Gout Flashcards
(19 cards)
What is Gout?
Metabolic disease characterized by high levels of uric acid in the blood (Hyperuricemia)
What are treatment strategies for Gout?
- Patient education (diet, lifestyle, comorbidities – AVOID EtOH and LIMIT purine-rich meats/seafood)
- Interfere with uric acid synthesis (Allopurinol – 1st LINE ULT)
- INC uric acid excretion (Probenecid/sulfinpyrazone)
- Inhibit Leukocyte entry (Colchicine)
- NSAIDs
What medications are classified as Xanthine oxidase inhibitors (XOI)? (2)
- Allopurinol
- Febuxostat
How does Allopurinol function?
- Reduces uric acid synthesis (inhibits enzyme, xanthine oxidase, that converts purines into uric acid)
- Indicated when observed hyperuricemia or recurrent renal stones
WHat are ADRs associated with Allopurinol?
- Headache
- Somnolence
- N/V/D
- Dyspepsia
- Abdominal cramping
- Jaundice, liver problems
- Hypersensitivity (esp. Asians, genetic testing should be conducted prior to administration)
- Gout flare
How does Febuxostat function?
Selectively inhibits Xanthine Oxidase
What are ADRs associated with Febuxostat?
- Liver function abnormalities
- Gout flares
- Hypersensitivity
- RARE: MI, Stroke, severe skin reactions
What medications are classified as Uricosuric agents? (2)
- Probenecid
- Sulfinpyrazone
How does Probenecid function?
Inhibits resorption of urate in proximal convoluted tubule (INC uric acid excretion)
What are therapeutic uses for Probenecid?
1st CHOICE alternative to XOI therapy (DO NOT START TX until Acute flare subsides)
What are ADRs of Probenecid?
- HA
- dizziness
- anemia
- flushing
- sore gums
- GI: N/V anorexia
- Uric acid stones
- exacerbation of gout
What are drug interactions with Probenecid?
Salicylates: INC Probenecid levels
What are some prophylactic therapies for Gout? (5)
- 1st LINE GOUT Prophylaxis
- Colchicine
- LOW-DOSE NSAID
- 1:1 (XOI/Uricosuric)
- Refractory GOUT
- Pegloticase
How does Pegloticase function?
Converts uric acid to allantoin (water-soluble inactive metabolite)
WHat are ADRs associated with Pegloticase?
- Ab formation
- Gout flare
- Infusion reactions
- Nausea
What NSAIDs are approved for 1st LINE treatment of Acute Gout?
- Indomethacin
- Naproxen
- Sulindac
- Celecoxib
(ASA and other Salicylates CONTRAINDICATED)
What Corticosteroids are approved for 1st LINE treatment of Acute Gout?
- Prednisone (Oral)
- Methylprednisone (Oral)
- Triamcinolone (IM)
How does Colchicine function?
- (1st LINE treatment to Acute Gout) Prevents migration of leukocytes and phagocytosis via binding tubulin
- Not uricosuric, Not analgesic
- Pain and inflammation reduced within 12 hours
What are ADRs associated with Colchicine?
- N/V/D
-
CHRONIC USE:
- myopathy
- bone marrow depression
- alopecia
