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OU Module GI/Rheum > Treatment of Gout Exam 2 > Flashcards

Treatment of Gout Exam 2 Flashcards

1
Q

Nondrug for acute gouty arthritis

A
  • Topical ice
  • Rest inflamed joint
  • Diet: 8-16 cups water/d, no alcohol, meat <4-6 oz/d; get protein from low fat dairy, tofu, eggs, nut butters
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2
Q

Drug treatment overview for acute gouty arthritis

A
  • Colchicine
  • NSAIDs
  • Corticosteroids
  • IL-1 antagonist
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3
Q

Treatment goal for acute gouty arthritis

A

relieve pain and inflammation (NOT decrease uric acid)

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4
Q

Drug treatment for acute gouty arthritis: Colchicine

A
  • At first sign of flare – two 0.6 mg doses, then 0.6 mg after 1 h
  • Best response if first dose given within 12 h of onset of attack, not recommended if over 36 h since onset
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5
Q

Drug treatment for acute gouty arthritis: NSAIDs

A
  • very effective, may take 24 h for benefits
  • Indomethacin, naproxen, sulindac FDA approved for acute gouty arthritis
  • Salicylates should not be used; low doses inhibit urate secretion into renal tubules, high doses also inhibit reabsorption
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6
Q

Drug treatment for acute gouty arthritis: Corticosteroids

A
  • May be combined with colchicine to prevent rebound flares of gout as steroid is discontinued
  • Oral prednisone, ACTH, IA injections
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7
Q

Drug treatment for acute gouty arthritis: IL-1 antagonist

A
  • b/c IL-1beta involved in urate crystal-induced inflammation
  • anakinra (Kineret), rilonacept (Arcalyst), & canakinumab (Ilaris)?
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8
Q

Colchicine MOA

A

inhibits neutrophil function & inflammatory response to urate crystals; persists in neutrophils as long as 10 d after single dose

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9
Q

Colchicine choice in therapy

A
  • Favorable for acute attacks (Pain relief in 24-48 h)

- also useful for chronic therapy

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10
Q

IL-1 antagonist MOA

A

Reduce urate crystal-induced inflammation

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11
Q

Allopurinol MOA

A

Xanthine Oxidase Inhibitor; purine analog

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12
Q

Allopurinol choice in therapy

A

Prophylactic; urate lowering; treat to target uric acid

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13
Q

Febuxostat MOA

A

Selective Xanthine Oxidase Inhibitor; non-purine

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14
Q

Febuxostat choice in therapy

A

Prophylactic; urate lowering; use in patients with allopurinol hypersensitivity, intolerance, or treatment failure

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15
Q

Uricosurics MOA

A

Inhibit reabsorption of urate by renal tubules

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16
Q

Uricosurics choice in therapy

A

Prophylactic; urate lowering; preferred for underexcreters

17
Q

Lesinurad (Zurampic) MOA

A

Selective inhibitor of uric acid reabsorption; inhibits uric acid transporter URAT 1 & organic anion transporter OAT 4

18
Q

Lesinurad (Zurampic) choice in therapy

A

Prophylactic; urate lowering; Dose with xanthine oxidase inhibitor; combination product: Duzallo

19
Q

Fenofibrate MOA

A

reduces renal tubular reabsorption of uric acid

20
Q

Uricases (urate oxidases) MOA

A

Convert uric acid to allantoin (more soluble)

21
Q

Pegloticase MOA

A

PEGylated uricase enzyme

22
Q

Pegloticase choice in therapy

A

Prophylactic; urate lowering; hyperuricemia associated with refractory chronic gout or if intolerant to oral options

23
Q

Rasburicase (Elitek) choice in therapy

A

Prophylactic; urate lowering; hyperuricemia-associated with malignancy (tumor lysis syndrome)

24
Q

drugs that can induce hyperuricemia

A
  • Diuretics
  • Cyclosporine
  • Salicylates (low dose)
  • Other: pyrazinamide, ethambutol, nicotinic acid, levodopa, cytotoxic drugs, didanosine (ddI), topiramate
25
Q

Describe how presence of nephrolithiasis affects drug choice for hyperuricemia

A
  • Uricosurics should not be used for patients with history of kidney stones
  • Allopurinol is the drug of choice for hyperuricemia with kidney stones
  • Do not give probenecid, fenofibrate, or losartan if pt has history of nephrolithiasis
26
Q

Describe the treatment of urate nephrolithiasis

A
  • Maintain urine volume 2-3 L/d
  • Alkalinize urine to pH 6-6.5: Na bicarbonate, Shohl’s solution, Acetazolamide
  • Avoid high purine foods
  • Limit protein to <=90 g/d
  • Xanthine oxidase inhibitor (NOT uricosuric)
27
Q

How do you alkalinize the urine?

A

– Na bicarbonate
– Shohl’s solution
– Acetazolamide

28
Q

What are the Uricosurics?

A
  • Probenecid
  • Lesinurad (Zurampic)
  • Lesinurad/allopurinol combination product (Duzallo)
  • Losartan
  • Fenofibrate
  • Atorvastatin & simvastatin
29
Q

What are the Uricases?

A
  • Pegloticase (Krystexxa)

* Rasburicase (Elitek)

30
Q

Uricosurics MOA

A

inhibit reabsorption of urate by renal tubules

31
Q

Uricase MOA

A

Convert uric acid to allantoin (more soluble)

OU Module GI/Rheum (30 decks)

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