Chapter 78 Drug Therapy for Gout Flashcards
(14 cards)
What is GOUT? Who is it seen in more?
It is uric acids deposited within the joints thus eliciting an inflammatory response seen in men within their large toe
This can be r/t excessive production of uric acid or poor clearance d/t renal impairment
Naturally,
Uric acid is a waste product produced by the body during the breakdown of purines, substances found in foods like meat, seafood, and alcohol.
Function:
Uric acid helps protect the body from oxidative stress.
It may also play a role in regulating blood pressure and metabolism.
When would you initiate short term tx of GOUT vs long term therapy?
<3 times per year = short term (pain mgmt)
>3 times per year = long term (urate lowering therapy)
What is first line tx for GOUT?
NSAIDs (i.e., Indomethican) by suppressing inflammation of an acute gouty attack
What med is highly effective for reducing pain associated with gouty attacks and is seen as 2nd line?
Glucocorticoids (i.e., Prednisone) d/t ineffectiveness/contraindicate use of NSAIDs
What medication acts as an anti-inflammatory SPECIFICALLY for GOUT?
Specific A/e?
Colchicine - ONLY treats GOUT pain, NO OTHER pain
A/e - GI adverse effects, myelosuppression, myopathies (mm. weakness)
What GOUT medication interacts with lipid lowering medications such as meds that end in -statins
Colchicine mm. injury
What happens if GI symptoms occur with Colchicine?
D/c immediately regardless of the status of the joint pain!
What is the goal of GOUT therapy for patients who have FREQUENT gout flair ups 3+ annually?
Urate lowering therapy STRICTLY! Can also use NSAIDs for pain mgmt, but GOUT meds ONLY help LOWER urate levels, not reduce pain
Allopurinol is considered to do what? Drug interactions?
Inhibit serum uric acid formation
Warfarin - Allopurinol can delay inactivation of warfarin therefore it needs to be DECREASED - excessive bleeding can occur
Febuoxstat is considered what to allopurinol? What is the BIG BLACK BOX WARNING?
It is second line to allopurinol.
NSAIDs must be given secondary to any uric acid lowering medication.
BBW = CV DEATH
When would you use Febuxostat vs allopurinol?
Only use when the pt had inadequate response to max allopurinol use
Probenecid (a GOUT uric acid lowering medication) should be used when?
delayed until the acute attack has passed as it can exacerbate the acute episodes of GOUT.
Pegloticase is what? Expense? Contraindications? Screening for?
LAST RESORT TX via IV tx for chronic gout pts who have not respond to oral tx
VERY EXPENSIVE
Contraindicated for pts who have G6PD d/t risk of hemolysis and methemoglobinemia
AA should be screened
What should you pretreat with for Pegloticase IV admin?
With antihistamine and glucocorticoid to decrease risk of SERIOUS adverse drug reactions such as anaphylaxis, reactions, and flares
