PAIN-Gout Flashcards
What cause DEC renal excretion of UA?
Etoh, cyclosporin, ethambutal, pyrasinamed, aspirin, levodopa, niacin.
What cause INC production of UA?
Ethanol/ETOH, cytoxic drugs, VB12. meats, obese,
Which DOC NSAID for acute gout are AVOIDED if ARF?
Indomethacin, Sulindac, Naproxen
What PO corticosteroid is used of Acute gout?
Prednisolone. Intrarticular if multi jt or NPO pts.
This ANTI inflammatory ACUTE gout med MOA is unknown, NO ANALGESIC effects. **MAY inhibit leukocyte migration inhibition. (Choir blocking EMT)
Colchicine
What is the dose for Colchicine?
**Acute- 1.2mg, then 0.6mg 1hr later Prevent: 0.6mg 12hrs later. OR 0.6 PO BID til gone
What is main SE for Colchicine?
- Diarrhea VC 77%.
- DO not adjust dose RENAL and HEPATIC dfxn. CRCL <30 dec dose, dec 2wk
- Avoid STRONG CYPs ie. cyclosporin or clarithromycin, grapefruit juice-INC Toxicity
What is last resort for ACUTE GOUT if renal?
IL Blockers- Rilonacept Anakinra
This has a BBW for CV Death and used in Chronic Gout/hyperuricemia used if allergic to others?
Febuxostat
Who is consider for Urate lowering therapy?
- Tophus on PE or image
- > 2/yr
- Urolithiasis.
- NOT FOR ACUTE!!
Which *1st LINE CHRONIC TX inhibits xanthine XO enzyme that converts two steps to uric acid?
Allopurinol
What is Allopurinol Dose for pt *overproducing uric acid?
Prohylasix- 100mg/d titrate Q2-5W until UA<6. MAX 800. Elderly and Renal dose adjust
What should you warn pts w/ dosing?
- May have acute attack
2.SJS rash d/c - Leukopenia
- N/V/D
5 INC LFTS
What may have INC levels with use of alluprinol?
Azathioprine, Cyclopsoin, theophyline. Warfarin
Which ULT RX are used for underexcretors of UA?
Probenecid, Sulfinpyrazone, Lesinurad.
How do underexcretors work?
inhibit reabsorption of uric acid, INC excretion in urine
This UA excretion works in proximal tubule, LOT of H2O, HCO3, Kcitrate are req maintain alkaline urine?
Probenecid (Benemid®)
This MAX DOSE is 2g/d with this SE?
Probenecid
Kidney stone, acute gout, N/V/D rash
What is CAUTION for DI with uricosurics?
Aspirin and Diuretics
DEC effectiveness, slow UA renal secretion.
CrCl <30 loss efficacy
Thiazide diuretics and ABX mix with allopurinol affect what?
hypersensitivity
This uricourics for underexcterors is caution kidney stones?
Sulfinpyrzone
What can be used with Allopurinol XO inhib?
Lesinurad- caution Kidney stones, ARF, Leshch Nyan syndrome (tumor lysis)
What is advised if need to use Febuxostat?
Combine with NSAID or colchicine up to 6m
This drug is synthetic uricase that is an enzyme absent in humans. This enzyme breaks down uric acid to a metabolite for renal excretion, BUT it does not inhib uric prodcution?
Pegloticase- IV Q2W. DO NOT USE w. other ULTs.
