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Pharmacology II > Gout > Flashcards

Gout Flashcards

1
Q

What turns uric acid into the more soluble allantoin?

A

Uricase (humans don’t have this)

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2
Q

Do gout patients typically have an issue with overproduction or underexcretion?

A

underexcretion (90%)

overproduction (10%)

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3
Q

Purine rich foods

A
  • anchovies
  • brain
  • kidney
  • liver
  • sardines
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4
Q

Drugs that can induce hyperuricemia and gout

A
  1. Diuretics
  2. Nicotinic acid
  3. Salicylates
  4. Ethanol
  5. Pyrazinamide
  6. Ethambutol
  7. Cytotoxic drugs
    8 Cyclosporine
  8. Levodopa
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5
Q

Where does acute gout most commonly affect?

A

1st MTP (“podagra”)

-typically in one joint of LE

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6
Q

Tophaceous gout

A
  • chronic gout

- monosodium urate in soft tissues and joints

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7
Q

If someone has asymptomatic hyperuricemia do they need treatment?

A

Not necessarily

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8
Q

What happens to serum uric acid levels during acute attacks?

A

it drops

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9
Q

What is the clinical triad for gout?

A
  1. Inflammatory monoarthritis
  2. Elevated serum uric acid level
  3. Response to colchicine
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10
Q

Acute gout-Mild/moderate: treatment

A

Monotherapy (NSAID, colchicine, systemic corticosteroid)

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11
Q

Acute gout - Severe: treatment

A

Combination therapy

  1. Colchicine + NSAID
  2. Colchicine + corticosteroid
  3. NSAID + intra articular steroid
  4. Colchicine + intra articular steroid injection
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12
Q

Where does colchicine work on the arachidonic acid cascade?

A

Lipoxygenase –> leukotriene B4

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13
Q

Which NSAID is the most used agent for gout?

A

Indomethacin

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14
Q

Colchicine: ADE

A

dose-dependent GI effects (diarrhea, nausea, vomiting)

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15
Q

Colchicine: metabolism

A

CYP3A4, so adjust dose if on other agents like this

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16
Q

When should colchicine be started to help stop a gout attack?

A

Start within 36 hours

17
Q

When can you think about injecting steroid for gout?

A
  • If only affecting 1-2 joints

- Always use in combination

18
Q

Which oral steroid should be used for acute gout attack?

A

methylprednisolone pack

19
Q

Ultimately allopurinol is the drug of choice to prevent gout attacks. What are the anti-inflammatory regimens that need to be in place before starting allopurinol?

A 
1. Colchicine
or
2. NSAIDs + PPI
or
3. Prednisone <10mg/day
20
Q

When should urate-lowering therapy xanthine oxidase inhibitors (ex. allopurinol) be initiated?

A
  1. 2 or more gout attacks/year
  2. 1 or more tophus
  3. Chronic Kidney Disease (stage 2 or worse)
  4. History of urolithiasis
21
Q

What is the goal serum urate concentration after starting a xanthine oxidase inhibitor like allopurinol?

A

<6mg/dL*****

22
Q

What is 1st line urate lowering therapy?

A

Allopurinol

23
Q

Allopurinol: Acute hypersensitivity syndrome

A

AVOID/Consider genetic testing in high risk populations:

  1. Koreans with CKD
  2. Han Chinese and Thai (irrespective of renal function)
24
Q

Allopurinol: ADE

A

pruritis, rash, elevated LFT

25
Q

What is the difference in mechanism and dose adjustment between allopurinol and Febuxostat?

A

Allopurinol - irreversibly inhibits xanthine oxidase. Needs to be adjusted in renal patients

Febuxostat - reversible inhibitor of xanthine oxidase. No need for dose adjustments in patients with kidney issues.

26
Q

What is drug is contraindicated with Febuxostat?

A

Azathioprine

27
Q

Febuxostat: ADE

A

liver enzyme elevation (ALT, AST)

28
Q

What is another approach to help uric acid excretion if patients can’t do it the normal way?

A

Xanthine oxidase inhibitor + fenofibrate or losartan

29
Q

Pegloticase: Indication

A

3rd line therapy for refractory gout. Heavy disease burden with chronic tophaceous disease

30
Q

Pegloticase: MOA

A

recombinant porcine-like uricase (biologic) which metabolizes uric acid to allantoin

31
Q

If patient is on max dose of Allopurinol what can be added??

A
  • Lesinurad

- Probenacid

32
Q

When can prophylactic treatment be discontinued?

A
  1. 6 months
    or
  2. 3 months following achieving urate target

Pharmacology II (31 decks)

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