Gout Flashcards
Normal serum values of uric acid
2-7 mg/dL but this is not diagnostic
Gout-contributing factors
heredity, gender, age, diet, alcohol, low fluid intake, cancer, radiation therapy
Drug induced gout
diuretics, nicotinic acid, salicylates, EtOH, glucocorticoids, levodopa, chemotherapy, sulfa antibiotics
4 stages of gout
asymptomatic hyperuricemia, acute gouty arthritis, interval gout, chronic taophaceous gout
2 types of gout
over-producers or under excretors
Non-pharmacological approach to gout treatment
drink lots of water, avoid EtOH, weight loss, dietary changes
Drugs for gout
NSAIDs (INdometacin, ibuprofen, naproxen), calchicine (Colcrys), corticosteroids (prednisone, methylpredneisolone), probenecid (Benemid), Allopurinol (Zyloprim), Febuxostat (Uloric)
Treatment for acute gouty attacks
NSAIDs, Colchicine, corticosteroids
Colchicine (Colcrys) MOA
inhibits migration of granulocytes, which ultimately prevent uric acid deposits
Colchicine (Colcrys) ADRs
Diarrhea, N/V/abdpain
Colchicine (Colcrys) dosing
must wait 3 days before another course can be given, must adjust if CrCl
Contraindication of Colchicine (Colcrys)
if anuric
NSAIDs MOA
inhibit prostaglandin synthesis
NSAID most studied for gout
Indomethacin
Other NSAIDs for gout
naproxen or ibuprofen
Corticosteroids for gout
reserved for pt that fail colchicine or NSAIDs, prednisone, methylprednisolone, triamcinolone
Intraarticular injection of corticosteroid
Triamcinolone
Initiate prophylactic treatment if
severe attack of gouty arthritis, complicated course, serum uric acid level greater than 10 mg/dL, 24 hour urinary excretion greater than 1000mg, pt has 2-3 attacks/year
Colchicine (Colcrys) for prophylactic treatment
only give once daily, d/c if sx free for >1 year
Allopurinol (Zyloprim) MOA
xanthine oxidase inhibitor, preventing synthesis of uric acid
Allopurinol (Zyloprim)
ideal for over-producers, not for acute attack, adjust renal
Allopurinol (Zyloprim) ADRs
rash, can lead to Steven’s Johnson syndrome
Febuxostat (Uloric)
Me too, $$$, once daily, no adjust, niche: more effective than allopurinol
Febuxostat (Uloric) MOA
xanhine oxidase inhibitor, prevent synthesis of uric acid
Febuxostat (Uloric) ADR
elevated liver enzymes
Probenecid (Benemid)
good for under excretors, do not use if CrCl
Probenecid (Benemid) MOA
Competitive inhibition of reabsorption of uric acid in the proximal convoluted tubule of the nephron, promoting urinary excretion of uric acid
Probenecid (Benemid) ADRs
GI upset (take with food), renal uric acid stones, usually well-tolerated
