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23 Cards in this Set
- Front
- Back
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Drug-Induced Hyperuricemia
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Increase Uric Acid Production: nicotinic acid, warfarin, & chemotherapy
Decrease Renal Clearance of Uric Acid: diuretics, low dose aspirin (<2g), & cyclosporine |
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Underexcreter
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< 600 mg/day
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Overproducer
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> 1,000 mg/day
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Cautions for NSAIDs (5)
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PUD
anticoagulants elderly renal impairment CHF |
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MOA: NSAIDs
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decrease inflammatory response, thereby decreasing neutrophil phagocytosis
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MOA: Colchicine (2)
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inhibits mitosis of neutrophils thereby decreasing migration of neutrophils to site of urate crystals
inhibits neutrophil phagocytosis of urate crystals thereby decreasing production of glycoprotein (less inflammation) |
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AE: Colchicine (4)
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GI (dose-dependent) – dose-limiting diarrhea
bone marrow neurologic & muscular: neuralgia & myalgia renal dysfunction |
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CI: Colchicine
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↓ 50% dose in patients with CrCl < 50 mg/ml
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MOA: Allopurinol
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analog of hypoxanthine which competitively inhibits XO & prevents uric acid production
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Dose: Allopurinol (2)
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Dose reduce...
↓ 50% if CrCl < 50 mg/ml mercaptopurine & azathioprine |
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AE: Allopurinol (5)
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rash
diarrhea leukopenia eosinophilia & rash (dose-dependent HSV) renal & hepatic dysfunction |
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MOA: Febuxostat
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xanthine oxidase inhibitor which acts by decreasing serum uric acid
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Dose: Febuxostat (3)
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double dose if serum UA > 6mg/dL after two weeks
due to gouty flare, prophylaxis with NSAID or colchicine recommended when first starting (up to 6 months) dose reduce for azathioprine, mercaptopurine, & theophylline |
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AE: Febuxostat (3)
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↑ LFTs
acute gout MI |
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MOA: Uriocurics (probenecid, sulfinpyrazone, & colchicine)
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↑ renal clearance of uric acid by inhibiting renal tubular reabsorption of uric acid
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Dose: Probenecid (2)
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drink at least 2L of fluid/day to prevent stones
not effective CrCl < 30 ml/min |
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AE: Probenecid (5)
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precipitation of acute gouty arthritis
nephrolithiasis GI upset rash HSV |
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DI: Probenecid (5)
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↑ carbapenem
↑ cephalosporin ↑ penicillin salicylates: uricosuric activity & may antagonize ↑ methotrexate |
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CI: Probenecid (4)
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CrCl < 30 ml/min – no benefit
high dose aspirin Tx blood dyscrasias uric acid kidney stones |
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Dose: Sulfinpyrazone
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Increase fluid uptake
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AE: Sulfinpyrazone (5)
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acute gout
nephrolithiasis nausea PUD blood dyscrasias |
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DI: Sulfinpyrazone
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salicylates (antagonizing effect)
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CI: Sulfinpyrazone (2)
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CrCl < 50 ml/min
sulfa-allergy |
