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NURS 424 > Week 11 - Antigout and Uricosuric Agents > Flashcards

Week 11 - Antigout and Uricosuric Agents Flashcards

1
Q

Xanthine oxidase inhibitors: examples

A
  • Allopurinol - first line
  • Febuxostat
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2
Q

Allopurinol and Febuxostat: indications

A

Chronic gout

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3
Q

Xanthine oxidase inhibitors: MOA

A

Decrease uric acid levels by selectively inhibiting xanthine oxidase (enzyme responsible for conversion of hypoxanthine to xanthine to uric acid)

Uric acid then decreases, reducing risk of crystallization and gout attack

Inhibits inflammation

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4
Q

Xanthine oxidase inhibitors: caution and contraindications

A
  • Caution in renal impairment
  • Avoid use w/ azathioprine, mercaptopurine, theophylline
  • Avoid in severe hepatic dysfunction
  • Avoid in pregnancy
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5
Q

Which xanthine oxidase inhibitor can be used in pediatrics?

A

Allopurinol

  • In children >6 years r/t hyperuricemia from cancer therapy
  • Caution in lactation
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6
Q

Xanthine oxidase inhibitors: ADR

A
  • Maculopapular skin rash
  • Arthralgias
  • N/D
  • Elevated transaminases

Rare: hepatotoxicity

Hypersensitivity rash (higher in blacks, Asians, and hispanics)

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7
Q

Probenecid: indications

A

Chronic gout

NOT monotherapy

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8
Q

Probenecid: MOA

A

Increases excretion of serum uric acid by competitively inhibiting reabsorption of uric acid at proximal convoluted tubule

Sulfa based

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9
Q

Probenecid: ADR

A
  • HA, dizziness, N/V
  • Anorexia
  • Gingival soreness
  • Urinary frequency
  • Dermatitis, pruritus
  • Flushing fever
  • Gout exacerbation

Rare: anaphylaxis, blood dyscrasias

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10
Q

Probenecid: caution and contraindications

A
  • Patients w/ diagnosed blood dyscrasias
  • Creatinine clearance is <30 mL/min
  • Children <2 years
  • Combination w/ ASA
  • Patients w/ G6PD deficiency
  • Pregnancy and lactation
  • Sulfa allergy
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11
Q

Colchicine: indications

A

Acute gout flare

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12
Q

Colchicine: MOA

A

Inhibits activation, degranulation, and migration of neutrophils to area of a gout attack

Decreases inflammation and pain associated w/ gout attack (but NOT an analgesic)

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13
Q

Colchicine: caution and contraindications

A
  • Combination w/ grapefruit juice
  • Renal and hepatic impairment
  • Elderly patients
  • Pregnancy and lactation
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14
Q

Can colchicine be used in pediatrics?

A

Yes, if >16 years

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15
Q

Corticosteroids (prednisone): indications

A

Acute gout, RA

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16
Q

Corticosteroids (prednisone): MOA

A

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes (neutophils, eosinophils, basophils) and reversing increased capillary permeability

17
Q

Corticosteroids (prednisone): caution and contraindications

A
  • Uncontrolled active infections
  • Prolonged use may lead to adrenal suppression and immunosuppression
  • Caution in diabetic patients and those w/ active GI disease
  • Renal and hepatic impairment
  • Pregnancy and lactation
18
Q

Can corticosteroids (e.g. prednisone) be used in pediatrics to treat acute gout?

A

Yes

19
Q

Corticosteroids (prednisone): ADR

A
  • HTN
  • Insomnia
  • Mood changes
  • Increased appetite
  • Glucose intolerance
  • Peptic ulcer (cutaneous atrophy, cataracts, glaucoma, osteoporosis, growth suppression, Cushing’s syndrome w/ chronic use)
20
Q

Patient education about gout

A
  • Increased HTN and cardiovascular risks are associated w/ higher uric acid levels
    • DASH diet helps w/ gout
  • Old gout diets NOT supported by evidence
  • Fluid intake is key
21
Q

True/False: Patients w/ gout should also take anti-inflammatory agents (indocin) and steroids

A

True

22
Q

Can gout medications be used in pregnancy and pediatrics?

A
  • ONLY probenecid can be used in pregnancy
  • Not used in children except for uricemia of malignancy
23
Q

True/False: When taking gout medications, it will be important to consider that uric acid crystals, when mobilized, can precipitate renal stones

A

True

24
Q

What are general common side effects seen with gout medications?

A

GI disturbances and peptic ulcers

25
Q

Colchicine: ADR

A
  • Myopathy
  • Weakness
  • Neuropathy
  • Malabsorption of B12
26
Q

Geriatric gout medication considerations

A

Uric acid more toxic in older adults

  • Drug of choice: probenecid
  • Allopurinol can be used for renal impairment
  • Toxic when combined w/ thiazides
27
Q

What are off-label uses of colchicines?

A

Pericarditis

Scleroderma

NURS 424 (35 decks)

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