Gout Flashcards

1
Q

Two types of gout pts

A
  1. Over producer

2. Under excretor

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2
Q

Two objectives in tx gout

A
  1. Terminate inflamm process of an acute attack (colchicine, Indomethacin, other antiinflamm drugs)
  2. Reduce hyperuricemia (uricosuric agents, allopurinol)
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3
Q

Symptoms of gout (3)

A
  • Acute attacks follow the deposition of uric acid crystals in peripheral joints
  • Crystals are phagocytosed by synoviocytes –> inflamm rxn due to prostaglandins and cells of immune system
  • Subsequent inflammation causes severe pain
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4
Q

Acute Gout Drugs (3)

A
  • Colchicine
  • Indomethacin
  • Antiinflamm drugs
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5
Q

Colchicine MOA (5)

A
  • NOT ANALGESIC EFFECT (no effect COX)
  • NO effect on urate excretion
  • BIND TO TUBULIN, inhibits assembly of microtubules
  • INHIBITS LEUKOCYTE MIGRATION AND PHAGOCYTOSIS
  • Inhibits formation of Leukotriene B4
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6
Q

Colchicine Admin

A
  • Oral

- IV (increased tox)

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7
Q

Colchicine affective in _____

A

12-24 hrs

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8
Q

Colchicine SE (3)

A
  • DIARRHEA
  • N/V
  • Abd pain
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9
Q

NSAIDs Tx

A
  • Very effective for inflammation associated with acute gouty arthritis
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10
Q

Primary NSAID used in tx gout

A

Indomethacin

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11
Q

NSAIDs contraindicated in gout (2) and why

A
  • ASA
  • Salicylates
  • Decrease urate excretion
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12
Q

NSAIDs MOA

A
  • Specific reversible inhibitors COX2
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13
Q

Uricosuric Agents MOA

A
  • Increase urinary excretion of uric acid by BLOCKING THE ACTIVE REABSORPTION OF URIC ACID in the prox tubule
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14
Q

Uricosuric Agents and Kidney stones (2)

A
  • Large vol of urine should be maintained to minimize KIDNEY STONES
  • Keep urine pH above 6.0 (alkali admin)
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15
Q

Uricosuric Agents Tx (1)

A
  • NOT in acute attacks; May aggravate symptoms in acute gout
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16
Q

Uricosuric Agents SE (1)

A
  • GI Irritation
17
Q

Uricosuric Agents

A
  • Probenecid
18
Q

Probenecid Admin

19
Q

Probenecid therapy should not be started until _____ after an acute attack

20
Q

Probenecid decreases excretion of (4):

A
  • PCN
  • Methotrexate
  • Clofibrate
  • Glucuronides of NSAIDs
    …acids basically
21
Q

Inhibition of the synthesis of uric acid (2)

A
  • Allopurinol

- Febuxostat

22
Q

Allopurinol & Febuxostat MOA

A
  • Inhibits Xanthine oxidase and thus inhibits the synth of uric acid
23
Q

Allopurinol & Febuxostat Tx (2)

A
  • Primary and secondary gout
24
Q

Allopurinol & Febuxostat SE

A
  • Vasculitis
  • Agranulocytosis
  • Hypersensitivity rxn
25
Q

Allopurinol & Febuxostat Drug Interactions (6)

A
  • Aluminum hydroxide (decreases the absorption of)
  • Mercaptopurines 6MP and Azathioprine (Increase effect of)
  • Cyclophosphamide (Increase effect of)
  • Chlorpropamide (Inhibit elimination of)
  • Warfarin and Probenecid (Inhibit the metabolism of)
  • Fluorouracil (Inhibit activation of)
26
Q

Enzyme converting Uric acid to Allantoin (2)

A
  • Rasburicase

- Pegloticase

27
Q

Rasburicase MOA (3)

A
  • RECOMBINANT FORM OF URATE OXIDASE
  • Uric oxidase is NOT ENDOGENOUS
  • Admin of Rasburicase catalyzes the enzymatic oxidation of uric acid into a readily excreted metabolite, allantoin, thus lowering high serun uric acid levels
28
Q

Rasburicase Tx

A
  • Hematological malignancies to decrease hyperuricemia
29
Q

Rasburicase Admin

30
Q

Rasburicase SE (3)

A
  • Severe hypersensitivity (anaphylaxis)
  • N/V/C/D, abd pain
  • Fever, HA
31
Q

General CI of Gout

A
  • ACID based drugs!