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Flashcards in Gout Deck (12)
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1
Q

Naprosyn

A

Naproxen

2
Q

Clinoril

A

Sulindac

  • Least renal toxic
3
Q

When to avoid NSAIDs

A
  • CrCl less than 50
  • CFH
  • PUD
  • Hyperkalemia
4
Q

Indocin

  • Avoid
  • Dose
  • ADEs
A

Indomethacin

  • Avoid: in elderly due to CNS SEs
  • Dose: 50mg Q8H 3-4d then taper off over 1-2wks
  • ADEs: GI and renal
5
Q

Colcrys

  • MOA
  • Dose
    Acute
    PPX
    IV
    Do not combine with:
    Dose adj
  • ADEs
  • Monitor
  • Counseling
A

Colchicine

  • MOA: inhibit cell division

Dose

  • Acute: two (0.6) tabs. Then 1 tab 1H later (total 3 tabs). Max 1.8mg
  • PPX: 0.6mg QD ( can range from QOD to 0.6 BID)
  • IV: DO NOT GIVE. Can cause death
  • Do not combine w/: clarithromycin, grapefruit or grapefruit juice.
  • Renal dose adj

ADEs

  • N/V/D/BMS, loss of hair
  • Malabsorption syndrome: decrease Vit B12, K and sugar

Monitor:
- CBC, renal fxn test

Counseling pt:

  • Muscle weakness or pain, numbness or tingling
  • Unusual bleeding or bruising
  • Severe diarrhea and vomiting
  • Feeling weak or tired or increased infections
  • Pale or gray color of the lips, tongue, or palms of hands
6
Q

Steroid agents

SEs

A

Agents

  • Methylprednisolone: 5-25mg per joint
  • Triamcinolone 8-10 mg per joint
  • Betamethasone 3-6mg
  • Oral prednisone 30-50mg/d

SEs: PREDNISONE

  • PUD = Peptic ulcer disease
  • Rash
  • Eye = glaucoma
  • Diabetes
  • Neurologic
  • Immunosuppression
  • Swelling (cushing)
  • Osteoporosis
  • Nausea
  • Electrolyte changes
7
Q

Benemid

  • MOA
  • Dose
  • Not effective in
  • Avoid
  • SEs
A

Probenecid

  • MOA: increase urinary excretion rate at the proximal convoluted tubule
  • Dose: 250mg BID 1st wk, then 500mg BID. Max 2g/d
  • Not effective in pt CrCl
8
Q

Anturane

  • MOA
  • SEs
A

Sulfinpyrazone

  • MOA: increase urinary excretion rate at the proximal convoluted tubule
  • Helps the body get rid of uric acid through the urine
  • SEs: watch for kidney stone
9
Q

Aloprim
Zyloprim

  • MOA
  • Indication
  • Dose
  • SEs
  • DDIs
  • Monitor
  • Genetic
  • Notes**
A

Allopurinol

  • MOA: Block xanthine oxidase
  • Indication: use in pt w/ uric acid production, kidney stone, renal failure, >1000 mg uric acid
  • Dose: start at 50-100mg/d and incur every 3-4 days. Max 800mg/day. Give w/ meal w/ plenty of fluid

SEs

  • Rash, hepatotoxicity, renal imp
  • BMS

DDI

  • Azathioprine
  • 6-MP
  • Warfarin
  • Thiazide and ACEI
  • Vitamin C: urinary acidification = inc kidney stone

Monitor: CBC, uric acid level, I and O, renal/liver fun

  • Genetic: HLA-B*5801
    (Abacavir 5701; CBZ 1502)

**DO NOT stop xanthine oxidase inhibitors during an acute attack. If acute attack occurs, start daily low dose of colchicine or low dose NSAIDs and cont x 6mo

10
Q

Uloric

  • MOA
  • Max dose
  • SEs
  • DDIs
A

Febuxostat

  • MOA: non purine, selective Xanthin oxidase inhibitor (different structure than allopurinol)
  • Max dose: 80mg/d
  • SEs: LFT abnormalities
  • DDIs: similar to allopurinol
11
Q

Krystexxa

  • MOA
  • Indication
  • Dose/Premedication
  • C/I
  • Warning
  • SEs
A

Pegloticase injection

  • MOA: PEGylated uric acid specific enzyme. break down uric acid
  • Indication: tx of chronic gout in adult pt refractory to conventional therapy
  • Dose: 8mg IV infusion over 120min Q2W
    Pre-mediated w/ antihistamines/steroid
  • C/I: G6PD
  • Warning: anaphylaxis, infusion rxn, gout flares, CHF
  • SEs: gout flares, infusion rxn, n/v/c, chest pain, anaphylaxis
12
Q

Drugs that may worse gout

EtOH

Foods

A

Drugs
- Thiazide, levodopa, niacin, cyclosporine, ethambutol, pyrazinamide

EtOH
- Beer contains the highest purine content

Foods
- Red meat, liver, kidney, shellfish, and yeast