Gout + Migraine

Question 1

Colchicine

Answer 1

MOA: binds to tubulin and inhibits polymerization
Effect: prevents formation of microtubules, disrupts mobility of granulocytes, blocks cell division by disturbing mitosis spindles, inhibits synthesis and release of LTs
Use: gout
SE: N/V/D, abd pn, myopathy, neutropenia, aplastic anemia, alopecia
CI: pregnancy (caution in pt’s w/ hepatic/renal/CV dz)

Question 2

Glucocorticoids (gout)

Answer 2

Use: acute attack in a single joint that is unresponsive to NSAIDs or colchicine a depot prep of steroid is injected into the site

Question 3

Allopurinol

Answer 3

MOA: purine analogue, inhibits xanthine oxidase
Effect: reduces formation of uric acid and uric acid concentration in serum
Use: first-line tx for gout
SE: HS rxn, Steven-Johnson Syndrome
Drug interaction: mercaptopurine and Azathioprine are metabolized by xanthine oxidase so given concurrently with allopurinol could result in toxic levels of those drugs in the serum resulting in BM suppression

Question 4

Febuxostat

Answer 4

same as allopurinol all around but different structural compound

Question 5

Probenecid

Answer 5

MOA: inhibition of URAT1 transporter in lumen
Effect: lowers plasma irate, and dissolution of urate crystals
SE: GI sx’s, HS rxn, urate stones
CI: pt’s w/ nephrolithiasis or overproduction of uric acid

Question 6

Losartan and Fenofibrate (gout)

Answer 6

MOA: inhibit URAT1
Effect: reduce plasma uric acid levels

Question 7

Pegloticase

Answer 7

MOA: oxidizes uric acid to allantoin
Effect: increased metabolism and excretion of uric acid
Use: pt’s that are refractory to other tx’s

Question 8

Triptans

Answer 8

MOA: selective agonists at 5-HT1D and 5-HT1B
Use: DOC for moderate to severe migraine
SE: tingling, flushing, dizziness, fatigue, angina, MI, arrhythmia, CVA, death
CI: coronary, cerebrovascular or arterial dz or uncontrolled HTN

Question 9

Ergotamine

Answer 9

MOA: agonist at α receptors and 5-HT and D2 receptors
SE: N/V, vascular occlusion, gangrene
CI: arterial dz and uncontrolled HTN

Question 10

Dihydroergotamine

Answer 10

MOA: agonist at α receptors and 5-HT and D2 receptors
SE: weaker vasoconstrictor than Ergotamine so fewer SEs
CI: arterial dz and uncontrolled HTN

Question 11

β-Blockers (migraine)

Answer 11

Use: first line prophylaxis of migraine

Question 12

Valproate

Answer 12

Use: bipolar disorder, epilepsy, migraine prophylaxis
SE: GI sx’s, thrombocytopenia, hepatotoxicity
CI: pregnancy (teratogenic)

Question 13

Topiramate

Answer 13

MOA: inhibits voltage-gated Na+ channels, GABAa receptor agonist, glutamate antagonist
Use: epilepsy and migraine prophylaxis
SE: somnolence, fatigue, nervousness, confusion, acute myopia, glaucoma, hyperthermia, renal stones
CI: pregnancy (teratogenic)

Question 14

Amitriptyline / Nortriptyline / Imipramine

Answer 14

TCAs
MOA: inhibit NE and serotonin reuptake
SE: sedation, dry mouth, wt gain

Question 15

Venlafaxine

Answer 15

MOA: SNRI
Use: migraine prophylaxis
SE: nausea, constipation, insomnia, HA, sexual dysfunction

Question 16

Verapamil

Answer 16

CCB

Use: prevention of migraine but weak effectiveness

Question 17

Gabapentin

Answer 17

MOA: blocks presynaptic voltage-gated Ca2+ channels
Effect: decreases Glutamate release
SE: sleepiness, dizziness, fatigue

Question 18

Botulinum Toxin

Answer 18

Use: pericardial injections in pt’s w/ migraines (>15 HA days per month)

Question 19

NSAIDs (migraine)

Answer 19

Naproxen and Ibuprofen for short term prevention

Question 20

Lisinopril and Candesartan

Answer 20

ACEI and ARBs

Use: reduce migraine frequency