Gout

Question 1

Two types of gout pts

Answer 1

1. Over producer

2. Under excretor

Question 2

Two objectives in tx gout

Answer 2

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

Question 3

Symptoms of gout (3)

Answer 3

• 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

Question 4

Acute Gout Drugs (3)

Answer 4

• Colchicine
• Indomethacin
• Antiinflamm drugs

Question 5

Colchicine MOA (5)

Answer 5

• 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

Question 6

Colchicine Admin

Answer 6

• Oral

- IV (increased tox)

Question 7

Colchicine affective in _____

Answer 7

12-24 hrs

Question 8

Colchicine SE (3)

Answer 8

• DIARRHEA
• N/V
• Abd pain

Question 9

NSAIDs Tx

Answer 9

• Very effective for inflammation associated with acute gouty arthritis

Question 10

Primary NSAID used in tx gout

Answer 10

Indomethacin

Question 11

NSAIDs contraindicated in gout (2) and why

Answer 11

• ASA
• Salicylates
• Decrease urate excretion

Question 12

NSAIDs MOA

Answer 12

• Specific reversible inhibitors COX2

Question 13

Uricosuric Agents MOA

Answer 13

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

Question 14

Uricosuric Agents and Kidney stones (2)

Answer 14

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

Question 15

Uricosuric Agents Tx (1)

Answer 15

• NOT in acute attacks; May aggravate symptoms in acute gout

Question 16

Uricosuric Agents SE (1)

Answer 16

• GI Irritation

Question 17

Uricosuric Agents

Answer 17

• Probenecid

Question 18

Probenecid Admin

Answer 18

• Oral

Question 19

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

Answer 19

2-3 weeks

Question 20

Probenecid decreases excretion of (4):

Answer 20

• PCN
• Methotrexate
• Clofibrate
• Glucuronides of NSAIDs
  …acids basically

Question 21

Inhibition of the synthesis of uric acid (2)

Answer 21

• Allopurinol

- Febuxostat

Question 22

Allopurinol & Febuxostat MOA

Answer 22

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

Question 23

Allopurinol & Febuxostat Tx (2)

Answer 23

• Primary and secondary gout

Question 24

Allopurinol & Febuxostat SE

Answer 24

• Vasculitis
• Agranulocytosis
• Hypersensitivity rxn

Question 25

Allopurinol & Febuxostat Drug Interactions (6)

Answer 25

• 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)

Question 26

Enzyme converting Uric acid to Allantoin (2)

Answer 26

• Rasburicase

- Pegloticase

Question 27

Rasburicase MOA (3)

Answer 27

• 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

Question 28

Rasburicase Tx

Answer 28

• Hematological malignancies to decrease hyperuricemia

Question 29

Rasburicase Admin

Answer 29

IV

Question 30

Rasburicase SE (3)

Answer 30

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

Question 31

General CI of Gout

Answer 31

• ACID based drugs!