Gout Drugs

Question 1

Acute Managment of Gout/Pseudogout

Answer 1

Acute gout, will commonly manifest in the 1st metatarsal
——————————————————————————–

-NSAID s - 1st line treatment in acute gout
(indomethacin)
(Fire extinguisher”

-Glucocorticoids (prednisone) treat acute gout
(“Moon Face”)

-Colchicine treats acute gout
(“Choir sing”)

Question 2

Cholchicine Properties

(“Choir Sing”)

Answer 2

-taken orally 12-24 hours

• colchicine binds intracellular tubulin preventing
  polymerization of microtubules
  (“Binding palm fronds”)

-colchicine disrupts the cytoskeleton of neutrophils thereby inhibiting neutrophil migration, phagocytosis, and degranulation
(“First responders blocked by choir”)

-can cause diarrhea
(“Muddy floor”)

Question 3

what is the difference between Gout and Pseudogout (CPPD) ?

Answer 3

Gout

• Uric acid crystals
  (“Knitting needles”)
• Needle shaped
• (-) Birefringent

​Pseudogout (“they should not lie”)

• Calcium pyrophosphate
• Rhomboid shaped
  (“Blue rhomboid incense holder”)
• (+) Birefringent

​

Question 4

Chronic Managment of Gout

Answer 4

Allopurinol
(“Pure nun”)

Febuxostat

Probenacid
(“Probation officer Cid”)

Pegloticase
(“Just in case” plegoticase”)

Question 5

Allopurinol MOA

(“Pure Nun”)

Answer 5

-inhibits xanthine oxidase
(“Nun grabbing XO notes”)

Question 6

Allopurinol can be useful when …

Answer 6

• prevent uric acid deposition in setting of tumor lysis syndrome
• uric acid crystals can form in tumor lysis syndrome after starting cytotoxic chemotherapy

(“Shattered cancer crab glass”)
* ​ most common with treatment of lymphoma and acute lymphoblastic leukemia

(“White T Cell crusaders”)

• Lesch-Nyhan syndrome -associated with hyperuricemia is managed with allopurinol.
• Will see picking of the skin or biting of the lips in a child where uric acid is causing pain

(“Needle in flesh and biting of finger of kid by stained glass window”)

(“Nun sweeping crystals from broken cancer vitrage”)

Question 7

Allopurinol Side effects

Answer 7

-Allopurinol inhibits breakdown of purine analogs

• 6 mercaptopurine and azathioprine, thus increasing risk of toxicity and may cause a mild rash
  (“Concentrated purine beads on nuns”)

-can cause Stevens-Johnsons syndrome
(“Sloughed off red mask”)

-can cause drug reaction with eosinophilia and systemic symptoms (DRESS syndrome)

(“Eosinophilic Dress”)

Question 8

Probenacid MOA

(“Probation officer cid”)

Answer 8

-decreases renal tubular reabsorption of uric acid

(“Preventing punk from grabbing yarn”)

Question 9

Probenacid Side Effect

(“probation officer cid”)

Answer 9

-may increase the risk of forming renal stones due to increased uric acid excretion.
(“Accumulating yarn and needles”)

-probenecid can inhibit the excretion of many drugs
(“probation officer cid holding back guy with “Drugs” tattoo”)

• prevents excretion of penicillin
  (“probation officer Cid’s purple pencil”)

-probenecid is a sulfa drug
(“Rotten sulfas eggs”)

Question 10

THE ASPIRIN PARADOX IN GOUT DISEASE

Answer 10

-aspirin at low doses inhibits uric acid excretion

-at high doses can prevent tubular reabsorption of uric acid
(“Little ASA umpire yarn”)

(“ASA umpire preventing son from grabbing yarn”)

Question 11

Pegloticase MOA

(holy water “jusT InCASE”)

Answer 11

-pegloticase converts uric acid into water soluble allantoin
(“Holy water just in case!”)

-pegloticase is administered IV
(“poison ivy next holy water stand”)

Question 12

Pegloticase Side Effects

(holy water “jus_T I_nCASE”)

Answer 12

-can cause hemolysis in G6PD deficiency (bite cells)
(“Watermelon with bite”)

-pegloticase can cause anaphylaxis
(“Choking Kid”)