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12 Cards in this Set
- Front
- Back
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What is the normal level for uric acid?
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3-8 mg/dL
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What drugs (4) can cause gout?
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Loop and Thiazide diuretics (HCTZ)
ASA (low dose) Niacin Cytotoxic drugs |
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Long term goals of gout treatment?
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Uric acid < 6 mg/dL
Convert uric acid to allantoin. This is done by pegloticase. Rasburicase is an enzyme that converts uric acide to allantoin and is found in many mammals, just not humans. |
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What is an example of a uricosuric and where does it work?
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Probenecid
blocks uric acid resorption in proximal convoluted tube |
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Non-pharmacologic ways to prevent gout are (3)?
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reduced high purine diet (meat, seafood, beans, peas, asparagus)
lose weight eliminate alcohol consumption |
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Colcrys (Colchicine):
indication dose MOA renal impairment most common side effects Leathal dose, antidote |
0.6 mg scored tablet
indication: acute and prophylaxis treatment of gout in pts >16 yrs familial metiterranean fever > 4 yrs dose: acute - 1.2 mg at first sign, then 0.6mg one hour later proph - 0.6 mg q day up to 1.2 mg MOA: impairs leukocyte migration to inflamed areas. This disrupts urate deposition and the subsequent inflammatory response renal impairment: no change in dose side effects: diarrhea, abdominal pain, N/V LD, antidote: 60mg, no antidote, dialysis wont work |
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Zyloprim (allopurinol):
dose MOA renal impairment if given with mercaptopurine (6MP) - Purinethol if given with azathioprine - imuran |
dose: 100 mg q d x 1 wk; then BID x 1 wk; then 300mg qd.
max is 800 mg/d (MUST USE DIVIDED DOSES > 300 mg/d) MOA: xanthine oxidase inhibitor renal impairment: reduce dose w/ 6MP and azathiprine - decrease 6MP dose by 25-33% *azathioprine is metabolized to 6MP *allopurinol decreases metabolism of 6MP and azathioprine |
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Uloric (febuxostat)
dose MOA renal or hepatic impairment gout flares flare proph contraindication side effects |
dose: 40mg q d (> 18 yrs)
*if target uric acid level not met w/in two weeks bump up to 80 mg q d MOA: xanthine oxidase inhibitor renal or hepatic impairment: no dose adjustment gout flares: this may occur after initiation due to changing serum uric acid levels resuling in mobilization of urate from tissue deposits flare proph: NSAIDS or colchicine is recommended contraindications: pts on azathioprine, 6-mercaptopurine, theophylline side effects: liver function abnormalities, nausea, arthralgia, rash, dizziness |
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Krystexxa (Pegloticase)
indication dose dilution MOA anaphylaxis and infusion proph Contraindications/Pearls |
indication: cronic gout treatment
dose: 8 mg q 2 wks over at least 2 hours dilution: dilute in 250 mg NS; stable for 4 hrs at 26-45F, protect from light, DO NOT SHAKE MOA: Converts uric acide to allantoin whcih is inert and water soluble so its eliminated from kidneys anaph and infusion proph: pretreatment with antihistamines and corticosteroids Contraindications: Do not use if G6PD deficient NO IV PUSH OR BOLUS monitor serum uric acid levels before each infusion premedicate w anti-hist and corticosteroids |
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Probenicid
dose MOA |
dose: 250mg BID x 1 wk; then 500 mg BID
MOA: blocks reabsorption in the proximal convoluted tube thereby increasing excretion of uric acid *can use w/ colchicine |
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Corticosteroids
administration dose |
administration: intra-articular directly into joint
dose: methylprednisolone 5-10 mg for smaller joints and 20-60 mg for larger joints |
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Indomethacin
dose and dosage form |
dose: regular caps 50 mg TID x 3-5 days
*NO SR |
