Gout Flashcards
Composition of Gout Crystals
Sodium Urate
What is tumor lysis syndrome
Massive tumor lysis
Release of nucleotides
Hyperuricemia
Renal injury
What is the DOC for gout pain
Indomethacin
What can be given to control pain in gout
Indomethacin
NSAIDs
Colchicine
Glucocorticoids
What can be given to treat gout (reduce serum urate)
Allopurinol
Probenecid
Sulfinpyrazone
Rasburicase
What suppresses leukocyte recruitment and activation
Indomethacin
NSAIDs
Colchicine
Glucocorticoids
Why are COX-2 inhibitor use limited
Increased CV risk
What are the AE for Indomethacin
Bleeding
Na, H2O retention
Renal Insufficiency
What do you never give for gout pain
Low dose Aspirin
Competes with urate for PT secretion
How does Colchicine work
Bind tubulin to inhibit MT production
Disrupts mitotic spindle
Inhibition of synth/release of LTs
Do we give Colchicine anymore
No…Then why the fuck are we learning this
Main Colchicine AE
Diarrhea
Other Colchicine AE
Pain
N/V
Myopathy, neutropenia, aplastic anemia, alopecia
When should Colchicine be given with caution
Hepatic, Renal, CV disease
What decreases uric acid synthesis
Allopurinol
How does Allopurinol work
Inhibits xanthine oxidase
Dissolutes tophi
What is Allopurinol an analog of
Purine
What is the initial effect of Allopurinol
Increase attacks
Mobilization of tissue stores of urate
What do you co-administer Allopurinol with
NSAID
Colchicine
What are the main AE of Allopurinol
HS
Skin rash –> S-J syndrome
Allopurinol with rash next step
Stop the damn Allopurinol
What prevents renal damage during cancer therapy
Allopurinol
Rasburicase
Reduces doses of 6-MP and Azathioprine
Allopurinol
How does Allopurinol decrease doses of 6-MP and Azathioprine
Xanthine oxidase metabolizes them normally
What enhances urate excretion
Probenecid
Sulfinpyrazone
How do Uricosuric agents work
Compete with urate for transporter blocking reabsorption
What do you coadminister uricosuric agents with
NSAIDs
Main AE of Sulfinpyrazone
Decrease hematopoesis
Inhibit Warfarin metabolism
What are the Uricosuric agent AEs
GI irritation
HS
Renal stones
When are Uricosuric agents contraindicated
Gout pt with nephrolithiasis/urate overproduction
Blood dyscrasia
How does Rasburicase work
Oxidizes uric acid to allantoin
Easily excreted
What is a recombinant Aspergillus uricase
Rasburicase