Gout

Question 1

Naprosyn

Answer 1

Naproxen

Question 2

Clinoril

Answer 2

Sulindac

• Least renal toxic

Question 3

When to avoid NSAIDs

Answer 3

• CrCl less than 50
• CFH
• PUD
• Hyperkalemia

Question 4

Indocin

• Avoid
• Dose
• ADEs

Answer 4

Indomethacin

• Avoid: in elderly due to CNS SEs
• Dose: 50mg Q8H 3-4d then taper off over 1-2wks
• ADEs: GI and renal

Question 5

Colcrys

• MOA
• Dose
  Acute
  PPX
  IV
  Do not combine with:
  Dose adj
• ADEs
• Monitor
• Counseling

Answer 5

Colchicine

• MOA: inhibit cell division

Dose

• Acute: two (0.6) tabs. Then 1 tab 1H later (total 3 tabs). Max 1.8mg
• PPX: 0.6mg QD ( can range from QOD to 0.6 BID)
• IV: DO NOT GIVE. Can cause death
• Do not combine w/: clarithromycin, grapefruit or grapefruit juice.
• Renal dose adj

ADEs

• N/V/D/BMS, loss of hair
• Malabsorption syndrome: decrease Vit B12, K and sugar

Monitor:
- CBC, renal fxn test

Counseling pt:

• Muscle weakness or pain, numbness or tingling
• Unusual bleeding or bruising
• Severe diarrhea and vomiting
• Feeling weak or tired or increased infections
• Pale or gray color of the lips, tongue, or palms of hands

Question 6

Steroid agents

SEs

Answer 6

Agents

• Methylprednisolone: 5-25mg per joint
• Triamcinolone 8-10 mg per joint
• Betamethasone 3-6mg
• Oral prednisone 30-50mg/d

SEs: PREDNISONE

• PUD = Peptic ulcer disease
• Rash
• Eye = glaucoma
• Diabetes
• Neurologic
• Immunosuppression
• Swelling (cushing)
• Osteoporosis
• Nausea
• Electrolyte changes

Question 7

Benemid

• MOA
• Dose
• Not effective in
• Avoid
• SEs

Answer 7

Probenecid

• MOA: increase urinary excretion rate at the proximal convoluted tubule
• Dose: 250mg BID 1st wk, then 500mg BID. Max 2g/d
• Not effective in pt CrCl

Question 8

Anturane

• MOA
• SEs

Answer 8

Sulfinpyrazone

• MOA: increase urinary excretion rate at the proximal convoluted tubule
• Helps the body get rid of uric acid through the urine
• SEs: watch for kidney stone

Question 9

Aloprim
Zyloprim

• MOA
• Indication
• Dose
• SEs
• DDIs
• Monitor
• Genetic
• Notes**

Answer 9

Allopurinol

• MOA: Block xanthine oxidase
• Indication: use in pt w/ uric acid production, kidney stone, renal failure, >1000 mg uric acid
• Dose: start at 50-100mg/d and incur every 3-4 days. Max 800mg/day. Give w/ meal w/ plenty of fluid

SEs

• Rash, hepatotoxicity, renal imp
• BMS

DDI

• Azathioprine
• 6-MP
• Warfarin
• Thiazide and ACEI
• Vitamin C: urinary acidification = inc kidney stone

Monitor: CBC, uric acid level, I and O, renal/liver fun

• Genetic: HLA-B*5801
  (Abacavir 5701; CBZ 1502)

**DO NOT stop xanthine oxidase inhibitors during an acute attack. If acute attack occurs, start daily low dose of colchicine or low dose NSAIDs and cont x 6mo

Question 10

Uloric

• MOA
• Max dose
• SEs
• DDIs

Answer 10

Febuxostat

• MOA: non purine, selective Xanthin oxidase inhibitor (different structure than allopurinol)
• Max dose: 80mg/d
• SEs: LFT abnormalities
• DDIs: similar to allopurinol

Question 11

Krystexxa

• MOA
• Indication
• Dose/Premedication
• C/I
• Warning
• SEs

Answer 11

Pegloticase injection

• MOA: PEGylated uric acid specific enzyme. break down uric acid
• Indication: tx of chronic gout in adult pt refractory to conventional therapy
• Dose: 8mg IV infusion over 120min Q2W
  Pre-mediated w/ antihistamines/steroid
• C/I: G6PD
• Warning: anaphylaxis, infusion rxn, gout flares, CHF
• SEs: gout flares, infusion rxn, n/v/c, chest pain, anaphylaxis

Question 12

Drugs that may worse gout

EtOH

Foods

Answer 12

Drugs
- Thiazide, levodopa, niacin, cyclosporine, ethambutol, pyrazinamide

EtOH
- Beer contains the highest purine content

Foods
- Red meat, liver, kidney, shellfish, and yeast