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26 Cards in this Set

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Gout what is it
characterized biochemically by hyperuricemia and clinically by episodes of severe, acute arthritis due to deposits of monosodium urate in joints and cartilage.

i.e., IMBALANCE OF URIC ACID -- OVERPRODUCTION & UNDERSECRETION
The untreated disease may develop through four stages.
1. Asymptomatic hyperuricemia: 90% due to undersecretion of uric acid.
2. Acute gouty arthritis - - PAINFUL; inflammation
• Urate deposits in synovial space
• First metatarsophalangeal joint--“Hot Toe”
3.Asymptomatic intercritical period
4.Chronic tophaceous gout
• Tophi: Chalky aggregates of monosodium urate monohydrate in joints, cartilage, tendon, bursae.
• Destructive arthropathy; ulceration
URATE STONES IN KIDNEY
Principal objectives of treatment are:
1. Terminate the inflammatory process of an acute attack.
2. Reduce hyperuricemia: Prevent formation of urate deposits and recurrent attacks; resolution of tophi.
DRUGS USED FOR ACUTE ATTACKS OF GOUTY ARTHRITIS
1. Nonsteroidal anti-inflammatory drug(NSAID’s)--DOC
- Indomethacin (Indocin)
- naproxen (Naprosyn; Anaprox)
- ibuprofen (Motrin)
2. Colchicine
3. Adrenal corticosteroids and corticotropin (ACTH): “Last resort”
Colchicine
MOA
INHIBITS PHAGOCYTOSIS BY & release of chemotactic factors by NEUTROPHILS

Binds tubulin and inhibits mictotubule formation
Colchicine: route
IV or oral
Colchicine: Clinical Use
ACUTE gouty arthritis if you can't use NSAIDS. Will relieve pain 12-24 hrs

Chronic gout to prevent acute flair up when using allopurinol or probenecid
Colchicine
Adverse reactions:
NV, Diarrhea, abdominal cramping (80%)
Colchicine
Overdose toxicity:
NV, bloody diarrhea,vascular damage, shock, kidney damage, blood dyscrasias, CNS toxicity,etc.
Colchicine
Contraindications:
Serious GI, renal, hepatic or cardiac disease; bone marrow depression.
Indomethacin (Indocin)
most common NSAID used for ACUTE gout-- short term relief of pain, inflammation.

watch for GI upset. Contridicted in renal failure or CHF.
DRUG USED FOR THE CHRONIC TREATMENT OF GOUT:
Uricosuric Agents:
Probenecid
Probenecid:
route and excretion
PO, kidney
Uricosuric Agent:Probenecid
MOA:
effects:
BLOCKS REABSOPTION OF URIC ACIDS
effects:
•increased excretion of uric acid
•decreased total body pool of uric acid
•tophaceous deposits of urate are reabsorbed
•decreased plasma uric acid levels
Probenecid enhances the blood levels of penicillins when administered together)
T/F
Probenecid
clinical uses
chronic gout

Less effective if creatinine clearance is < 50 ml/min; maintain adequate hydration
Probenecid
Adverse reactions:
GI irritation - - especially
Intrarenal precipitation of uric acid

Hypersensitivity reactions:
-Erythema, pruritus

May precipitate an attack of acute gouty arthritis - - avoided by simultaneously giving colchicine.
Probenecid
Contraindications, cautions, drug interactions:
• History of peptic ulcer or renal calculi

• Blood dyscrasias; leukopenia

• Plenty of fluids; alkalinize urine
• Do NOT initiate therapy during acute attack
Probenecid
drug interactions:
salicylates
sulfonamides
indomethacin
oral hypoglycemic agents rifampin.
Allopurinol (Zyloprim; Lopurin)
Route
PO
Allopurinol (Zyloprim; Lopurin)
MOA
INHIBITS XO & URATE SYNTHESIS
Allopurinol (Zyloprim; Lopurin)
Effects:
• Plasma uric acid level decreases
• Total body pool of uric acid is decreased
• Tophi are reabsorbed and formation inhibited
• Urinary excretion of uric acid is decreased
• Uric acid stone formation is decreased
Allopurinol (Zyloprim; Lopurin)
Clinical use:
Chronic tophaceous gout and in patients with renal urate stones - - preferred

Treatment of hyperuricemia associated with excessive production of uric acid.
Allopurinol (Zyloprim; Lopurin)
Adverse reactions:
Attacks of acute gouty arthritis may occur when therapy initiated; start with low dose and use with colchicine.

Occasionally - - headache, drowsiness, GI effects

Hypersensitivity reactions: rash, pruritus (1-3%)

• Exfoliative dermatitis; urticaria; blood dyscrasias; peripheral neuritis; liver toxicity – rare.
Allopurinol (Zyloprim; Lopurin)
Contraindications, cautions, and drug interactions
Do not use if a severe reaction has previously occurred

Do not initiate therapy during acue attack
• Plenty of fluids; alkalinize urine
• Renal insufficiency; liver disease; blood dyscrasias
Allopurinol (Zyloprim; Lopurin)
and drug interactions
-- probenecid
-- mercaptopurine and azathioprine
-- oral anticoagulants
-- ampicillin - - rash