Gout🥩🍺 🦶🏻(Lauren 🌭)

Question 1

What are the 2 ways someone can have too much uric acid in their body and get gout?

Answer 1

Overproducing uric acid

Underexcretion of uric acid

Question 2

What are the 2 goals of drug therapy in gout?

Answer 2

Stop inflammation during an acute attack (Colchicine, indomethacin and other NSAIDs)

Reduce hyperuricemia to prevent future attacks (Probenecid, sulfinpyrazine, allopurinol, febuxostat, etc)

Question 3

What drugs are used for acute attacks of gout?

Answer 3

NSAIDs (indomethacin or naproxen)

Colchicine

Question 4

What are two uricosuric agents used to prevent gout attacks?

Answer 4

Probenecid (Benemid)

Lesinurad (Zurampic)

Question 5

What are two drugs that inhibit uric acid synthesis to prevent gout attacks?

Answer 5

Allopurinol

Febuxostat (Uloric)

Question 6

What are two drugs that prevent gout attacks by converting uric acid into something else (allantoin)

Answer 6

Rasburicase (Fasturtec)

Pegloticase (Krystexxa)

Question 7

How do acidic drugs affect the renal excretion of uric acid?

Answer 7

They compete for reabsorption and you’ll end up with more uric acid build up in your body

Question 8

My crackhead neighbor just got diagnosed with gout. He wants to smoke meth this weekend, but he’s worried that it might increase his uric acid concentration. Should he abstain from meth to prevent another gout attack?

Answer 8

No, meth is a base and will have no effect on the excretion of uric acid 👍

Question 9

What causes the pain of a gout attack?

Answer 9

1. Uric crystals are deposited in the joint

2. Synoviocytes EAT the crystals which causes the inflammation and pain!!!

Question 10

What are the primary NSAIDs used to treat inflammation in gout attacks?

Answer 10

Indomethacin*** #1🏆

Naproxen

Sulindac (probably not important)

Question 11

What NSAIDs are CONTRAINDICATED in the treatment of gout?

Answer 11

Aspirin

Salicylates

They are ACIDS and will decrease urate excretion!

Question 12

If someone has never had PUD, what NSAIDs can they use (ever, not just for gout)

Answer 12

Any NSAID

Question 13

If someone used to have PUD but they dont anymore, what NSAIDs can they use (ever, not just for gout)

Answer 13

Celecoxib (+/- an antacid)

some NSAIDs + a PPI or misoprostol

Question 14

If someone has active PUD, what NSAIDs can they use?

Answer 14

None.

They can use Tylenol or opioids only

Question 15

True or false:

Colchicine is an analgesic

Answer 15

FALSE

No analgesia, no effect on COX, no effect on urate excretion

Question 16

Wtf does Colchicine do to help your acute gout attack

Answer 16

Inhibits the assembly of microtubules by binding to tubulin

+ it inhibits the phagocytosis by leukocytes

Question 17

How long after taking colchicine will it take to get some relief for your acute gout

Answer 17

12-24 hours

Question 18

What is the MAIN side effect of colchicine?

Answer 18

DIARRHEA

Question 19

My crackhead neighbor was prescribed colchicine for his gout, but now he’s texting me saying the side effect is so bad, he can’t take it anymore. What is the side effect he is probably referring to

Answer 19

Diarrhea 🧻

Question 20

How do uricosuric agents (probenecid and lesinurad) work?

Answer 20

Block the active reabsorption of urate in the renal tubule

Question 21

What do you need to take with your probenecid or Lesinurad (Zurampic) the first time you start taking it?

Answer 21

Take with colchicine.

If you don’t, you can trigger a gout attack

Question 22

My crackhead neighbor with gout stayed up all night smoking meth, and it got him thinking about how he’s going to prevent more gout attacks in the future.
He has some Probenecid, and he wants to know when he should start taking it?

Answer 22

2-3 weeks after his gout attack

Question 23

Hmmm using Probenecid to decrease absorption of uric acid in the kidney tubule seems like it might have some effect on other drugs. Will that happen?

Answer 23

Yes, it will decrease the excretion of many acidic drugs.

Question 24

What drugs will Probenecid decrease the excretion of?

Answer 24

Penicillin**

Methotrexate

Clofibrate

Glucuronides of NSAIDs

Question 25

How do Allopurinol and Febuxostat prevent the symthesis of uric acid?

Answer 25

Inhibit the enzyme Xanthine Oxidase

Question 26

What is a risk when you first start taking Allopurinol or Febuxostat?

Answer 26

May trigger a gout attack

Must combine with colchicine at first

Question 27

What are the 2 most important drug interactions of allopurinol and febuxostat?

Answer 27

Makes 6-MP MORE toxic

Makes 5-FU work LESS

Question 28

Rasburicase (Fasturtec) and Pegloticase (Krystexxa) are enzymes, but they don’t come from humans ;)

Where do they come from?

Answer 28

Rasburicase (Fasturtec) is fungal 🍄

Pegloticase (Krystexxa) is “mammalian” 🐩? 🦏? 🦍? 🐋? 🦇? 🐼?

i looked it up its actually: 🐷

Question 29

What do Rasburicase (Fasturtec) and Pegloticase (Krystexxa) do?

Answer 29

They are enzymes that turn uric acid into allantoin, a metabolite that is easily excreted 🚽

Question 30

What kind of patients are usually prescribed Rasburicase (Fasturtec) or Pegloticase (Krystexxa)?

Answer 30

Patients with tumors/malignancies who are at risk of tumor lysis syndrome (which includes hyperuricemia)

Question 31

How does Lesinurad (Zurampic) inhibit the reabsorption of urate in the renal tubule?

Answer 31

It inhibits the URAT1 transporter