Gout Flashcards
1st line of tx for gout
indomethacin (NSAID)
what is Colchicine used for? what is its process?
reducing pain and inflammation in acute gout attack
produce anti-inflammatory effect by inhibiting leukocytes migration and phogyctosis
Side effect Colchicine
Diarrhea
Xanthine oxidase inhibitors
Allopurinol and Febuxostat
when is Allopurinol used?
agent for periods between acute gout attack
when is Febuxostat
when people have allopurinol intolerance
Uricosuric drugs: agents and function?
Probenecid or Sulfinpyrazone
increase renal clearance of uric acid
what agents are used for acute gout?
NSAIDS: indomethacin
Colchicine
Low dose Aspirin
analgesic, antipyretic effects: shorter 1/2 life, 1st order kinetics
high dose Aspirin
Anti-inflammatory; longer 1/2 life, zero order kinetics
Aspirin therapeutic effect
- acute rheumatic fever
- analgesia
- anti-inflammatory
- anti-pyretic
- anticoagulant effect
Anti-inflammatory MOA
inhibition of COX2 & PG synthesis
ANti- pyretic MOA
inhibition of PGE2(fever)–blocks production of prostaglandin to CNS to “reset” temp contorl in hypothalamus –>fall of temp due to dilation of superficial blood vessels
Antithrombotic effects
irreversible inhibition of COX1–inhibit platelet formation
Asprin rxn with:
Ethanol
Warfarin
Uricosurics
ethanol: increase GI bleeding
warfarin: increase effects
Uricosuric: decrease effects
NSAIDS (Aspirin) adverse effects
GI upset: GI bleeding due to COX1
- prolong bleeding due to platelet inhibition
- decreased kidney fuction
- edema
what are the COX2 selective inhibitors
Celecoxib, Etoricoxib, Meloxicam
what can cause Hypersensitivity: pruritus
Aspirin (non-selecive NSAIDS)
what can cause Reye’s syndrome
Aspirin(NSAIDS)
COX 2 inhibitor therapeutic effects
analgesic, antipyretic, anti-inflammatory with LESS GI adverse effects
which NSAID is approved for rheumatoid arthritis and osteoarthritis with black box warning
Celecoxib
Which NSAID SE can cause cardiovascular thrombotic events?
COX2 inhibitors
Acetaminophen therapeutic use/ pharmokinetics
inhibits COX1/2, pain reliever and fever reducer, NO anti-inflammatory properties
DO not inhibit platelet aggregation
Acetaminophen Adverse effects
Hepatotoxicity–has narrow therapeutic window
Non selective NSAID side effects
Gastric ulcers, anemia, GI hemorrhage, perforation/obstruction
COX2 specific side effects
Cardio effects: MI, stroke, thrombosis
what enzyme is the main inflammatory resposne
PGE2 and PGI2
COX1 function
protective function, produce prostaglandin in stomach mucosa–protect stomach lining from gastric acid
- mediates platelets
- continuously active; ‘house keeping functions’
COX2 function
inducible: requires event in order to be stimulated. Production of inflammatory molecules
which COX mediates platelets
COX1
