Gout (Exam #2)

Question 1

What are the two etiologies/types of Gout?

Answer 1

• Overproducers

- Underexcretors

Question 2

How is uric acid eliminated, and how might this be affected by other drugs?

Answer 2

Eliminated by kidneys

- Other acids compete with uric acid for elimination (meds MUST be acids)

Question 3

What is the primary NSAID used to treat Gout, and why? What is an alternative choice?

Answer 3

Indomethacin
- POTENT NSAID for acute attacks

Also, Naproxen

Question 4

What two meds are CI for tx of Gout, and why?

Answer 4

NO ASA or Salicylates

- Both are acids so decrease uric acid excretion (compete)

Question 5

What is the MOA of Colchicine, and what is it used to treat (specific)?

Answer 5

Inhibit microtubule assembly

- Used for ACUTE Gouty attacks

Question 6

What is the primary AE associated with Colchicine?

Answer 6

Diarrhea

Question 7

What is an important PK to consider with use of Colchicine?

Answer 7

TAKES TIME to take effect

- 12 to 24 hours (oral - IV has increased toxicity)

Question 8

What medication produces an anti-inflammatory effect by inhibiting leukocyte migration and phagocytosis?

Answer 8

Colchicine

Question 9

For chronic prevention of Gout, what medication should ALWAYS be added with initial administration, and why?

Answer 9

Colchicine (prophylactically)

- Initial admin can trigger an acute gouty attack so Colchicine prevents this

Question 10

MOA of Uricosuric agents, and what is one possible AE?

Answer 10

Block active reabsorption of uric acid

- Possible kidney stone formation (if low urine volume)

Question 11

What Gout tx drug decreases excretion of many acidic compounds? What is an example of an acidic compound?

Answer 11

Probenecid

- Ex. PCN, MTX

Question 12

What gout medication is a URAT1 inhibitor?

Answer 12

Lesinurad (Zurampic)

- Inhibits reabsorption of uric acid

Question 13

What is the MOA of Allopurinol?

Answer 13

Inhibit xanthine oxidase → inhibit uric acid synthesis

Question 14

With which two meds specifically was it mentioned that Colchicine be added initially?

Answer 14

• Uricosuric Agents

- Allopurinol

Question 15

Which Gout tx drug is associated with drug interactions? What are two examples (1 increase toxicity, 1 decrease effects)

Answer 15

Allopurinol

• Increase effects/toxicity of 6-MP (Purinethol)
• Inhibit effects/activation of 5-FU (fluorouracil)

Question 16

Wich Gout tx drug is a recombinant form of urate oxidase that is more readily excreted (as allantoin)?

Answer 16

Rasburicase (Fasturtec)

Question 17

What patient population is Rasburicase (Fasturtec) often used for, and why?

Answer 17

Those with heme CA or solid tumors at risk for Tumor Lysis Syndrome (TLS)
- At increased risk for hyperuricemia → Gout

Question 18

What is the primary AE associated with Rasburicase (Fasturtec)?

Answer 18

Allergic reaction (possible anaphylactic shock)

Question 19

What is the MOA of Pegloticase (Krystexxa)?

Answer 19

Recombinant mammalian urate oxidase enzyme

- Converts uric acid to Allantoin = more easily excreted