Gout Flashcards
Uric acid is an end product of ______ metabolism. It is excreted 80% ____ and 20% _____. Gout is caused by either…
Purine
renally 80%, GI 20%
too much production, under secretion
Under secretion of uric acid can be worse via ________ and ________ diuretics.
loop
thiazide
What enzyme is used in the making of uric acid?
xanthine oxidase
What can bring on an acute gout attack?
alcohol, purine diet, kidney disease
How do you treat acute gout attacks?
Indomethacin and colcichine
What is the rule regarding uric acid lowering drugs and acute attacks?
Do not start uric acid lower meds until 2-4 weeks after resolution of attack
Chronic gout is caused by what 3 etiologies?
- Genetic defect
- Renal deficiency
- Excessive uric acid with cancer
What are the goals of chronic gout treatment?What is the typical regimen?
Increase excretion or decrease production of uric acid
-Xanthine oxidase inhibitors +/- colcichine and probenicid
MOA of Probenecid and lesinurad. Who is not a good candidate for these drugs?
Promote renal clearance of uric acid (1st line treatment)
- impaired renal function - drugs are likely to be ineffective
What is the major 2 disadvantages of probenecid?
- Drug interactions - will increase drug levels of PNCs, naproxen, ketoprofen, indomethacin
- Difficult dosing
Why is colcichine called a hyrbid drug? What effect does it have?
Treatment of initial flare and prevention of gout attacks
Anti-inflammatory
When do you need to dose adjust colcichine?
- Renal function
2. Drug interactions (CP-450 inhibitor)
What is the mainstay of chronic gout treatment? MOA? Starting dose?
Allopurinol - prevention of gout attacks
- Xanthine oxidase inhibitor (XOI)
- 100 mg/day, titrate up weekly
What are the AEs of allopurinol?
What is the “ALL” for in allopurinol?
- ALLERGY - dose related allergy
- Leukopenia or thrombocytopenia
- Diarrhea
- Drug fever
Do you need to dose adjust allopurinol?
Yes, it needs to be dose down in renal impairment.
What is another xanthine oxidase inhibitor that is used for those who cannot tolerate allopurinol? How is it different from allopurinol in regards to monitoring?
Febuxostat
Need to monitor LFTs and use with caution in those with severe liver disease.
Allopurinol and febuxostat should NOT be taken in conjunction with what other drug?
azathioprine - immunosuppressant
What is the last line treatment for chronic gout?
Corticosteroids
Another expensive option for treatment of chronic gout refractory to conventional therapies is ________. How does it work?
Pegloticase (Krystexxa) - recombinant uricase
Increases uric acid excretion
What are the disadvantages of taking Pegloticase?
- $$$$
2. Risk of anaphylaxis
What is the goal serum urid acid level in those taking allopurinol?
less than 6 miligrams per decileter
