W2 gout drugs

Question 1

NSAIDS

Answer 1

• excluding aspirin

- used for acute attacks of gout

Question 2

Aspirin

Answer 2

• at low doses, can cause uric acid retention by kidney
• higher doses has uricosuric effect
• not recommended for gout
• if being used for CV does not usually need to be discontinued

Question 3

Colchicine

Answer 3

-acute gout

MOA

• inhibits microtubule assembly
• suppresses inflammasome driven caspas 1 activation, IL-1B processing and release and L selectin expression

SE

• GI symptoms
• reversible Peripheral neuropath
• more severe: (rare) blood cytopenias, cutaneous eruptions

Condraindication
-patients with renal or hepatic impairment

Notes
-used in patients who have contraindications to NSAIDS

Question 4

allopurinol

Answer 4

-chronic gout

MOA

• xanthine oxidase inhibitor
• inhibits uric acid synthesis

SE

• mild rash, leukopenia, thrombocytopenia
• diarrhea
• can precipitate acute gouty arthritis

Caution
-patients with renal insufficiency

Contraindication
-known hypersensitivity

Notes
-first line pharmacologic treatment for recurrent gout despite uric acid excretion being the primary problem for most patients, not production

Question 5

febuxostat

Answer 5

-chronic gout

MOA
-xanthine oxidase inhibitor

SE

• liver function abnormalities
• nausea
• arthralgia and rash
• increased risk of gouty attack

Caution
-monitor liver function (transaminase levels)

Note
-more expensive than allopurinol

Question 6

probenecid

Answer 6

-chronic gout

MOA
-promotes renal clearance by inhibiting URAT1 in the proximal tubule

SE
-rash, precipation of acute gouty arthritis, GI intolerance, uric acid stone formation

Contraindication
-uric acid nephropathy in patients with nephrolithiasis

Caution
-interferes with renal transport of various drugs, need to adjust dosage

Notes

• short half life
• drug interactions with a lot of drugs

Question 7

lesinurad

Answer 7

-chronic gout

MOA

• inhibits URAT1 and OAT4 in vitro
• inhibits fewer things than probenecid

SE
-headache, flu, increased creatinine, acid reflux

Caution
-stay well hydrated

Warning

• risk of acute renal failure
• don’t use in patients with other kidney issues

Note
-often used with allopurinol

Question 8

Pegloticase

Answer 8

-chronic gout

MOA
-recombinant uricase which converts uric acid to allantoin

SE
-increased risk of acute gouty attack

Caution

• infusion reaction
• may develop antibodies to peplocticase and lose effect of urate lowering
• shouldn’t be used with other drugs

Contraindication
-patients with G6PD deficiency