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IPFC 1 Midterm 1 > Gout Pharmacology > Flashcards

Gout Pharmacology Flashcards

1
Q

How is the pain caused in gout?

A
  • Urate crystals in the joint are taken up by synoviocytes
  • Synoviocytes release inflammatory mediators (IL-1)
  • IL-1 attracts wbc including (polymorphonuclear leukocytes, mononuclear phagocytes)
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2
Q

What drugs inhibit uric acid PRODUCTION

A

Allopurinol
febuxostat

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3
Q

what drug increase uric acid secretion

A

probenecid

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4
Q

What is the MOA of allopurinol and febuxostat?

A

prevents conversion of xanthine and hypoxanthine (soluble) into uric acid (less soluble)

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5
Q

Differentiate between allopurinol and febuxostat

A

Allopurinol is a purine analogue

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6
Q

What is the toxicity problem with xanthine oxidase inhibitors? What is the solution

A

Rebound: decreasing plasma uric acid can lead to deposition of other uric acid into a joint
- solution: use colchicine/NSAIDs at beginning of ULT

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7
Q

Why is allopurinol only dosed once daily but has a short-life

A

Its active metabolite oxypurinol as a longer half life

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8
Q

What is the PK of febuxostat

A

Liver metabolism
- multiple phase I and II enzymes involved

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9
Q

What is the MOA of pegloticase (pig-dervied urate oxidase). How is it used/dose?

A

converts uric acid into soluble allantoin then secreted.

IV every 2 weeks

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10
Q

How to mitigate infusion reactions of pegloticase?

A

antihistamine or steroid pre-treatment

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11
Q

What drug is used for cancer patients

A

rasburicase

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12
Q

What is the MOA of probenecid?

A

Uricosuric agent

  1. inhibits urate transporter and organic anion transporter
  2. inhibits active reabsoprtion of uric acid in the proximal tubules –> more uric acid stays in urine –> excreted
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13
Q

What is colchicine class and MOA

A

Antimitotic (tubulin inhibitor)

  • binds tubulin to inhibit leukocyte (WBC) migration to sites of inflammation
  • tubulin inhibition can also impair white blood cell phagocytosis of urate crystals (impair inflammation)
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14
Q

Which anti-inflammatory has a large volume of distribution

A

colchicine

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15
Q

Which 2 drugs have positive physiological drug interaction?

A

Allopurinol + probenicid

Allopurinol inhibits probenecid and warfarin metabolism
Probenecid also inhibits allopurinol conversion to oxypurinol

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16
Q

Which drug requires good renal function for efficacy?

A

Probenecid

17
Q

Which drug can also reduce the reabsorption of other acid drugs

A

probenecid

IPFC 1 Midterm 1 (8 decks)

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