Gout meds

Question 1

prophylactic tx of gout

Answer 1

NSAIDS
colchicine- mitotic inhibitor
allopurinol- purine analog
probenecid- uricosuric

Question 2

tx of acute gouty attacks

Answer 2

steroids- cortisone
colchicine- mitotic inhibitor
NSAIDS- indomethacin

Question 3

indomethacin/ indocin

Answer 3

NSAID
for gout, arthritis, bursitis, migraine HA, hemicrania, pain & swelling
MOA- COX 1 & 2 inhibition
PO tab or cap, syrup, suppository, IM
SE- bleeding, gastritis, PUS, exacerbation of HTN or CHF. caution with renal or liver dz pts
avoid use in pts with hx of asthma or nasal/sinus polyps
do not use during pregnancy- may close ductus arteriosus

Question 4

NSAIDS

Answer 4

usual firt line therapy for gout
onset is usu within 4hrs of tx, recommended for 1-2 wks
ibuprofen may be better choice than indomethacin due to its better SE profile
PPI may be added to tx fo those at risk for gastric SE

Question 5

cortisone

Answer 5

Steroid injection
for short term pain relief & reduced swellign/inflammation of jt, tendon or bursa. for marked allergic rxn post-epinephrine tx
MOA- dec inflammation by inhibiting pro-inflammatory proteins
-intra-articular(IA) injection, PO, IM, IV, spray, topical formulations
SE- systemic: hyperglycemia, insulin resistance, DM, osteoporosis, anxiety, depression, amenorrhea, cataracts, glaucoma. local: from injection- pain, infx, skin pigment chx, loss of fatty tissue & tendon rupture
** removal & testing jt fluid before injection is a must!! esp if dx is uncertain…

Question 6

colchicine

Answer 6

mitotic inhibitor
for gout- both acute flares & prophylaxis
MOA- inhibits microtubule polymerzation by binding ro tubulin- essential for mitosis- therefore mitosis is inhibited in affected cells. also inhibits neutrophil moltility & activity= anti-inflammatory effect
SE- GI upset, anemia, neutropenia, hair loss, peripheral neuropathy
OD ssx: vomiting, diarrhea, renal failure, possible hypovolemic shock- no known antidotes known
narrow TI

Question 7

allopurinol/ zyloprim

Answer 7

purine analog
for hyperglycemia, gout, prophylaxis against tumor lysis syndrome
MOA- xanthine oxidase inhibitor
PO
SE- N/V, skin rash, SJS, hypersensitivity syndrome- fever, skin rash, eosinophilia, hepatitis & dec renal funx

Question 8

**probenecid/ probalan

Answer 8

uricosuric
for hyperglycemia & gout
MOA- interferes with kidney’s organic anion transporter(OAT) which reclaims uric acid from the plasma to the urine. decreases tubular reabsorption of uric acid to inc urinary excretion of uric acid.
PO
SE- N/V, GI upset, gastritis, anemia, leukopenia, possible hemolytic anemia- esp in pts with G-6ph dehydrogenase deficiency. possible drug induced heapatitis, dizziness
**may cz formatin of uric acid renal stones- particularly in pts with renal insufficency
**exacerbation of gout after tx may occur
**co-use of salicylates is contraindicated- antagonist of probenecid

Question 9

uricosurics

Answer 9

substances that inc excretion of uric acid in the urine. reducing the conc. of uric acid in plasma. dec in plasma lvls of uric acid helps to dissolve the crystals & limit new formation

• may contribute to kidney stones.
• action on the proximal tubule.