Gout

Question 1

Allopurinol (Progout)

Answer 1

A) Xanthine Oxidase inhibitor

B)

1. Chronic symptomatic HYPERURICAEMIA (gout, tophi, urate nephrolithiasis or acute uric acid nephropathy)
2. Hyperuricaemia SECONDARY to disease, chemotherapy or radiotherapy

C)
50-900 mg daily (1 or 2 doses)

D)

1. Hypersensitivity*** (esp. if doses increased too fast)
2. Serum URATE levels***
3. RENAL (use lower starting dose)
4. HEPATIC

E)
Labels: 5, 12+, B(with FOOD)
#Take this medicine with or shortly AFTER food to reduce possibility of stomach upset
#Taken CONTINUOUSLY to PREVENT or reduce frequency of gout attacks.
#DRINK at least 1.5-2L of fluids each day to prevent precipitation of urate crystals
#You will probably get more gout attacks (flares) in the first few months of taking this medicine. Flares will gradually improve
#Your doctor will need to measure urate in your blood to make sure that your dose is adequate
**DR - rash, swollen lips or mouth
**DR - persistent fever, sore throat (blood dyscrasias)
S/E
acute gout flare, oedema and rash and abdo pain

Question 2

Febuxostat (Adenuric)

Answer 2

A) Xanthine Oxidase Inhibitor

B)
1. Chronic symptomatic hyperuricaemia (gout or tophi)

C)
40-120 mg ONCE daily

D)

1. Hypersensitivity*** (esp. if doses increased too fast)
2. Serum URATE levels***
3. RENAL (use lower starting dose)
4. HEPATIC

E)
Labels: 5, 12
#Take tablets at the same time each day (preferably in the morning)
#Taken CONTINUOUSLY to PREVENT or reduce frequency of gout attacks.
#DRINK at least 1.5-2L of fluids each day to prevent precipitation of urate crystals
#You will probably get more gout attacks (flares) in the first few months of taking this medicine. Flares will gradually improve
#Your doctor will need to measure urate in your blood to make sure that your dose is adequate
**DR - rash, swollen lips or mouth
**DR - persistent fever, sore throat (blood dyscrasias)
S/E
acute gout flare, oedema and rash and abdo pain

Question 3

Colchicine (Colgout)

Answer 3

A) Gout medication

B)

1. Relief of pain in ACUTE gout
2. PROPHYLAXIS of gout FLARES
3. Familial Mediterranean Fever (FMF)
4. Acute Pericarditis

C)
Gout flare: 1mg stat, then 0.5mg 1hr later (max 1.5mg); do not repeat within 3 days
Prophylaxis: 0.5mg ONCE or TWICE daily
FMF: 0.25-2.5mg daily (1 or 2 doses)

D)

1. Complete Blood Count (myelosuppression)
2. Drug INTERACTIONS (CYP3A4 and P-gp)
3. GI Bleeding
4. Myopathy
5. RENAL
6. HEPATIC

E)
Labels: 5, 18, 21, A
#Avoid GRAPEFRUIT
#Acute Gout: Don’t take more than 3 tabs (1.5mg) in a course to treat acute gout or repeat the course within 3 days
#Start taking this medicine at the earliest sign of an attack
#PARACETAMOL can be taken while waiting for colchicine to take effect (12-24hrs)
**DR - (GI bleed) severe diarrhoea, vomiting, unusual bleeding or bruising
**DR - (myopathy) muscle pain, tenderness or weakness
**DR - (peripheral neuropathy) - numbness or tingling in your fingers or toes
**DR - (myelosuppression) - infection

Question 4

Probenacid (Pro-Cid)

Answer 4

A) Uricosuric

B)

1. Gout
2. Beta-Lactam Antibacterial Tx (adjunct)

C)
Gout: 250-500 mg TWICE daily
ABx: 500 mg QID or 1g single dose

D)

1. Allergy
2. Adequate FLUID intake (reduce risk of kidney stones)
3. Complete BLOOD Count (blood dyscrasias)
4. RENAL (kidney stones)
5. URATE levels

E)
Labels: 10a, B (with FOOD)
#Taken WITH FOOD to reduce stomach upset
#Make sure you drink lots of FLUID during treatment to prevent kidney stones
#Gout: you will probably get more flares in the first few months. Gradually flares will improve.
#Your doctor will need measure urate in your blood to make sure that your dose is adequate
S/E
nausea, rash and vomiting