Flashcards in Drugs for Gout, Hyperuricemia - Fitz Deck (20)
Foods that can increased uric acid
Proteins, alcohol, fructose
Drug goal for uric acid level
Under 6 mg/dL
Determinants of gout accumulation (4)
- Blood pH (low = more)
- Temperature (low = more)
- Hydration (night = joint dehyd.)
- Altered matrix, exposed cartilage, debris, etc.
3 ways to treat gout (w/ drugs)
- Colchicine, NSAIDs
Re-uptake (URAT1) inhibitor
- Probenecid, Sulfinpyrazone
- Allopurinol, Febuxostat
Advanced or resistant cases of gout...treatment?
Uricosolytics (urate oxidase)
- Pegloticase, Rasburicase
Metabolizes the crystals in the blood
Colchicine - MoA
Binds tubulin and depolymerizes microtubules -- disrupts granulocyte function, inhibits LTB4 formation
Acute, sporadic gout attacks...only good treatment?
NSAIDs (often more than the OTC dose)
Acute, sporadic gout attacks. NSAIDs are contraindicated. Treatment?
Does not decrease ___ or ___
Prevents chemotaxis and degranulation of PMNs
Uric acid levels, inflammation
GI toxicity (diarrhea, abd pain)
Gout, problems w/ blood sugar, DM, HTN, risks for osteoporosis...what to avoid?
If not contraindicated, when are they used?
2+ joint involved and colchicine is contraindicated or ineffective
1st line urate lowering therapy
Can add what if needed?
Severe disease or failure?
Uricosolytic (urate oxidase)
Patient started on urate lowering therapy, presents soon after w/ gout attacks. What's up?
***How to prevent?
Paradox - can cause increased solubilization when starting therapy
Give Colchicine or an NSAID when starting on urate lowering therapy
**Drugs to avoid if giving Allopurinol or Febuxostat? (3)
- 6-Mercaptopurine - marrow suppression
- Azathioprine - marrow suppression
- Theophylline - CNS agitation
These are based off of Xanthine structure, so will cause excess accumulation and toxicity
Patient has HLA-B*5801...so?
Potential for SEVERE hypersensitivity to allopurinol...must get genetic testing
Han Chinese, Thai descent
With probenacid vs. w/o probenacid, how much uric acid is excreted in urine?
Without = 10%
With = 20%
Probenacid - side effect
Nephrolithiasis or uric acid nephropathy
Patient is taking Probenacid. What other drugs could cause issues? (2) Why (for each)?
Aspirin (low level) -- competes for organic acid transporters at basolateral side, preventing excretion of uric acid
Diuretics (loop, thiazide) -- dehydration can lead to crystallization
Patient w/ gout due to tumor lysis syndrome. Treatment?
Pegloticase/Raasburicase...will see increased levels of what?
Allantoin (breakdown product)