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18 Musculoskeletal System > Drugs for Gout > Flashcards

Flashcards in Drugs for Gout Deck (22)
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1

Why take NSAID or Colchicine while taking Allopurinol?

-allopurinol has the paradoxical effect of inducing an acute gout attack.

1

why is probenecid contraindicated in pts with kidney disease or are overproducers of uric acid?

they are more likely with probenecid to produce uric acid stones in their kidney

1

this gout drug has interactions with 6-MP and azathioprine. why?

Allopurinol.

-as a xanthase oxidase inhibitor, it inhibits purine metabolism. 6-MP (azathioprine is its produg) is a purine analog, so allopurinol increases risk of 6-MP toxicity.

3

Colchicine:

-side effects

-GI symptoms! nausea, vomiting, diarrhea, pain.

-occurs because rapidly growing GI cells are affected

3

Allopurinol

-theurapeutic use

-prevent primary hyperurecemia of chronic gout

4

probenecid,

therapeutic use

-chronic gout

-however, not in pts with kidney disease or overproducers of uric acid because they are more likely to produce uric acid stones in the kidney

6

When would you use steroid over NSAID in gout patient?

When NSAIDS are contraindicated in the patient (eg stomach ulcers)

6

Pegloticase

-mech

-uricase

-converts uric acid to allantoin, which is excreted.

7

pegloticase

-therapeutic use

-refractory chronic gout

-limited use

8

Colchicine:

-why do certain drugs interact with it?

1. active form is metabolized by CYP3A4

2. it is a substrate for P-glycoprotein pump

-drugs that interact with either will increase colchicine to toxic levels.

9

If your patient presents with gout, what 2 common drugs he might already be using do you tell him to stop taking?

and why?

1. aspirin (low doses decrease renal urate excretion)

2. HCTZ (thiazaide diuretics decrease renal urate excretion)

10

Colchicine:

-therapeutic uses (2)

-decreases inflammation

1. acute gout attacks (use within hours)

2. chronic gout prophylaxis

11

pegloticase

-adverse effects (3)

-infusion site reactions

-gout flare

-immune response: body may make Ab against PEG porion of drug

12

This gout drug is metabolized by P450 and p-glycoprotein

colchicine.

So, drugs that block CYP3A4 or P-gp transport can increase colchicine to toxic levels

13

Why is colchicine not the drug of choice in tx of gout?

Strong adverse GI effects

15

Why is aspirin contraindicated in gout?

At low doses, aspirin inhibits uric acid secretion

17

Colchicine

-mech

-antimitotic--arrests cell in G1 by interfering with microtubule formation

-in gout, colchicine binds to microtubules in neutrophils, inhibiting their activation/migration and inflammatory response

18

probenecid 

-mech

-increases renal urate excretion

-OAT blocker

-competes with OAT (which normally reabsorbs urate)

19

probenecid

-side effects

-contraindications

-GI effects

-ineffective in pts with renal sufficiency

-contraindicated in pt with uric acid kidney stones

20

Allopurinol

-adverse effects

1. hypersensitivity

2. acute gout attack (paradoxical!)--allopurinol mobilizes tissue stores of uric acid. So, give drug with NSAID or colchicine

21

Allopurinol

-mech

-inhibits terminal steps in uric acid synthesis

-blocks xanthine oxidase

22

Febuxostat

-mech

-xanthine oxidase inhibitor, just like allopurinol

-more potent than allopurinol