GOUT

Question 1

drugs that increase uric acid

Answer 1

aspirin, lower doses
calcineurin inhibitors (tacrolimus and cyclosporine)
Diuretics (Loops and thiazides)
Niacin
Pyrazinamide
select chemotherapy (w/ tumor lysis syndrome)
Select pancreatic enzyme products

Question 2

tx basics for gout

Answer 2

• tx acute pain with anti-inflammatory
  —> colchicine
  —> steroids (including intra-articular inj.)
  —> NSAIDs (often starting at high dose)
• tx chronically to prevent future attacks
  —> Xanthine oxidase inhibitors (XOI): allopurinol (preferred), or febuxostat
  ——-> acute gout flair while on XOI can be tx w/ colchicine and NSAIDs

if XOI didn’t work and UA >6mg/dL:
- add on probenecide or lesinurad to daily XOI
- Replace the XOI w/ IV pegloticase (Krystexxa)

Question 3

Colchicine

Answer 3

Colcrys

Question 4

colchicine warning, notes

Answer 4

warning: myelosuppression, neuromuscular toxicity
do not use w/ cyclosporine, diltiazem, verapamil, gemfibrozil or statin (these drugs increase myopathy risk)

start w/in 36 hrs of symptom onset
wait 12 of tx dose before resuming prophylaxis dose

Question 5

NSAIDs

Answer 5

Indomethacin (indocin)
Naproxen (Aleve)
Celecoxib (Celebrex)

Question 6

Steroids

Answer 6

Prednisone/Prednisolone
Methylprednisolone (Medrol, solu-medrol)

Question 7

Allopurinol

Answer 7

Zyloprim, Aloprime
- HLA-B*5801 testing prior to use- do not use if positive (hypersensitivity)
- hepatotoxicity, bone marrow suppression
Due to high rates of gout attacks when beginning, use w/ colchicine or NSAIDs

Question 8

Febuxostat

Answer 8

Uloric
- limited to those who can not tolerate allopurinol, increased CV risk!
- do not use w/ mercaptopurine or azathioprine
- hepatotoxicity

Due to high rates of gout attacks when beginning, use w/ colchicine or NSAIDs

Question 9

uricosurics:

Answer 9

inhibit reabsorption of UA in the kidney

Question 10

Lesinurad

Answer 10

zurampic
warning: acute renal failure, more common if used alone, only use w/ XOI

keep hydrated

Question 11

Probenecid

Answer 11

contra: Do not use w/ aspirin therapy, UA kidney stones
can increase beta-lactam levels

Question 12

Pegloticase

Answer 12

Krystexxa
warning: anaphylactic reaction- monitor and pre medicate w/ antihistamines and steroids
contra: G6PD deficiency

DO NOT use in combo w/ allopurinol, febuxotant, or probenecide

recombinant Uricase: converts uric acid to allantoin, which is excreted

Question 13

Rasburicase

Answer 13

Elitek
tx of TLS. contra in G6PD deficinecy