Pharm Flashcards
Uric Acid Pathway
ribose 5P -> PRPP + glutamine -> -> inosinic acid -> inosine -> hypoxanthine -> xanthine -> uric acid
Tx goals in Gout
terminate acute attack, prevent recurrence, reverse or prevent complications, prevent formation of kidney stones
Colchicine MoA
Depolimerizes microtubules, indicated for acute attacks of gout, prevent gouty arthritis, familial Mediterranean fever
Colchicine AE
GI disturbances acutely, Blood dyscrasias chronically. Monitor CBC, serum alk phos
Indomethacine MoA
Cycloxygenase inhibitor, analgesic and antipyretic, inhibits leuokocyte motility. Indicated for acute gout attack
Indomethacine AE
GI- N/V and ulcers, severe frontal HA, hematopoietic disorders, antagonize furosemide and HCTZ
Allopurinol MoA
Gout drug. Competitive inhibitor of xanthine oxidase, also metabolized to oxypurinol (non-comp inhibitor of XO)
Allopurinol AE
dermatitis, liver, interacts with 6 mercaptopurine, concurrent ampicillin is contraindicated
Febuxostat MoA
gout drug. Xanthine oxidase inhibitor, structurally unrelated to allopurinol, lowers urate levels. Can be used in pts with mild or moderate renal impairment (unlike allo)
Febuxostat AE
mild, but may have increase in transaminases
Probenecid MoA
gout drug. Inhibits transport f organic anions across epithelial barriers. Interferes with uric acid (post secretory) reabsorption in the brush border of proximal tubule
Probenecid AE
salicylates inhibit its uricosuric action
Pegloticase
recombinant pegylated form of a mammalian urate oxidase, which lowers uric acid by converting UA into allantoin which is excreted benignly in the urine
Pegloticase AE
gout flares due to UA tophi dissolution, give pt colchicine or NSAID prophylactically. very expensive and administered IV every 2 weeks
Colchicine metabolism
de acetylated in liver and excreted in biliary system, but 20% in urine. In impaired renal and liver dysfxn - increased toxicity - myopathy, peripheral neuropathy, rhabdomyolysis. Not removed by dialysis, no specific antidote.
