Sketchy Pharm: Gout Drugs

Question 1

What two reactions does xanthine oxidase catalyze?

Answer 1

Hypoxanthine to xanthine and then xanthine to uric acid

Question 2

Why are NSAIDs used to treat gouty attacks?

Answer 2

Because the accumulation of uric acid crystals causes the release of prostaglandins

(Think of the altar boy spraying the other priest with the NSAID fire extinguisher.)

Question 3

Other than NSAIDs, what can be used to treat gouty attacks?

Answer 3

Corticosteroids

Think of the moon facies in the basin of water that the priest is falling into after tripping on the uric acid yarn.

Question 4

Colchicine inhibits cells’ ability to ______________.

Answer 4

phagocytose crystals, degranulate, and migrate to sites of inflammation

(Think of the neutrophil first responders who are unable to get past the colchicine choir to the uric acid crystals.)

Question 5

Colchicine has a mechanism analogous to what other drugs?

Answer 5

Vincristine and vinblastine (both prevent polymerization of microtubules)

Question 6

What side effect is most common with colchicine use?

Answer 6

Diarrhea, because the fast-dividing cells of the GI tract will be killed by colchicine

(Think of the diarrhea-evoking mud trailed in by the first responders near the colchicine choir.)

Question 7

Histologically, how can you differentiate between gout and pseudogout?

Answer 7

Pseudogout is calcium pyrophosphate crystals that are rhomboid and positively birefringent, while gout is uric acid crystals are needle-shaped and negatively birefringent.

(Think of the rhomboid-shaped incense –fragrance, get it? –holder next to the ten commandments plate with the injunction to not lie… just like how pseudogout lies about being gout.)

Question 8

How does allopurinol work?

Answer 8

It is a xanthine oxidase inhibitor that prevents the accumulation of uric acid.

(Think of the PURe nun who it removing the XO notes being passed around the pews.)

Question 9

What drug other than allopurinol works by inhibiting xanthine oxidase?

Answer 9

Febuxostat (“It puts a stop to XO, STAT!”)

Question 10

Tumor lysis syndrome presents with elevations of what serum values?

Answer 10

K
Phos
Urate

Question 11

Tumor lysis syndrome most commonly occurs from the treatment of which two cancers?

Answer 11

T-cell lymphoma and leukemia?

Think of the crusaders with Ts on their WHITE shirts –like WBCs.

Question 12

Why do those with Lesch-Nyhan injure themselves?

Answer 12

Uric acid accumulates in the skin and lips and causes pain. Patients will bite or scratch to relieve the pain.

Question 13

Be careful giving allopurinol to someone receiving _______________.

Answer 13

drugs that are purine analogues, such as 6-mercaptopurine and azathioprine

(Think of the PURe nuns wearing the purine-analogue rosaries.)

Question 14

What side effects can allopurinol cause?

Answer 14

SJS (think of the nun removing the boy’s red mask) and dress syndrome –characterized by eosinophilia, fever, and lymphadenopathy (think of the girl in the pink [eosinophilic] DRESS who is eo-slingshotting the nun)

Question 15

What drug works to treat chronic gout by inhibiting the reabsorption of urate from the proximal renal tubule?

Answer 15

Probenecid (like Cid the PROBation officer who takes cons to church and is preventing them from stealing the ball of yarn)

Question 16

Probenecid increases risk of _____________.

Answer 16

uric acid stone formation

Question 17

What is a potential DDI of probenecid?

Answer 17

It prevents the excretion of some drugs (notably penicillin), thus prolonging their half-lives.

(Think of the “drugs” tattoo on the convict’s arm and the large pencil on Cid’s lap.)

Question 18

Probenecid can trigger __________ allergies.

Answer 18

sulfur (think of the kid throwing rotten eggs)

Question 19

Low-dose aspirin can cause _____________, while high-dose aspirin can cause ______________.

Answer 19

inhibition of uric acid excretion; inhibition of uric acid reabsorption

(Think of the ASA coach –who represents high-dose aspirin –preventing the kid from reabsorbing the yarn and the coach’s kid – who represents low-dose aspirin –preventing the excretion of yarn.)

Question 20

Pegloticase can treat refractory gout by ______________.

Answer 20

converting uric acid into the water-soluble allantoin

Think of the holy water next to the yarn –”water to GO… just in CASE”

Question 21

What side effects does pegloticase have?

Answer 21

Triggering hemolytic anemia in those with G6PD deficiency and anaphylaxis