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Flashcards in Gout Deck (12):
1

Naprosyn


Naproxen

2

Clinoril

Sulindac

- Least renal toxic

3

When to avoid NSAIDs

- CrCl less than 50
- CFH
- PUD
- Hyperkalemia

4

Indocin

- Avoid
- Dose
- ADEs

Indomethacin

- Avoid: in elderly due to CNS SEs
- Dose: 50mg Q8H 3-4d then taper off over 1-2wks
- ADEs: GI and renal

5

Colcrys

- MOA
- Dose
Acute
PPX
IV
Do not combine with:
Dose adj

- ADEs
- Monitor
- Counseling

Colchicine

- MOA: inhibit cell division

Dose
- Acute: two (0.6) tabs. Then 1 tab 1H later (total 3 tabs). Max 1.8mg
- PPX: 0.6mg QD ( can range from QOD to 0.6 BID)
- IV: DO NOT GIVE. Can cause death
- Do not combine w/: clarithromycin, grapefruit or grapefruit juice.
- Renal dose adj

ADEs
- N/V/D/BMS, loss of hair
- Malabsorption syndrome: decrease Vit B12, K and sugar

Monitor:
- CBC, renal fxn test

Counseling pt:
- Muscle weakness or pain, numbness or tingling
- Unusual bleeding or bruising
- Severe diarrhea and vomiting
- Feeling weak or tired or increased infections
- Pale or gray color of the lips, tongue, or palms of hands

6

Steroid agents

SEs

Agents
- Methylprednisolone: 5-25mg per joint
- Triamcinolone 8-10 mg per joint
- Betamethasone 3-6mg
- Oral prednisone 30-50mg/d

SEs: PREDNISONE
- PUD = Peptic ulcer disease
- Rash
- Eye = glaucoma
- Diabetes
- Neurologic
- Immunosuppression
- Swelling (cushing)
- Osteoporosis
- Nausea
- Electrolyte changes

7

Benemid

- MOA
- Dose
- Not effective in
- Avoid
- SEs

Probenecid

- MOA: increase urinary excretion rate at the proximal convoluted tubule
- Dose: 250mg BID 1st wk, then 500mg BID. Max 2g/d
- Not effective in pt CrCl

8

Anturane

- MOA
- SEs

Sulfinpyrazone

- MOA: increase urinary excretion rate at the proximal convoluted tubule
- Helps the body get rid of uric acid through the urine
- SEs: watch for kidney stone

9

Aloprim
Zyloprim

- MOA
- Indication
- Dose
- SEs
- DDIs
- Monitor
- Genetic
- Notes**

Allopurinol

- MOA: Block xanthine oxidase
- Indication: use in pt w/ uric acid production, kidney stone, renal failure, >1000 mg uric acid
- Dose: start at 50-100mg/d and incur every 3-4 days. Max 800mg/day. Give w/ meal w/ plenty of fluid

SEs
- Rash, hepatotoxicity, renal imp
- BMS

DDI
- Azathioprine
- 6-MP
- Warfarin
- Thiazide and ACEI
- Vitamin C: urinary acidification = inc kidney stone

Monitor: CBC, uric acid level, I and O, renal/liver fun

- Genetic: HLA-B*5801
(Abacavir 5701; CBZ 1502)

**DO NOT stop xanthine oxidase inhibitors during an acute attack. If acute attack occurs, start daily low dose of colchicine or low dose NSAIDs and cont x 6mo

10

Uloric

- MOA
- Max dose
- SEs
- DDIs

Febuxostat

- MOA: non purine, selective Xanthin oxidase inhibitor (different structure than allopurinol)
- Max dose: 80mg/d
- SEs: LFT abnormalities
- DDIs: similar to allopurinol

11

Krystexxa

- MOA
- Indication
- Dose/Premedication
- C/I
- Warning
- SEs

Pegloticase injection

- MOA: PEGylated uric acid specific enzyme. break down uric acid
- Indication: tx of chronic gout in adult pt refractory to conventional therapy
- Dose: 8mg IV infusion over 120min Q2W
Pre-mediated w/ antihistamines/steroid
- C/I: G6PD
- Warning: anaphylaxis, infusion rxn, gout flares, CHF
- SEs: gout flares, infusion rxn, n/v/c, chest pain, anaphylaxis

12

Drugs that may worse gout

EtOH

Foods

Drugs
- Thiazide, levodopa, niacin, cyclosporine, ethambutol, pyrazinamide

EtOH
- Beer contains the highest purine content

Foods
- Red meat, liver, kidney, shellfish, and yeast