Gout Flashcards
Indomethacin and Colchicine are used for _________ management of Gout
acute
probenecid, allopurinol, febuxostat, rasburicase and prgloticase are used for ___________ of gout
chronic prevention
Other than indomethacin, which NSAID can be used for acute gout flares?
naproxen
Which NSAIDs are C/I for gout and why?
ASA/Salicylates
acidic = decreased urate excretion via OAT-2 competition
Does colchicine has analgesic effects?
no
Mechanism of action for colchicine?
binds tubulin and inhibits leukocyte migration and phagocytosis
How long for colchicine to take effect?
12-24 hours
major adverse effect of colchicine?
diarrhea
Which drugs for gout are uricosuric agents?
probenecid
lesinurad
Uricosuric agents have what mechanism?
block active reabsorption of uric acid in PCT
uricosuric agents must be administered with adequate hydration due to this potential SE
stone formation
Urine pH must be above _______ when administering uricosuric agents…
6.0
major SE of uricosuric agents?
GI irritation
Which uricosuric agent?
decrease excretion of many acidic compounds or metabolites like PCN
PO admin
probenecid
When should probenecid be started?
2-3 weeks after acute attack
Which uricosuric agent?
URAT1 inhibitor
combine with XOI
lesinurad
this class is effective in both primary and secondary gout.
initial therapy may provoke gouty attack
administer with colchicine prophylaxis
XOIs (allopurinol, febuxostat)
Mechanism of allopurinol and febuxostat…
inhibit uric acid synth via xanthine oxidase inhibition
SEs of allopurinol and febuxostat? (3)
vasculitis
agranulocytosis
hypersensitivity
aluminum hydroxide _______ the absorption of allopurinol
decreases
Allopurinol increases the effects of which three drugs?
Mercaptopurines (6MP, azathioprine)
Cyclphosphamide
Allpurinol inhibits the elimination of…
chlorpropamide
Allopruinol inhibits metabolism of which 2 drugs?
warfarin and probenecid
Allopurinol inhibits the activation of…
5FU
This is a recombinant form of urate oxidase, which isn’t present in humans.
Rasburicase
Rasburicase catalyzes oxidation of uric acid to ________, which has what effect?
uric acid to allantoin, readily excreted
Major SE of rasburicase…
anaphylaxis
rasburicase can be used for those at risk of…
TLS
“Me too” drug of rasburicase…
recombinant mammalian urate oxidase
pegloticase
This drug is a URAT 1 inhibitor, which decreases the reabsorption of uric acid
lesinurad
Lesinurad has a warning on acute renal failure… this is more common when administered how?
monotherapy, higher doses
What should lesinurad be combined with?
XOI
