Gout Flashcards
Two types of gout pts
- Over producer
2. Under excretor
Two objectives in tx gout
- Terminate inflamm process of an acute attack (colchicine, Indomethacin, other antiinflamm drugs)
- Reduce hyperuricemia (uricosuric agents, allopurinol)
Symptoms of gout (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
Acute Gout Drugs (3)
- Colchicine
- Indomethacin
- Antiinflamm drugs
Colchicine MOA (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
Colchicine Admin
- Oral
- IV (increased tox)
Colchicine affective in _____
12-24 hrs
Colchicine SE (3)
- DIARRHEA
- N/V
- Abd pain
NSAIDs Tx
- Very effective for inflammation associated with acute gouty arthritis
Primary NSAID used in tx gout
Indomethacin
NSAIDs contraindicated in gout (2) and why
- ASA
- Salicylates
- Decrease urate excretion
NSAIDs MOA
- Specific reversible inhibitors COX2
Uricosuric Agents MOA
- Increase urinary excretion of uric acid by BLOCKING THE ACTIVE REABSORPTION OF URIC ACID in the prox tubule
Uricosuric Agents and Kidney stones (2)
- Large vol of urine should be maintained to minimize KIDNEY STONES
- Keep urine pH above 6.0 (alkali admin)
Uricosuric Agents Tx (1)
- NOT in acute attacks; May aggravate symptoms in acute gout
Uricosuric Agents SE (1)
- GI Irritation
Uricosuric Agents
- Probenecid
Probenecid Admin
- Oral
Probenecid therapy should not be started until _____ after an acute attack
2-3 weeks
Probenecid decreases excretion of (4):
- PCN
- Methotrexate
- Clofibrate
- Glucuronides of NSAIDs
…acids basically
Inhibition of the synthesis of uric acid (2)
- Allopurinol
- Febuxostat
Allopurinol & Febuxostat MOA
- Inhibits Xanthine oxidase and thus inhibits the synth of uric acid
Allopurinol & Febuxostat Tx (2)
- Primary and secondary gout
Allopurinol & Febuxostat SE
- Vasculitis
- Agranulocytosis
- Hypersensitivity rxn
Allopurinol & Febuxostat Drug Interactions (6)
- 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)
Enzyme converting Uric acid to Allantoin (2)
- Rasburicase
- Pegloticase
Rasburicase MOA (3)
- 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
Rasburicase Tx
- Hematological malignancies to decrease hyperuricemia
Rasburicase Admin
IV
Rasburicase SE (3)
- Severe hypersensitivity (anaphylaxis)
- N/V/C/D, abd pain
- Fever, HA
General CI of Gout
- ACID based drugs!
