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pharmacology > gout drugs > Flashcards

gout drugs Flashcards

1
Q

what is the prevalence of gout?

A

Most common cause of inflammatory arthritis in the US (not autoimmune)
Most common rheumatic disease of adults

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2
Q

how is gout dx?

A 
synovial aspiration (gold standard) :Seen via monosodium urate crystals 
more commonly- can see on PE
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3
Q

what is gout?

A

protein metabolism product–>uric acid
too much protein breakdown or the diminished kidney function (where uric acid is excreted)
–> uric acid increases ( in blood tissues)
When it deposits in the joint it is called gout.

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4
Q

can you have hyperuricemia without gout?

A

yes! (if uric acid >6 = hyperuricemia) BUT if its not in the joints then its NOT gout

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5
Q

common presentation of gout

A

Painful, red, swollen inflammation of a joint (common area is first toe)

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6
Q

who usually gets gout?

A

poor diet (alcohol, fish, red meat, soda)
sedentary
older, male

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7
Q

what drugs can CAUSE hyperuricemia?

A 
Thiazide diuretics (HCTZ)
Nicotine
Cyclosporine
Ethambutol (TB drug) 
Pyrazinamide (TB drug) 
Salicylates

“C SPENT”

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8
Q

what is a Ddx that must be ruled out when suspecting gout?

A

septic arthritis

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9
Q

3 drugs for acute txt of gout

A

Colchicine (Colcrys)
NSAIDs
Corticosteroids

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10
Q

prophylatic urate lowering therapy

A
  1. uricosuric agents
  2. xanthine oxidase inhibitors
  3. Recombinant Urate-Oxidase Enzyme
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11
Q

what are the three uricosuric agents?

A

Probenecid - no longer used
Losartan (Cozaar)
Fenofibrate

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12
Q

what are the two xanthine oxidase inhibitors?

A

Allopurinol (Zyloprim)

Febuxostat (Uloric)

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13
Q

what are the two recombinant urate-oxidase enzyme drugs?

A

Pegloticase (Krystexxa)
Rasburicase (Elitek)
“-icase”

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14
Q

MOA of allopurinol

A

MOA: Inhibits Xanthine Oxidase (XO) preventing the conversion of xanthine to uric acid

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15
Q

what is allopurinol or febuxostat (uloric) used for?

A

uric-acid lowering therapy, as prophylaxis for gout

but of the two, allopurinol ALWAYS better choice.

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16
Q

ADRs of allopurinol

A

SJS, Hepatotoxicity, Hemolytic anemia (G6PD)

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17
Q

dosing for allopurinol

A

starts at 100mg daily and titrated to maximum 800mg/day
***Goal is Uric Acid < 6
(full effect 2-3 months)

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18
Q

why should allopurinol ONLY be used for prophylaxis of gout?

A

Can precipitate flare if given during active flare d/t mobilization of uric acid

19
Q

MOA of febuxostat (uloric)

A

MOA: similar to Allopurinol (XO inhibitor) - just more specific but DOESNT mean its better

20
Q

ADRs of febuxostat

A

Hepatotoxicity, SJS, CV events

worse CV -thrombotic- events than allopurinol

21
Q

MOA of probenecid?

A

Inhibits tubular reabsorption of urate causing excretion of uric acid (uricosuric drug)

22
Q

when is probenecid used for gout?

A

really not ever anymore

due to need for adequately functioning kidneys, adequate hydration, and drug-drug-interactions

23
Q

MOA of pegloticase

A

Enhances the oxidation of uric acid to allantoin which is readily excreted through the urine (uricosuric drug)

24
Q

what do you need to do to preven the MAJOR adr of pegloticase ?

A

premedicated with antihistamines and corticosteroids before administration (b/c of anaphylaxi risk)

25
Q

2 ADRs of pegloticase

A

Anaphylaxis, CHF exacerbation

26
Q

what is rasburicase used for? MOA?

A

similar MOA to pegloticase and only indicated for Tumor Lysis Syndrome (TLS) - chemotherapy use

27
Q

NSAIDs for gout?

A

relieving the inflammation gout crystals cause

*Indomethacin, *naproxen, and sulindac favored but any will do

28
Q

corticosteroids for gout?

A

Intra-articular injections indicated if gout present in a single joint
Oral steroids indicated for multiple joints or large joint involvement

29
Q

MOA of colchicine?

A

inhibits polymerization of beta-tubulin into microtubules (dis-assemble structure- so more neutrophils can’t be assembled and draw more to the area)

30
Q

main ADR of colchicine?

A

BAD GI upset (N/D)

31
Q

dosing for colchicine- gout acute flare?

“do not repeat course of txt more than every __ weeks”

A

first ign of flare: 1.2 mg ORALLY
one hr later: 0.6 mg (MAX 1.8 mg over 1 hour)
Then 0.6 mg once or twice daily until attack resolves
*2 weeks

32
Q

gout- 3 phases of txt

A

Treat acute inflammation:
Prevent acute inflammation
Lower uric acid

33
Q

1st phase: acute inflammation txt:

mild-moderate affecting 1 or few small joints or 2 large joints

A

monotherapy

34
Q

1st phase: acute inflammation txt: severe pain or multiple large joints

A

combination therapy
NSAIDs
Oral Corticosteroids:
Colchicine

35
Q

corticosteroids: one joint vs multiple

A

One joint do a corticosteroid injection. Multiple joints give oral steroids

36
Q

2nd phase: prevention of acute inflamm. (3 options)

A
  1. Colchicine : Oral low dose (once or twice a day) is first line option
  2. NSAIDs: Also first line option, must use low-dose
    If using long term, consider PPI for suppression of peptic ulcer disease
  3. urate lowering therapy: allopurinol
37
Q

Urate lowering therapy can be initiated during an acute gout attack as long as concomitant ________ is given.

A

anti-inflammatory therapy is given

38
Q

*colchicine txt dose

A

1.2mg x 1 then 0.6mg one hour later

39
Q

*allopurinol: common ADR? ddi?

A

Rash common, DDI w/ Azathioprine

40
Q

*febuxostat: ADR? ddi?

A

CV warning, DDI w/ azathioprine

41
Q

*uses for pegloticase vs rasburicase

which has a risk? how do you avoid it?

A

Pegloticase : only refractory gout, anaphylaxis risk (must pre-medicate prior to administration)
Rasburicase : only for TLS

42
Q

*which drug? … Blocks renal elimination of penicillins increasing serum concentrations and half life (block tubular reabs)

A

probenecid

43
Q

A 49 year old alcoholic businessman complains of 2 days of severe worsening pain with redness and swelling of his first metatarsophalangeal joint. He has no history of injury or trauma. He is afebrile with no other symptoms. Which of the following drugs is the most appropriate pharmacotherapy?

A

Indomethacin (NSAID- add PPI b/c an alcoholic)

pharmacology (24 decks)

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