2- Gout and Migraines Flashcards Preview

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Flashcards in 2- Gout and Migraines Deck (40)
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1
Q

Are NSAIDs and Colchicine used in the acute or chronic tx of gout?

A

Acute

2
Q

Are Uricosuric Agents, Xanthine Oxidase Inhibitors and enzymes that convert uric acid to allantoin used in the tx of acute or chronic gout?

A

Chronic

3
Q

What is the use of NSAIDs in the tx of gout?

A

Inflammation due to acute attack of gouty arthritis

4
Q

What is the primary NSAID used in the tx of gout?

A

Indomethacin

(can also use naproxen and sulindac)

5
Q

What NSAIDs are contraindicated in the tx of gout because they decrease urate excretion?

A

ASA and Salicylates

6
Q

What drug binds tubulin to inhibit leukocyte migration and phagocytosis, has NO analgesic effect, no effect on urate excretion, and is used to treat acute attack of gouty arthritis (12-24 hrs)?

A

Colchicine

(oral admin, increased toxicity with IV)

7
Q

What are the SEs of colchicine?

A

Diarrhea, N/V, abd pain

8
Q

What drugs are uricosuric agents (block active reabsorption of uric acid) and used in the tx of gout?

A

Probenecid

Lesinurad (Zurampic)

9
Q

What is a SE of uricosuric agents?

(Probenecid, Lesinurad (Zurampic))

A

GI irritation

10
Q

When using uricosuric agents, what should be maintained in order to minimize the possibility of kidney stone formation?

A

A large urine volume

11
Q

What is the caution with uricosuric agents and what should be done to help prevent this?

A

May trigger gouty attack

Prophylactic colchicine

12
Q

What drug should be started 2-3 weeks AFTER acute gouty attack and is given orally?

A

Probenecid

13
Q

What are the SEs of Probenecid?

A

Decrease excretion of acidic compounds (ex. Penicillin, MTX)

14
Q

What drug is a URAT1 inhibitor and can be combined with a xanthine oxidase inhibitor in the tx of gout?

A

Lesinurad (Zurampic)

15
Q

What is the SE of Lesinurad (Zurampic)?

A

Renal failure

(more common when used as monotherapy or at higher doses)

16
Q

What drugs are xanthine oxidase inhibitors (inhibit synthesis of uric acid) and are effective in both primary and secondary forms of gout?

A

Allopurinol, Febuxostat

17
Q

What are the SEs of Allopurinol and Febuxostat?

A

Vasculitis, agranulocytosis, hypersensitivity

18
Q

What can be used to decrease the possibility of an acute gouty attack with initial Allopurinol or Febuxostat therapy?

A

Colchicine prophylaxis

19
Q

What drug interactions should you be aware of for Allopurinol and Febuxostat?

(increased effect, elimination, metabolism, activation)

A

Increases:

  • Effect of mercaptopurines
  • Elimination of cyclophosphamide
  • Metabolism of warfarin, probenecid
  • Activation of 5-FU
20
Q

Aluminum Hydroxide decreases the absorption of what drug used in the tx of gout?

A

Allopurinol

21
Q

What drugs are enzymes that convert uric acid to allantoin?

A

Rasburicase (Fasturtec)

Pegloticase (Krystexxa)

22
Q

What drug is a recombinant form of urate oxidase, given IV, and can be used in the tx of gout as well as to decrease risk of tumor lysis syndrome (TLS) in patients with hematological malignancies or solid tumors (especially after chemo initiation?

(urate oxidase is NOT endogenous in humans)

A

Rasburicase (Fasturtec)

23
Q

Aside from GI issues, what is a concerning SE a/w Rasburicase (Fasturtec)?

A

Anaphylactic shock

24
Q

What drug is a recombinant mammalian urate oxidase enzyme that is easily excreted in the urine and used in the tx of gout?

A

Pegloticase (Krystexxa)

25
Q

What drug class is first line for treating acute migraine sxs?

A

“Triptans”

All 5-HT1D agonists, cause vasoconstriction

(Sumatriptan, Rizatriptan, Naratriptan, Zolmitriptan, Eletriptan, Frovatriptan)

26
Q

If a “triptan” is used in the tx of an acute migraine, and a HA recurs within 24-48 hours, what should you do?

A

2nd dose required

27
Q

What are the SEs of the “triptans”?

(tx of acute migraine sxs)

A

Vasoconstrictive effects

CV (arrhythmias, angina, MI, cardiac arrest, stroke, PVD, hemorrhage)

GI (bowel ischemia, bloody diarrhea)

28
Q

What are the contraindications to use of a “triptan” for acute migraine sxs?

A

Due to vasoconstriction risk (CV, CAD, HTN)

Breastfeeding/ pregnancy, DM, tobacco smoking, renal impairment

29
Q

What drugs are used in the tx of acute migraine sxs?

A

Triptans, Ergotamine, Dihydroergotamine

30
Q

What drug is a 5-HT agonist (but less specific than “triptans”), results in STRONG vasoconstriction and is most effective if administered early?

A

Ergotamine (Ergomar)

31
Q

What increases the absorption (and therefore potentiates the effect) of Ergotamine?

A

Caffeine

32
Q

What are the SEs of Ergotamine?

A

Acute (GI effects, CV toxicity)

Chronic (ergotism, vasoconstriction + CNS)

33
Q

What drug is similar to Ergotamine but less vasoconstriction and has a SE of nausea?

A

Dihydroergotamine (Migranal)

34
Q

What analgesics are used to treat the pain a/w migraines?

A

Aspirin, acetaminophen, naproxen, propoxyphene

35
Q

What BB is used for chronic prevention (prophylaxis) of migraines?

A

Propranolol

36
Q

What CCB is used for chronic prevention (prophylaxis) of migraines?

A

Verapamil

37
Q

What antidepressants are used for chronic prevention (prophylaxis) of migraines?

A

Amitriptyline, Fluoxetine

38
Q

What anticonvulsants are used for chronic prevention (prophylaxis) of migraines?

A

Valproic Acid, Topiramate

39
Q

The following drugs are all used prophylactically for tx of what?

Clonidine, Botox, ARBs & ACE-Is

A

Migraines

40
Q

What drug is used for migraine prophylaxis and is an IgG2 monoclonal Ab that binds CGRP?

A

Erenumab (Aimovig)