Drugs to Treat Gout Flashcards
1
Q
Gout
A
is caused by accumulation of uric acid crystals in joints (pH is slightly diff here, therefore happens here)
can cause a condition known as “gouty arthritis”, acute joint inflammation.
Because it is associated with ingesting red meat, cheese and wine (large intake of purines), it was once known as the “rich man’s disease”.
2
Q
Uric Acid Production:
A
Purine Nucleotides (dietary & usually cellular) –> Inosinic Acid –> Hypoxanthine –> Xanthine –> Uric Acid
**Xanthine oxidase is the enzyme that converts last 2 conversions
3
Q
What is the drug therapy of Gout?
A
- Colchicine
- Allopurinol
- Probenecid
- NSAIDs (Indomethacin)
4
Q
Colchicine:
A
- Weak anti- inflammatory agent
- NOT analgesic or antipyretic
- Impairs PMN motility & chemotaxis, & thus inflammatory response to urate crystals
- DOSE TO TOXICITY - nausea, vomiting, diarrhea, abdominal cramping, may cause death
- (come in with v. low dose & then increase until sick)
- NO EFFECT on plasma or urinary uric acid
- May be considered for low dose continuous prophylactic therapy
(inhibits immune cells ability to move)
5
Q
Allopurinol:
A
- Xanthine oxidase inhibitor (*inhibits uric acid production)
- Reduces urate formation
- Active metabolite (oxypurinol/alloxanthine)
- Risk of hypoxanthine stones (b/c buildup hypoxanthine)
- For prophylaxis when acute gouty attacks happen frequently
- Caution: fluid intake, acute attack of gout
- Adverse events: allergic rxns, bone marrow suppression, liver toxicity, renal toxicity
6
Q
NSAIDs (Indomethacin):
A
- Probs the drug of choice for gouty arthritis
- Less toxic than colchicine with short term use
- NOT uricosuric
- Affords symptomatic relief
- GI SE’s with indomethacin
(reduces inflammation)
(a local cream can help too)
7
Q
Probenecid:
A
- Uricosuric - inhibits reabsorption of uric acid
- Half-life dose-dependent
- Highly protein bound
- Inhibits excretion of other acidic drugs
*-Caution: renal urate stones (fluid intake)
