Module 2 gout Flashcards
Gout patho
alteration in purine metabolism resulting in hyperuricemia and deposition of urate crystals in tissues
- 30-50 y/o
- men > women
gout s/s
sudden pain
erythema
limited range of motion
swelling in joint
primary gout
defect in purine metabolism and or uric acid excretion
secondary gout
r/t
- cancer
- CRF
- drugs
- salicylates, antineoplastics, diuretics, ethambutol, nicotinic acid, cyclosporin, ethanol
Gout pharmacological pain tx
NSAID
corticosteroids
Antigout medication
colchicine
allopurinol
febuxastat
uricosuric agents
probenecid
sulfinpyrazone
colchicine MOA
disruption of urate deposition and subsequent inflammatory reaction
Colchicine use
acute gout attack
prophylaxis with chronic gout
colchicine AE
adb. pain
N/V/D
colchicine interactions
cyclosporine
tacrolimus
verapamil
colchicine administration
acute attack:
- 1.2mg x 1, 0.6-1.2mg q1-2hr till relief of diarrhea
Maintenance:
- < 1 attack/year: 0.6mg 3-4x/week
- > 1 attack/year: 0.6-1.2mg/day
- serious case: 1.2-1.8mg/day
No effect on uric acid levels
probenecid use
uricosuric agent
prophylactic gout tx
prevention of disease progression
probenecid MOA
dec. urate reabsorption in PCT
non-selective blockade of active renal transport of organic acids
probenecid AE
hypersensitivity
GI upset
Urate kidney stones
probenecid precaustions
do not start during acute attack inc. attacks may occur with first 6-12mo to minimize risk of urate kidney stones - inc. fluids, min. of 2L/day - alkaline urine: NaHCO3
probenecid interactions
penicillin
naproxen
allopurinol MOA
antigout
inhibits uric acid production
- Prodrug: converted by xanthine oxidase
allopurinol interactions
azathioprine: 6-metcaptopurine toxicity
allopurinol education
as uric acid levels dec
-> dissolution of deposits
-> acute attacks
Can take with colchicine
febuxostat MOA
antigout
inhibits xanthine oxidase
- prevents uric acid production
febuxostat AE
elevated LFT
febuxostat precautions
inc. risk gouty attacks with tx initiation
- take with NSAID or Colchicine
sulfinpyrazone MOA
inhibit renal tubular reabsorption of urate and thus inc. renal excretion
sulfinpyrazone use
gout
- when probenecid and allopurinol are not tolerated
sulfinpyrazone AE
GI upset
- take with food
sulfinpyrazone contraindications
sulfa allergy
avoid aspirin
asymptomatic hyperuricemia features
plasma urate:
> 6.0 mg/dL in women
> 7.0 mg/dL in men
acute gout features
acute arthritis
typically metatarsophalangeal joints
excruciating pain
acute gout Rx
NSAID
colcichine
glucocorticoids
intercritical phase features
asymptomatic hyperuricemia
10% may never have another attack
intercritical phase Rx
none
chronic gout features
hyperuricemia
development of tophi
recurrent attacks of acute gout
chronic gout Rx
allopurinal
probenecid
sulfinpyrazone
