Gout (Exam #2) Flashcards
What are the two etiologies/types of Gout?
- Overproducers
- Underexcretors
How is uric acid eliminated, and how might this be affected by other drugs?
Eliminated by kidneys
- Other acids compete with uric acid for elimination (meds MUST be acids)
What is the primary NSAID used to treat Gout, and why? What is an alternative choice?
Indomethacin
- POTENT NSAID for acute attacks
Also, Naproxen
What two meds are CI for tx of Gout, and why?
NO ASA or Salicylates
- Both are acids so decrease uric acid excretion (compete)
What is the MOA of Colchicine, and what is it used to treat (specific)?
Inhibit microtubule assembly
- Used for ACUTE Gouty attacks
What is the primary AE associated with Colchicine?
Diarrhea
What is an important PK to consider with use of Colchicine?
TAKES TIME to take effect
- 12 to 24 hours (oral - IV has increased toxicity)
What medication produces an anti-inflammatory effect by inhibiting leukocyte migration and phagocytosis?
Colchicine
For chronic prevention of Gout, what medication should ALWAYS be added with initial administration, and why?
Colchicine (prophylactically)
- Initial admin can trigger an acute gouty attack so Colchicine prevents this
MOA of Uricosuric agents, and what is one possible AE?
Block active reabsorption of uric acid
- Possible kidney stone formation (if low urine volume)
What Gout tx drug decreases excretion of many acidic compounds? What is an example of an acidic compound?
Probenecid
- Ex. PCN, MTX
What gout medication is a URAT1 inhibitor?
Lesinurad (Zurampic)
- Inhibits reabsorption of uric acid
What is the MOA of Allopurinol?
Inhibit xanthine oxidase → inhibit uric acid synthesis
With which two meds specifically was it mentioned that Colchicine be added initially?
- Uricosuric Agents
- Allopurinol
Which Gout tx drug is associated with drug interactions? What are two examples (1 increase toxicity, 1 decrease effects)
Allopurinol
- Increase effects/toxicity of 6-MP (Purinethol)
- Inhibit effects/activation of 5-FU (fluorouracil)
Wich Gout tx drug is a recombinant form of urate oxidase that is more readily excreted (as allantoin)?
Rasburicase (Fasturtec)
What patient population is Rasburicase (Fasturtec) often used for, and why?
Those with heme CA or solid tumors at risk for Tumor Lysis Syndrome (TLS)
- At increased risk for hyperuricemia → Gout
What is the primary AE associated with Rasburicase (Fasturtec)?
Allergic reaction (possible anaphylactic shock)
What is the MOA of Pegloticase (Krystexxa)?
Recombinant mammalian urate oxidase enzyme
- Converts uric acid to Allantoin = more easily excreted
