Drugs Used to Treat Gout Flashcards Preview

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Flashcards in Drugs Used to Treat Gout Deck (50):
1

what is gout the result of

increased uric acid in blood
hyperuricemia

2

when does uric acid deposit in or around joints

exceeds it solubility at pH 7.4

3

which gender has more cases of gout

male

4

when is gout seen more often in women

post-menopausal

5

what happens to uric acid when pH is lowered

Uric acid deposition lowered
- uric acid is converted to unionized form, poorly soluble in water

6

what are 2 ways drugs can induce hyperuricemia

- killing large numbers of cells
- decreasing renal recreation of urate by proximal tubular cells

7

what is the cycle of gout?

- crystals deposit in joint
- granulocytes phagocyte crystals
- granulocytes release kinins and lysosomal into blood stream
- increase lactic acid
- decrease pH
- increase urate deposition

8

who primarily excretes urate

kidneys

9

where is urate filtered

glomerulus

10

where is urate actively reabsorbed

early proximal tubule
late proximal tubule
distal tubule

11

what happens in the mid-section of the proximal tubule? what can inhibit this process

active secretion
- inhibition of secretion by weak acids occurs here
- urate retention

12

what are 3 non-drug therapy of gout

avoid obesity
avoid dehydration
avoid alcohol

13

what is the mechanism of Colchicine (6)

- decrease leukocyte mobilization
- decrease lactic acid production
- decrease leukocyte enzymes for leukocytes
- decrease release of histamine from mast cells
- decrease release of inflammatory glycoprotein from neutrophils following phagocytosis of urate crystals
-inhibit leukotriene synthesis

14

what are three general properties of Colchicine

antimitotic
anti-inflammatory

15

how does Colchicine decrease leukocyte mobilzition

binds and interferes with microtubule function to inhibit mobilization of leukocytes

16

how does Colchicine inhibit leukotriene synthesis

inhibits lipoxygenase pathway

17

what is the toxicity of Colchicine? with chronic use

GI ( nausea, vomiting, diarrhea)
chronic use - increase risk of aplastic anemia

18

therapeutic uses of Colchicine

treat acute gout
prevent acute attacks of gout

19

Name two Xanthine Oxidase inhibitors

Allopurinol (Zyloprim)
Febuxostat ( Uloric)

20

MOA of Allopurinol (Zyloprim)

- antimetabolite of hypoxanthine

21

what is the role of Hypoxanthine

inhibits enzyme xanthine oxidase to uric acid formation

22

how does Allupurinol work at low concentrations? high?

low: competitive inhibitor
high: non-competitive inhibitor

23

an active metabolite of Allpurinol ( alloxanthine) works how

at all concentrations is non-competitive inhibitor

24

what type of patients should get Allopurinol? why

-impaired renal function or history of renal urate stones
- does not increase renal urate levels
- xanthine oxidase inhibition products are water soluble

25

Allopurinol is combined with what other drugs

antineoplastic agents to prevent hyperuricemia

26

what is the toxicity of Allopurinol

uncommon,
rash, fever, vasculitis, hepatotoxicity

27

therapeurtic uses of Allopurinol

chronic gout
secondary hyperuricemia

28

what happens when someone starts using Allopurinol? how can this be fixed

acute attack of gout may precipitate due to fluctuations in serum urate levels and resulting dissolving of deposited
urate crystals
- Cholchicine or non-steroidal inflammatory: prevent symptoms of acute gout attack

29

MOA of Febuxostat

inhibition of Xanthine oxidase

30

Pharmacokinetics of Febuxostat

absorption reduced by Mg OH and Al OH antacids
-food slightly reduces absorption

31

what is Febuxostat used for

hyperuric patients w/ gout attacks
- not for asymptomatic hyperuricemia

32

what is the toxicity of Febuxostat

liver function abnormalities
nausea
joint pain
rash

33

what happens when a patient starts Febuxostat

cause acute attack of gout due to decreased serum levels of urate which mobilize urate from deposited crystals

34

what other drugs can you take Febuxostat with

NSAIDs or Cholchicine therapy

35

what is the MOA for Rasburicase ( Elitek) ? compared to other drugs

recombinant urate oxidase enzyme
- catalyzes oxidation of uric acid into soluble allantoin
- lowers uric plasma levels better than Allopurinol

36

define: allantoin

a crystalline compound formed in the nitrogen metabolism of many mammals

37

Who usually gets perscribed Rasburicase

pediatric patients with leukemia, lymphoma, and solid tumors who are receiving cancer chemotherapies treatments that will result in cell lysis and hyperuricemia

38

what is the toxicity of Rasburicase

hemolysis of GGPD deficient patients
- methemoglobinemia
- acute renal failure

39

Uricosuric agents name 2

Probenecid
Sulfinpyraozone

40

what is the MOA for Uricosuric agents

competitively inhibit active reabsorption of urate by URAT-1 in proximal tubule of nerphon to increase urate excretion

41

low doses of Uricosuric agents do what

only inhibit active secretion of urate to cause UA retention

42

what is the toxicity of Uricouric agents

GI irritation with aggrevation of peptic ulcer
(sulfinpyrazone > Porbenecid)

43

For Uricouric agents, what should the patient do to prevent intrarenal urate stone formation

increase fluid intake

44

what are theraputic uses of Uricouric agents

chronic gout
hyperuricemic states
- decreaes platelet aggregation : prophylactic treatment of mycardial infarction

45

where is Sulfinpyrazone not available

U.S.

46

Benzbromarone is a Uricouric agents and what does it do? who uses it? where is it availbale

- increases urate excretion without urate retention
- decreased renal function or allergic to probenecid or sulfinpyrazone
- used in Europe

47

what NSAIDS are FDA approved for gout

indomethacin
nproxen
sulindac

48

which NSAID should not be used for gout and why

aspirin
normal doses: decreases urate secretion
high doses: increase risk of renal calculi

49

what drugs are perfered for elderly patients with cardiac, renal or GI dseaes

NSAIDS or glucocorticoids over Colchicine

50

what os Glucocorticoids used for

acute gout with other threapies fail