Drugs for Gout, Hyperuricemia - Fitz Flashcards Preview

MSK 2 > Drugs for Gout, Hyperuricemia - Fitz > Flashcards

Flashcards in Drugs for Gout, Hyperuricemia - Fitz Deck (20)
1

Foods that can increased uric acid

Proteins, alcohol, fructose

2

Drug goal for uric acid level

Under 6 mg/dL

3

Determinants of gout accumulation (4)

- Blood pH (low = more)
- Temperature (low = more)
- Hydration (night = joint dehyd.)
- Altered matrix, exposed cartilage, debris, etc.

4

3 ways to treat gout (w/ drugs)

Anti-inflammatories
- Colchicine, NSAIDs

Re-uptake (URAT1) inhibitor
- Probenecid, Sulfinpyrazone

Synthesis inhibitor
- Allopurinol, Febuxostat

5

Advanced or resistant cases of gout...treatment?

MoA?

Uricosolytics (urate oxidase)
- Pegloticase, Rasburicase

Metabolizes the crystals in the blood

6

Colchicine - MoA

Binds tubulin and depolymerizes microtubules -- disrupts granulocyte function, inhibits LTB4 formation

7

Acute, sporadic gout attacks...only good treatment?

NSAIDs (often more than the OTC dose)

8

Acute, sporadic gout attacks. NSAIDs are contraindicated. Treatment?

MoA?

Does not decrease ___ or ___

Side effect?

Colchicine

Prevents chemotaxis and degranulation of PMNs

Uric acid levels, inflammation

GI toxicity (diarrhea, abd pain)

9

Gout, problems w/ blood sugar, DM, HTN, risks for osteoporosis...what to avoid?

If not contraindicated, when are they used?

Steroids

2+ joint involved and colchicine is contraindicated or ineffective

10

1st line urate lowering therapy

Can add what if needed?

Severe disease or failure?

XO inhibitor

Uricosuric (Probenecid)

Uricosolytic (urate oxidase)

11

Allopurinol...what accumulates?

Hypoxanthine

12

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

13

**Drugs to avoid if giving Allopurinol or Febuxostat? (3)

Toxicities?

Why?

- 6-Mercaptopurine - marrow suppression
- Azathioprine - marrow suppression
- Theophylline - CNS agitation

These are based off of Xanthine structure, so will cause excess accumulation and toxicity

14

Patient has HLA-B*5801...so?

Populations?

Potential for SEVERE hypersensitivity to allopurinol...must get genetic testing

Han Chinese, Thai descent

15

With probenacid vs. w/o probenacid, how much uric acid is excreted in urine?

Without = 10%

With = 20%

16

Probenacid - side effect

Nephrolithiasis or uric acid nephropathy

17

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

18

Patient w/ gout due to tumor lysis syndrome. Treatment?

Pegloticase (IV)

19

Pegloticase/Raasburicase...will see increased levels of what?

Allantoin (breakdown product)

20

Why does high-dose Aspirin not cause increased uric acid?

Blocks ALL organic acid transporters, thus can't be reabsorbed into the blood following the 100% glomerular filtration