reuptake at the proximal convoluted tubule
What should pts do when on probenecid or sulfinpyrazone?
Drink at least 2 liters of water per day to decrease the risk of uric acid stone formation. Take w/food if GI intolerance occurs
Probenecid drug interactions
Interacts with renally excreted weak acids, Penicillins, Cephalosporins, Nitrofurantoin (Reduction in efficacy), Rifampin
Do not use Benemid and ASA together!
Increases effects of furosemide and HCTZ
Sulfonylureas –> hypoglycemia
When should Benemid or Anturane not be started?
At the beginning of an acute attack! Can make it worse!
Allopurinol (Zyloprim) MoA
Allopurinol and its metabolite (oxypurinol) inhibit xanthine oxidase formation –> allows uric acid water soluble precusors to be cleared
Zyloprim ADE
Rash - may occur at any time in therapy (maculopapular to SJS), percipitation of acute attacks, AHS
how should patients take allopurinol?
patient take it once daily awith a meal to reduce sotmch upcet. Cant take several weeks for it to work. Report rash :)
Average dose of allopurinol
50 - 200mg QD, Dose adjust for renal insufficiency
What is the name of the other xanthine oxidase inhibitor?
Febuxostat (Uloric)
