Gout Flashcards
Colchicine
(Lengout)
MOA
Antimitotic – tubulin inhibitor
- stops cell division
- ↓ Mast cell histamine release
- ↓neutrophils & chemotaxis
- ↓body tempt/ respiratory centre
-anti-inflammatory only (symptoms only)
Colchicine
Dose and use
- Acute gout attacks ONLY
- Prophylaxis of acute gout attacks
1mg, then 0.5mg 1 hr later (1.5mg Max) Do not repeat within three days → These directions are new- be careful of old doctors
Colchicine
Adverse/caution
GIT adverse - can make people quite sick
- renal/liver impairment makes S/E worse
- avoid with statins
Allopurinol
MOA
Xanthine Oxidase inhibitor
-↓ uric acid production
-indicated for >2 attacks in 1 year
-stops conversion of xanthine to uric acid
-initially:
100mg daily WITH colchicine 0.5mg 6 months
THEN increase to 300mg if needed
Probenecid
MOA
Uricosuric agents
-↑ excretion of uric acid
-stops uric acid passing back into the kidney tubule
250mg bd for 1 week, then 500mg -2g bd
-increases methotrexate in body for longer
-need to drink a lot of water
=doesnt work for lower than 50% Crcl
Rasburicase
MOA
Urate-oxidase enzyme
- converts uric acid to allantoin
- a soluble form, doesn’t accumulate in joints
Types of gout attacks
- Acute gouty arthritis
- severe pain, red, hot swollen - Chronic tophaceous gout
- ongoing low grade inflammation - gouty nephropathy
- uric acid build up in renal tubules
- proteinuria
Diet modifications
Food high in purines:
Alcohol, fish, seafood (shellfish)
Foods high in protein
-nuts, meat
avoid processed foods
exercise
target serum uric acid levels
0.36 mmol/L
