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Pharmacology > Gout and Hypeurecemia > Flashcards

Gout and Hypeurecemia Flashcards

1
Q

Uric acid has no known physiological purpose?

A

TRUE

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2
Q

Uric acid is the degradation of what nucleic acid type?

A

purines

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3
Q

T/F Humans express uricase which allows metabolism of uric acid into a less harmful substance

A

False

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4
Q

What is the water soluble form of uric acid?

A

allantoin

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5
Q

Drugs active in gout block what process?

A

stop phagcytosis of uric acid particles

block mediator release/inflammation induced by PMN

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6
Q

T/F 90% of people with gout are underexcreters?

A

TRUE
2/3 eliminated by urine
1/3 eliminated by GI

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7
Q

T/F asymptomatic tx for hyperurecemia may not require tx?

A

TRUE

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8
Q

How do you dx gout?

A

Tap on joint

examine uric acid crystals in lab

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9
Q

T/F During an attack uric acid crystal levels fall?

A

TRUE

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10
Q

Differentiate Acute Gout vs Chronic Gout?

A

Acute:

  • 3-10 days
  • attack of inflammation
  • most common to occur at LE joint for 1st episode
  • affects first MTP -podagra aka foot pain

Chronic:

  • rheumatoid like
  • Tophaceous gout
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11
Q

What should you initiate before starting urate lowring medication and why??

A

Anti-inflammatory: NSAID, colchicine, because if you don’t you can cause an acute attack

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12
Q

Which drugs are used to treat acute gout?

A 
Corticosteroids : triamcinolone (IM), methylprednisone (Iv), prednisone (oral)
Colchicine 
NSAIDS
Indomethicin 
Naproxen 
Ibuprofen 
Celecoxib
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13
Q

What is prophylactic tx for gout?

A

NSAID

colchicine

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14
Q

What is tx for chronic gout?

A

allopurinol
febuxostat
probenecid
pegloticase

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15
Q

What is the target level or uric acid with chronic tx?

A

uric acid <6 mg/dL

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16
Q

How long should you tx acute gout after an attack?

A

Continue tx for 5-8 days after initial onset

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17
Q

What is MOA of colchicine?

A

blocks B4 leukotriene-decreasing inflammation

decreases macrophage migration and phagocytosis

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18
Q

What is Clinical application of colchicine?

A

treats gout attack if attack within 36 hrs

prophylaxis

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19
Q

What is the unique dosage associated with colchicine prophylaxis?

A

1.2 mg for initial dose, followed by 0.6mg 1 hr later and begin 0.6 mg of colchicine BID on day 2 for thenext 4-7 days

20
Q

Who should use oral glucocorticoids for acute gout?

A

people on anti-coagulants who cannot take NSAIDS

DONT TAKE IF DM, recent or current infection,

21
Q

Who should not use NSAIDS?

A

elderly, people who have GI bleed risk, NSAID allergy, low eGFR

22
Q

Who should avoid corticosteroid injection?

A

suspected joint infection

2 or more joints affected

23
Q

What are ADE of colchicine?

A

GI, diarrhea, nausea, vomiting

24
Q

What are drug interactions with colchicine?

A

CYP3A4 and P-glycoprotein inhibitors

25
Q

What corticosteroids can be given for acute gout?

A

methylprednisolone pack
triamcinolone IM-must be given followed with oral prednisolone
intra-articular (TAC-kenalog): must be used in combo with NSAID, colchicine, or oral steroid

26
Q

What are ADE of steroids?

A
  • adrenal suppression
  • muscle wasting
  • mood changes
  • growth inhibition
27
Q

What is MOA of XOI?

A

blocks xanthine oxidase to stop the conversion of hypoxanthine or xanthine into uric acid

28
Q

What is the clinical use of XOI?

A 
when >2 gout attacks per year
presence of multiple tophus 
CKD
hx of urolithiasis 
used in both underexcretes or over producers of uric acid
29
Q

What is 1st line XOI?

A

Allopurinol

30
Q

Mechanism of allopurinols?

A

irreversibly inhibits xanthine oxidase

31
Q

What is clinical use of allopurinol?

A

chronic gout

32
Q

What are ADE of allopurinol?

A

AHS/Acute Hypersensitivity syndrome: like DRESS syndrome

-consider genetic testing in Asian or Koreans with CKD, or Thai or HAN chinese

33
Q

T/F Febuxostat is reversible in binding xanthine oxidase

A

TRUE

34
Q

What is ADE of Febuxostat?

A

elevated liver enzymes

35
Q

T/F No dose adjustment necessary in those with mild to moderate renal impairment?

A

TRUE

36
Q

what is MOA of probenecid?

A

helps excrete uric acid

take with alot of water

37
Q

When do you not use probenecid?

A

with hx of urolithiasis or CC< 50

38
Q

T/F XOI and fenofibrate or losartan help with increased uric acid excretion

A

TRUE

39
Q

What is MOA of pegloticase?

A

recombinant porcine like uricase that converts uric acid into allantoin

40
Q

What is clinical use of pegloticase?

A

refractory gout

41
Q

What is MOA of Lesinurad?

A

blocks 1-URAT-1 to stop the reabsorption of uric acid in the kidneys

42
Q

T/F Lesinurad must be taken with XOI due to risk of kidney injury with monotherapy

A

TRUE

43
Q

What is clinical use of Lesinurad?

A

refractory hyperurecemia in gout

44
Q

What is alternative therapy for gout?

A

Drugs targeting IL-1

Anakinra, Canakinumab

45
Q

What is clinical use of IL-1 inhibitor therapy

A

off-label tx for refractory acute gout

46
Q

Which drugs can icrease uric aicd?

A 
Diuretics-HCTZ
Nicotinic acid 
salicylates
ethanol 
pyrazinamide 
ethambutol
cytotoxic drugs
cyclosporine
Levydopa

Pharmacology (47 decks)

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