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Pharmacology > Overview of drug treatments of gout > Flashcards

Overview of drug treatments of gout Flashcards

1
Q

Is gout treatment different for acute and chronic gout attacks?

A

Yes

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2
Q

What molecules build up and cause gout, and how does this affect joints

A

Build up of monosodium urate crystals, which exert pressure around joints

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3
Q

What is gouty tophi/tophaceous gout?

A

Masses of monosodium urate crystals form in soft tissue and around joints

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4
Q

Give 3 reasons for monosodium urate build up in gout?

A

Urid acid overproduction

Kidney doesn’t filter out excess uric acid

Influence of drugs eg. thiazide diuretics

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5
Q

Why does uric acid build up in the body, and what enzyme is involved in this?

A

Xanthine oxidase catalyses breakdown of purines into uric acid

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6
Q

What is the target of treatment for an acute flare up of gout?

A

Relieve pain and swelling

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7
Q

What 3 treatments can be used to treat acute gout attacks?

A

NSAIDs, colchicine, corticosteroids

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8
Q

How efficacious are NSAIDs for acute gout attacks?

A

Moderate to good efficacy

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9
Q

Are NSAIDs suitable for both short and long term use for acute gout attacks?

A

Suitable for short-term use and in low dose

Not suitable for long-term use and in high dose

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10
Q

What are 4 side effects of long-term use/high dosage of NSAIDs in acute gout attacks?

A

Side effects of peptic ulcers, GI bleeds, renal failure, heart failure

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11
Q

Which patients are suitable to take NSAIDs for acute gout attacks?

A

Don’t have past/current/susceptibility to GI, heart diseases such as hypertension or congestive heart failure, asthma as NSAIDs can cause bronchospasms, CKD

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12
Q

Give 2 reasons why NSAIDs are convenient to take for acute gout attacks?

A

They can be taken orally and are inexpensive

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13
Q

Are NSAIDs started at high or low dosage for acute gout attacks?

A

NSAID often started at high dose

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14
Q

What is the usual duration of NSAID treatment for acute gout attacks?

A

Taken for few weeks until flare up settles

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15
Q

What is the dosage of ibuprofen (NSAID) for acute gout attacks?

A

400-800 mg ibuprofen tds (three times daily)

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16
Q

What is the dosage of naproxen (NSAID) for acute gout attacks?

A

First dose is 750 mg naproxen, then 250 mg tds for 7 days

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17
Q

What is colchicine and where is it derived from?

A

General anti-inflammatory drug derived from a plant alkaloid, used to treat acute gout attacks

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18
Q

What is the mechanism of action of colchicine in acute gout attacks?

A

Affects microtubule depolarisation, which changes the expression of genes associated to granulocyte migration, growth, adhesion, inhibiting acute inflammation

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19
Q

What is the efficacy of colchicine in acute gout attacks, and what drug is it similar to?

A

Very good efficacy, is similar to naproxen

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20
Q

What are the short-term and long-term side effects of colchicine use for acute gout attacks?

A

Short-term effects include common diarrhoea and nausea

Long-term effects include renal failure, bone marrow suppression

21
Q

Which patients are suitable to take colchicine for acute gout attacks?

A

Patients who can’t take NSAIDs, as colchicine is similar to naproxen

22
Q

What are the 2 differences between colchicine and naproxen in terms of side effects, when used for treating acute gout attacks?

A

Diarrhoea twice as common from colchicine use than naproxen use

Less risk of heart failure from colchicine use than naproxen use

23
Q

What is the dosage of colchicine for acute gout attacks?

A

0.5 mg daily for few weeks

24
Q

Why is the duration of colchicine treatment for acute gout attacks a few weeks?

A

Prevents recurrent flares

25
Q

Over the duration of one course of colchicine for acute gout attacks, what is the maximum total administered amount?

A

6 mg

26
Q

How and where are corticosteroids administered in acute gout attacks?

A

Locally injected into single large painful joint

27
Q

In severe acute gout flare ups, what corticosteroid is administered?

A

Oral prednisolone

28
Q

What is the efficacy of corticosteroids for acute gout attacks?

A

Good efficacy

29
Q

Are corticosteroids safe for short and long term use, when treating acute gout attacks?

A

Safe for short-term use,
but long-term use has side effects of weight gain, fluid retention, high blood pressure, diabetes and osteoporosis

30
Q

Which patients are suitable to take corticosteroids for acute gout attacks?

A

Patients who have other comorbidities

Patients who can’t take NSAIDs or colchicine

31
Q

What is canakinumab, and what is its mechanism of action in treating acute gout attacks?

A

Human monoclonal antibody that selectively inhibits IL-1 receptor

32
Q

How is canakinumab administered for acute gout attack treatment, and how long is the duration of one dose?

A

Subcutaneous injection that lasts up to 12 weeks

33
Q

Which patients are suitable for canakinumab use to treat acute gout attacks?

A

Patients with frequent, severe acute gout attacks that isn’t treated by other drugs

34
Q

When is treatment started to prevent gout attacks from recurring?

A

Treatment started 1-2 weeks after acute flare up settles, so that flare up won’t be triggered again

35
Q

Give 3 reasons why patients can have regular treatment to lower uric acid levels?

A

They had more that 2 gout attacks in a year

They have renal damage

Other complications

36
Q

Give 3 examples of lifestyle advice used to prevent recurrent gout attacks?

A

Low-purine diet

Avoid dehydration

Avoid certain drugs

37
Q

What is the first-line drug for preventing recurrent gout attacks?

A

Allopurinol

38
Q

What is the mechanism of action of allopurinol in prevention of recurrent gout attacks?

A

Inhibits xanthine oxidase, so purines can’t be broken down to form uric acid in the purine metabolic pathway

39
Q

How efficacious is allopurinol for treatment of preventing recurrent gout attacks?

A

Very good efficacy

40
Q

Is allopurinol safe for short and long term use?

A

Yes, can even be used as a life-long treatment

41
Q

Why is allopurinol safe for very long-term use?

A

Rarely causes serious allergies

42
Q

What is the dosage of allopurinol in prevention of recurrent gout attacks?

A

100-600 mg , usually start dose is 100mg then up titrated

43
Q

Does use of allopurinol need to be monitored?

A

Yes, needs to be monitored few weeks after administering each dose to check uric acid serum levels and renal function

44
Q

What 2 drugs does allopurinol have drug interactions with?

A

Purine analogs

Theophylline

45
Q

What is febuxostat?

A

Non-purine xanthine oxidase inhibitor, second-line drug to allopurinol for prevention of recurrent gout attacks

46
Q

What is the second-line drug for prevention of recurrent gout attacks?

A

Febuxostat

47
Q

Give 1 reason why febuxostat is inconvenient, in terms of its price?

A

It is very expensive, as it is the newest drug on the market

48
Q

Which patients are suitable for febuxostat?

A

Patients who couldn’t take allopurinol due to medical conditions

Patients who has such serious side effects to allopurinol that they couldn’t take recommended dose

used cautiously in patients with past/current/susceptibility to heart conditions

49
Q

What is the side effect of febuxostat?

A

Increased risk of cardiovascular problems

Pharmacology (11 decks)

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