Gout

Question 1

What are drugs which can cause Gout?

Answer 1

1) Aspirin
2) Calcineurin Inhibitors (tacrolimus and cyclosprine)
3) Diuretics (loop and thiazaide)
4) Niacin
5) Pyrazinamide

Question 2

Acute Gout Attack Treatment

Answer 2

1) NSAID
2) Colchicine
3) Steriod

Question 3

Colchicine

Answer 3

Brand: Colcrys 0.6mg

Treatment Dose: 1.2 mg PO, followed by 0.6 mg in 1 hour
MAX: 1.8 mg in 1 hour
MAX: 2.4 mg in 1 day

Prophylaxis: 0.6 mg OD or BID
MAX: 1.2 mg in 1 day

Side Effects:
-Loose Stools
-Mylosuppression and neuromyopathy (rare)

CI: Strong CYP3A4 Inhibitors
-Colchicine is a substrate of CYP3A4 and p-Glycoprotein

Question 4

Prevention of Future Gout Attacks

Answer 4

1) Xantine Oxidease Inhibitor (Allopurinol, Febuxostat)

2) Uricosurics (Lesinurad, Probenecid)

3) Recombinant Uricase (Pegloticase)

GOAL LEVEL: < 6 mg/dL

-If UA > 6 on treatment, add another drug
-when starting chronic ULT, colchicine, steroids or NSAIDs should be used as prophylaxis to reduce the risk of attacks.
-due to the high rate of gout attacks when beginning ULT, use with Colchicine or NSAID for the first 3-6 months
-FIRST LINE: Allopurinol

Question 5

NSAIDs for Gout

Answer 5

1) Indomethacin (Indocin)

2) Naproxen (Aleve)

3) Celecoxib (Celebrex)

Question 6

Acute treatment with Steroids

Answer 6

Given IM, PO, IV, Intra-articular

DRUGS:
1) Prednisone
2) Methylprednisolone (Medrol)
3) Triamcinolone

*Start high, then taper down

Question 7

Allopurinol

Answer 7

MOA: Xanthine Oxidase Inhibitor - blocking the enzyme stops the production of UA and produces a nontoxic end product.

-Patients at high risk of a severe allopurinol hypersensitivity reaction should be screened for the HLA-B 5801 allele prior to use.
-First-line therapy for chronic prophylactic use

Question 8

Febuxostat (Uloric)

Answer 8

MOA: Xanthine Oxidase Inhibitor - blocking the enzyme stops the production of UA and produces a nontoxic end product.

Boxed Warning: increased risk of CV death compared to allopurinol in patient with established CV disease. - limit use to those who cannot tolerate allopurinol or if allopurinol is not effective

Question 9

Probenecid

Answer 9

Uricosurics

MOA: inhibits the reabsorption of uric acid in the kidneys - increase uric acids excretion
Drugs: Probenecid and Lesinurad

Question 10

Uricosurics

Answer 10

MOA: inhibits the reabsorption of uric acid in the kidneys - increase uric acids excretion
-Requires good renal function

Probenecid
-Given with Colchicine
-250 mg BID

Lesinurad
-Given with Allopurinol
-200 mg QD

Question 11

Pegloticase

Answer 11

Injection: 8mg IV q2weeks

Brand: Krystexxa

MOA: Converts uric acid to allantoin, which is excreted