Overview of drug treatments of gout Flashcards
Is gout treatment different for acute and chronic gout attacks?
Yes
What molecules build up and cause gout, and how does this affect joints
Build up of monosodium urate crystals, which exert pressure around joints
What is gouty tophi/tophaceous gout?
Masses of monosodium urate crystals form in soft tissue and around joints
Give 3 reasons for monosodium urate build up in gout?
Urid acid overproduction
Kidney doesn’t filter out excess uric acid
Influence of drugs eg. thiazide diuretics
Why does uric acid build up in the body, and what enzyme is involved in this?
Xanthine oxidase catalyses breakdown of purines into uric acid
What is the target of treatment for an acute flare up of gout?
Relieve pain and swelling
What 3 treatments can be used to treat acute gout attacks?
NSAIDs, colchicine, corticosteroids
How efficacious are NSAIDs for acute gout attacks?
Moderate to good efficacy
Are NSAIDs suitable for both short and long term use for acute gout attacks?
Suitable for short-term use and in low dose
Not suitable for long-term use and in high dose
What are 4 side effects of long-term use/high dosage of NSAIDs in acute gout attacks?
Side effects of peptic ulcers, GI bleeds, renal failure, heart failure
Which patients are suitable to take NSAIDs for acute gout attacks?
Don’t have past/current/susceptibility to GI, heart diseases such as hypertension or congestive heart failure, asthma as NSAIDs can cause bronchospasms, CKD
Give 2 reasons why NSAIDs are convenient to take for acute gout attacks?
They can be taken orally and are inexpensive
Are NSAIDs started at high or low dosage for acute gout attacks?
NSAID often started at high dose
What is the usual duration of NSAID treatment for acute gout attacks?
Taken for few weeks until flare up settles
What is the dosage of ibuprofen (NSAID) for acute gout attacks?
400-800 mg ibuprofen tds (three times daily)
What is the dosage of naproxen (NSAID) for acute gout attacks?
First dose is 750 mg naproxen, then 250 mg tds for 7 days
What is colchicine and where is it derived from?
General anti-inflammatory drug derived from a plant alkaloid, used to treat acute gout attacks
What is the mechanism of action of colchicine in acute gout attacks?
Affects microtubule depolarisation, which changes the expression of genes associated to granulocyte migration, growth, adhesion, inhibiting acute inflammation
What is the efficacy of colchicine in acute gout attacks, and what drug is it similar to?
Very good efficacy, is similar to naproxen
What are the short-term and long-term side effects of colchicine use for acute gout attacks?
Short-term effects include common diarrhoea and nausea
Long-term effects include renal failure, bone marrow suppression
Which patients are suitable to take colchicine for acute gout attacks?
Patients who can’t take NSAIDs, as colchicine is similar to naproxen
What are the 2 differences between colchicine and naproxen in terms of side effects, when used for treating acute gout attacks?
Diarrhoea twice as common from colchicine use than naproxen use
Less risk of heart failure from colchicine use than naproxen use
What is the dosage of colchicine for acute gout attacks?
0.5 mg daily for few weeks
Why is the duration of colchicine treatment for acute gout attacks a few weeks?
Prevents recurrent flares
Over the duration of one course of colchicine for acute gout attacks, what is the maximum total administered amount?
6 mg
How and where are corticosteroids administered in acute gout attacks?
Locally injected into single large painful joint
In severe acute gout flare ups, what corticosteroid is administered?
Oral prednisolone
What is the efficacy of corticosteroids for acute gout attacks?
Good efficacy
Are corticosteroids safe for short and long term use, when treating acute gout attacks?
Safe for short-term use,
but long-term use has side effects of weight gain, fluid retention, high blood pressure, diabetes and osteoporosis
Which patients are suitable to take corticosteroids for acute gout attacks?
Patients who have other comorbidities
Patients who can’t take NSAIDs or colchicine
What is canakinumab, and what is its mechanism of action in treating acute gout attacks?
Human monoclonal antibody that selectively inhibits IL-1 receptor
How is canakinumab administered for acute gout attack treatment, and how long is the duration of one dose?
Subcutaneous injection that lasts up to 12 weeks
Which patients are suitable for canakinumab use to treat acute gout attacks?
Patients with frequent, severe acute gout attacks that isn’t treated by other drugs
When is treatment started to prevent gout attacks from recurring?
Treatment started 1-2 weeks after acute flare up settles, so that flare up won’t be triggered again
Give 3 reasons why patients can have regular treatment to lower uric acid levels?
They had more that 2 gout attacks in a year
They have renal damage
Other complications
Give 3 examples of lifestyle advice used to prevent recurrent gout attacks?
Low-purine diet
Avoid dehydration
Avoid certain drugs
What is the first-line drug for preventing recurrent gout attacks?
Allopurinol
What is the mechanism of action of allopurinol in prevention of recurrent gout attacks?
Inhibits xanthine oxidase, so purines can’t be broken down to form uric acid in the purine metabolic pathway
How efficacious is allopurinol for treatment of preventing recurrent gout attacks?
Very good efficacy
Is allopurinol safe for short and long term use?
Yes, can even be used as a life-long treatment
Why is allopurinol safe for very long-term use?
Rarely causes serious allergies
What is the dosage of allopurinol in prevention of recurrent gout attacks?
100-600 mg , usually start dose is 100mg then up titrated
Does use of allopurinol need to be monitored?
Yes, needs to be monitored few weeks after administering each dose to check uric acid serum levels and renal function
What 2 drugs does allopurinol have drug interactions with?
Purine analogs
Theophylline
What is febuxostat?
Non-purine xanthine oxidase inhibitor, second-line drug to allopurinol for prevention of recurrent gout attacks
What is the second-line drug for prevention of recurrent gout attacks?
Febuxostat
Give 1 reason why febuxostat is inconvenient, in terms of its price?
It is very expensive, as it is the newest drug on the market
Which patients are suitable for febuxostat?
Patients who couldn’t take allopurinol due to medical conditions
Patients who has such serious side effects to allopurinol that they couldn’t take recommended dose
used cautiously in patients with past/current/susceptibility to heart conditions
What is the side effect of febuxostat?
Increased risk of cardiovascular problems
