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Flashcards in Gout Deck (36)
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1
Q

What is the enzyme related to the rate-limiting step of uric acid formation?

A

Xanthine oxidase

2
Q

What are the main reasons for primary gouty attacks?

A

Defect in uric acid excretion, Or uric acid overproduction

3
Q

where is uric acid made?

A

produced as an end product of purine metabolism (DNA)

4
Q

How is uric acid excreted?

A

2/3Renally and 1/3 GI

5
Q

What drugs may cause hyperuricemia

A

ASA, Diuretics (EXCEPT spironolactone), Pyrazinamide, Niacin

6
Q

what are risk factors for getting gout?

A

male
overweight
drinks too much beer or etoh
high blood pressure
problems with kidney
older or meds that increase uric acid

7
Q

when do you start treatment with meds for gout?

A

only if the patient has an elevated uric acid level AND HAS A GOUT ATTACK

8
Q

Colcrys

A

colchicine

9
Q

What are the three treatments available for acute gouty attacks?

A

Colchicine, NSAIDS (indomethacin), Corticosteroids

10
Q

typical colchicine regimen for gout attack?

A

two 0.6 tabs then one hour later another tablet

11
Q

Indocin

A

indomethacin

12
Q

When should a pt stop taking Colchicine

A

Abdominal cramping or diarrhea

13
Q

Colchicine dosing limit

A

Three tablets within the first hour

14
Q

Colchicine ADEs

A

Common: n/v/abdomian pain, Diarrhea (GI), Rare w/ high doses: Bone marrow suppression and neuromyopathy

15
Q

When should you avoid NSAIDS with patients w/ gout?

A

if the patient has severe renal insufficiency

16
Q

what is the DOC NSAID for Gout? What is the dose?

A

indomethacin 50mg TID until pain is tolerable and then taper down to avoid rebound

17
Q

Is the IV form of colchicine available?

A

No - taken off the market for bad reactions

18
Q

what four NSAIDS are tyicall used for gout?

A

indomethacin, naproxen , sulindac or celecoxib

19
Q

Who should not take colchicine?

A

Pts with PUD

20
Q

What is the max dose of colchicine?

A

1.8 mg

21
Q

When is colchicine most effective?

A

12-36 hours after the attack

22
Q

Indomethacin (Indocin) gout information. When is it effective?

A

Most studied NSAID. Effective at any point of a gouty attack.

23
Q

with colchicine, when can you take a second course of therapy for a gout attach again?

A

3 days after the initial first course of therapy

24
Q

Corticosteroid treatment for acute gout

A

Prednisone intra-articularly, IV, IM or orally, or via ACTH. Use limited to colchicine and NSAID failures.

25
Q

Zyloprim

A

Allopurinol

26
Q

When is gout prophylaxis given?

A

After an actual gouty arthritis attack

27
Q

Pegloticase (Krystexxa) MoA / place in therapy

A

IV tx for chronic gout in pts refractory to conventional therapy.

28
Q

Probenecid (Benemid) MoA

A

Uricosuric agent that promotes the excretion of uric acid by blocking it reuptake at the proximal convoluted tubule

29
Q

What should pts do when on probenecid or sulfinpyrazone?

A

Drink at least 2 liters of water per day to decrease the risk of uric acid stone formation. Take w/food if GI intolerance occurs

30
Q

Probenecid drug interactions

A

Interacts with renally excreted weak acids, Penicillins, Cephalosporins, Nitrofurantoin (Reduction in efficacy), Rifampin
Do not use Benemid and ASA together!
Increases effects of furosemide and HCTZ
Sulfonylureas –> hypoglycemia

31
Q

When should Benemid or Anturane not be started?

A

At the beginning of an acute attack! Can make it worse!

32
Q

Allopurinol (Zyloprim) MoA

A

Allopurinol and its metabolite (oxypurinol) inhibit xanthine oxidase formation –> allows uric acid water soluble precusors to be cleared

33
Q

Zyloprim ADE

A

Rash - may occur at any time in therapy (maculopapular to SJS), percipitation of acute attacks, AHS

34
Q

how should patients take allopurinol?

A

patient take it once daily awith a meal to reduce sotmch upcet. Cant take several weeks for it to work. Report rash :)

35
Q

Average dose of allopurinol

A

50 - 200mg QD, Dose adjust for renal insufficiency

36
Q

What is the name of the other xanthine oxidase inhibitor?

A

Febuxostat (Uloric)