Gout Flashcards
(24 cards)
What is the key to gout treatment?
NEVER start urate lowering therapy during an acute attack (can continue if already taking htem)
What is uric acid?
End product of purine metabolism, usually excreted via GI and renal mechanisms
What can cause under secretion of uric acid?
Loop or thiazide diuretic use (increase net urate reabsorption)
Caution, ACEi / ARB may also
What can bring on an acute attack?
- Alcohol
- Purine diet
- Kidney disease
How do you treat an acute attack?
Indomethacin
Colchicine
They decrease movement of granulocytes into joints
Aspirin for acute attacks?
No, competes with uric acid excretion in the proximal tubule
How do you treat chronic gout?
Urate lowering medications with NSAIDS or colchicine
What are the uricosuric drugs?
Probenecid and lesinurad
Who should not use uricosuric drugs?
Patients with impaired renal function
Drug interactions of probenecid?
Increases drug levels of : Penicillin, naproxen, ketoprofen, indomethacin, methotrexate
What drug has decreased effectiveness with probenecid?
Salicylates
Contraindication of probenecid?
Nephrolithiasis
Adverse reaction of probenecid?
Rash
Use of colchicine?
Initial flare and prevention of gout attacks
Therapeutic effect of colchicine?
Decreased migration of granulocytes & decreased inflammation
Side effects of Colchicine?
GI disturbances, agranulocytosis, aplastic anemia, alopecia
When do you adjust colchicine?
Renal function, contraindicated if CrCl
Risk with allopurinol?
Allergy rash, leukopenia, thrombocytopenia, stevens Johnson
50% dose reduction with what?
Azothiapine and febuxostat
Who should get febuxostat?
If you can not tolerate allopurinol
What is allopurinol used for?
Prevention of gouty attacks
When should you use corticosteroids?
Bottom line agent for patients who can not take NSAIDS or colchicine
What is another therapy option?
Pegloticase, an exogenous uricase
Febuxostate contraindicated with what drug?
Azathioprine
