GOUT Flashcards
Drugs of choice for ACUTE gouty attacks?
NSAIDS
COLCHICINE
CORTICOSTEROIDS
When should NSAIDS be avoided in patients with ACUTE gout?
Avoid if:
- Renal Insufficiency (<60mL/min)
- Peptic Ulcers
- Heart Failure or poorly controlled HTN
- ^K+ (Hyperkalemia)
What are some concerns for patients taking INDOMETHACIN?
- Renal
- GI (avoid in pts w/ active GI bleed)
- CV disease
- Hyperkalemia
- Avoid in elderly (>65)
Colcrys
Colchicine
MOA: Inhibits Cell Division
Oral for ACUTE ATTACKS: TWO(0.6 mg) tabs
Then one tab 1 hr later. (3 tabs total)
Max. Dose: 1.8mg (Colcrys)
Prophylaxis: added at beginning when using antihyperuricemic agents. ONLY use with NORMAL RENAL AND HEPATIC FX.
IV: Not recommended.
Colcrys
DRUG interactions?
** Fatalities w/ toxicity especially when combined with Inhibitors such as CLARITHROMYCIN **
- Colchicine 3A4 SUBSTRATE( Do not use inhibitors if patient has RENAL or HEPATIC impairment)
- Watch for drug interactions w/ 3A4 inhibitors: Erythromycin, Clarithromycin, itraconazole, Ketoconazole, Posaconazole, Voriconazole, verapamil, Diltiazem, Ritonavir, Atazanavir, Darunavir, GFJ.
Colcrys
ADVERSE EFFECTS:
GI: N/V/D!!!! (Abdominal)
BMS
Alopecia( OVER BODY)
Renal toxicity occurring w/ 3A4 inhibitor.
Hepatic
Malabsorption syndrome: Decrease vitamin B12 (May need supplement w/ B12), fats
Steroid Side Effects:
PREDNISONE:
- PUD
- Rash
- Eye (glaucoma, cataracts)
- Diabetes
- Neurologic (CNS) : HA,insomnia, moodswings
- Immunosupp
- Swelling
- Osteoporosis
- Nausea
- Electrolyte changes: increase NA, decrease K
Probenecid
MOA: Increases Urinary EXCRETION of urate
- inhibits reabsorption of UA.
- Increases plasma levels of some BETA-LACTAMS by inhibiting tubular secretion
Indications: chronic gout
Prolong penicillin levels
Dosing: MAX - 2g/d
W/ FOOD or antacids to decrease GI S/s
A lot of FLUID INTAKE and alkaline urine w(NaHCO3)
Avoid in pts:
- CrCl < 50ml/min
- History of Renal Stones
- Overproducers who excrete > 800mg of UA/d
- on MTX: Probenecid may ^ serum levels of MTX
Zurampic
Lesinurad
MOA: Uric Acid Transporter INHIBITOR (URAT1)
Dose: 200mg QAM w/ food & H20
-ADD-ON To XANTHINE OXIDASE INHIBITOR: allopurinol or febuxostat; should NOT be used as MONOTHERAPY!!
Works in combo w/ xanthine oxidase inhibitors to decrease that decrease overproduction and then excrete it!!
S/E: HA, GERD, Influenza, MI, Nephrotoxicity
Cautions/ contraindications:
- CrCl: 30-45 mL/min: Tx should not be initiated
- Crcl: <30ml/min: DO NOT USED
Zyloprim; Aloprim
Max 800mg/d
- after meal w/ A LOT of fluid.
Crcl 10-20 : max: 200mg/d
Crcl < 10 : max: 100mg/d
Cancer therapy-induces hyperuricemia: PO/IV
SE: Rash, Dermatits, hepato-reno- toxicity
BMS, diarrhea, Nausea
Allopurinol MONITORING
CBC, UA, I & O’s, Hepatic/ Renal fx, PROTHROMBIN time
Enhance effects of WARFARIN!!!
Genetic testing: (HLA-B5801) should be considered in HIGH risk: Han chinese, Thai, and Koreans w/ CrCl < 60mL/min
DO NOT STOP XANTHINE OXIDASE INHIBITORS DURING AN ACUTE ATTACK
ALLOPURINOL
DRUG INTERACTIONS
Azathioprine: decrease by 75%
6-MP: decrease by 75%
Warfarin: INCREASE AG effect of warfarin
Thiazide & ACEI: increase hyper-sent RXN
BMS: in patients receiving chemo and other BMS AGENTS
Vit C: urinary acidification: increase risk of kidney stones
uLoric
Febuxostat
- Non PURINE selective xanthine oxidase Inhibitors
- for patients who cant tolerate ALLOPURINOL
Form: Tabs(40mg-80mg)
** Recommend to take with NSAID/colcrys for 6 months to PREVENT gout flare-ups. **
—** Metabolized in LIVER**
uLoric SE
LFTS: Liver
RENAL: caution w/ CrCl < 30
RASH: (DRESS)
Nausea:
Arthalgia
DI: Similar to Allopurinol w/ mercaptopurine/ azathioprine
KrysTEXXA
Pegloticase
MOA: PEGylated uric acid specific enzyme ( Breaks down urate)
Indication: chronic gout REFRACTORY to conventionL
Dose: IV ONLY Q 2WKS
**PreMedicate: antiHistamine, Oral APAP, and IV hydrocortisone(200mg)
CONTRAINDICATION: G6PD deficiency
