Gout Flashcards
Describe the pathophysiology of gout.
Hyperuricemia s/p uric acid being a byproduct of cell metabolism
DNA –> Hypoxanthine –> Xanthine –> Uric Acid –> Allantoin
What are the two most common pharmacologic causes of gout?
Chemotherapy (destroys cells) and Diuretics
Describe the mechanism of action of Allopurinol and Febuxostat.
Inhibit xanthine oxidase, an enzyme that participates in two steps in the process of making of uric acid. Both prevent the patient from making uric acid.
How commonly are Allopurinol and Febuxostat used in the management of gout?
One or the other is used as a first line agent.
What is the major AE associated with Allopurinol?
Rash
Describe the advantages and disadvantages of Febuxostat over Allopurinol.
Advantages: less prone to cause rash
Disadvantages: higher cost and has a black box warning.
What is the black box warning on Febuxostat?
For coronary artery and cerebrovascular disease
What is the second line medication for gout if one of the first line medications fail?
Lesinurad or probenecid (more rarely used than lesinurad)
What is the mechanism of action of Lesinurad?
It keeps uric acid in the kidneys for excretion and out of the blood stream.
Describe the mechanism of action of Pegloticase.
It is an enzyme, urate oxidase, humans don’t possess. When administered it promotes the breakdown of uric acid into allantoin so uric acid cannot crystalize
How is Pegloticase administered?
IV
When is Pegloticase used in the treatment of gout?
Last line –> in patients that have issues
What is the black box warning on Pegloticase?
High rate of causing anaphylaxis –> 5% risk.
What are the three NSAIDs used in the treatment of gout?
Sulindac, Indomethacin, Naproxen
Using other NSAIDs for gout is a “SIN”
Describe generally how NSAIDs are dosed when used to treat gout.
Start at higher than normal doses.
