Gout🥩🍺 🦶🏻(Lauren 🌭) Flashcards
What are the 2 ways someone can have too much uric acid in their body and get gout?
Overproducing uric acid
Underexcretion of uric acid
What are the 2 goals of drug therapy in gout?
Stop inflammation during an acute attack (Colchicine, indomethacin and other NSAIDs)
Reduce hyperuricemia to prevent future attacks (Probenecid, sulfinpyrazine, allopurinol, febuxostat, etc)
What drugs are used for acute attacks of gout?
NSAIDs (indomethacin or naproxen)
Colchicine
What are two uricosuric agents used to prevent gout attacks?
Probenecid (Benemid)
Lesinurad (Zurampic)
What are two drugs that inhibit uric acid synthesis to prevent gout attacks?
Allopurinol
Febuxostat (Uloric)
What are two drugs that prevent gout attacks by converting uric acid into something else (allantoin)
Rasburicase (Fasturtec)
Pegloticase (Krystexxa)
How do acidic drugs affect the renal excretion of uric acid?
They compete for reabsorption and you’ll end up with more uric acid build up in your body
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?
No, meth is a base and will have no effect on the excretion of uric acid 👍
What causes the pain of a gout attack?
- Uric crystals are deposited in the joint
2. Synoviocytes EAT the crystals which causes the inflammation and pain!!!
What are the primary NSAIDs used to treat inflammation in gout attacks?
Indomethacin*** #1🏆
Naproxen
Sulindac (probably not important)
What NSAIDs are CONTRAINDICATED in the treatment of gout?
Aspirin
Salicylates
They are ACIDS and will decrease urate excretion!
If someone has never had PUD, what NSAIDs can they use (ever, not just for gout)
Any NSAID
If someone used to have PUD but they dont anymore, what NSAIDs can they use (ever, not just for gout)
Celecoxib (+/- an antacid)
some NSAIDs + a PPI or misoprostol
If someone has active PUD, what NSAIDs can they use?
None.
They can use Tylenol or opioids only
True or false:
Colchicine is an analgesic
FALSE
No analgesia, no effect on COX, no effect on urate excretion
Wtf does Colchicine do to help your acute gout attack
Inhibits the assembly of microtubules by binding to tubulin
+ it inhibits the phagocytosis by leukocytes
How long after taking colchicine will it take to get some relief for your acute gout
12-24 hours
What is the MAIN side effect of colchicine?
DIARRHEA
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
Diarrhea 🧻
How do uricosuric agents (probenecid and lesinurad) work?
Block the active reabsorption of urate in the renal tubule
What do you need to take with your probenecid or Lesinurad (Zurampic) the first time you start taking it?
Take with colchicine.
If you don’t, you can trigger a gout attack
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?
2-3 weeks after his gout attack
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?
Yes, it will decrease the excretion of many acidic drugs.
What drugs will Probenecid decrease the excretion of?
Penicillin**
Methotrexate
Clofibrate
Glucuronides of NSAIDs
How do Allopurinol and Febuxostat prevent the symthesis of uric acid?
Inhibit the enzyme Xanthine Oxidase
What is a risk when you first start taking Allopurinol or Febuxostat?
May trigger a gout attack
Must combine with colchicine at first
What are the 2 most important drug interactions of allopurinol and febuxostat?
Makes 6-MP MORE toxic
Makes 5-FU work LESS
Rasburicase (Fasturtec) and Pegloticase (Krystexxa) are enzymes, but they don’t come from humans ;)
Where do they come from?
Rasburicase (Fasturtec) is fungal 🍄
Pegloticase (Krystexxa) is “mammalian” 🐩? 🦏? 🦍? 🐋? 🦇? 🐼?
i looked it up its actually: 🐷
What do Rasburicase (Fasturtec) and Pegloticase (Krystexxa) do?
They are enzymes that turn uric acid into allantoin, a metabolite that is easily excreted 🚽
What kind of patients are usually prescribed Rasburicase (Fasturtec) or Pegloticase (Krystexxa)?
Patients with tumors/malignancies who are at risk of tumor lysis syndrome (which includes hyperuricemia)
How does Lesinurad (Zurampic) inhibit the reabsorption of urate in the renal tubule?
It inhibits the URAT1 transporter
