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15 Cards in this Set
- Front
- Back
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Gout
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Build up of uric acid in joints
Hyperuricemia: >8 mg/dL in men and >7 mg/dL in women |
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Clinical Presentation of Gout
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First attack typically at night/early in the morning
Affected joints: ankle,finger wrist, elbow, heel Most common site for first attack: MTP joint (podagra) Ultimately tophi in kidneys causing nephropathy |
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Primary gout
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Increased purine metabolism (over producers) OR decreased excretion (underexcreters)
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Secondary gout
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Due to hematologic disorders, low-dose salicylate, all diuretics except spironolactone, other drugs: ethambutol, pyrazinamide, nicotinic acid, niacin, cyclosporine, ethanol
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Acute Gout Treatment
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Colchicine
NSAID corticosteroids |
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Colchicine in gout
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-Inhibits phagocytosis by leuckocytes
-Anti-inflammatory -0.6mg-1.2 mg q2hours until 8 mg, diarrhea, or pair resolution Must be initiated 12-36 hours after attack |
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Colchicine Adverse Effects
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Nausea, emesis, diarrhea
Do not take if active peptic ulcer disease |
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Indomethacin in acute gout
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-Can be used at any time during the attack
-50 mg TQID -Fluid retention, GI bleed |
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Corticosteroids in acute gout
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Use after NSAID and colchicine fail
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Gout Prophylaxis
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-Determine if overproducer or under excreter.
Benemid (Probenecid) Anturane (Sulfinpyrazone) Zyloprin (allopurinol) |
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Benemid (probenecid)
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-Uricosuric
-Drink at least 2 liters daily -250-500 mg BID with food -Well tolerated other than uric acid stones. |
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Drug-Drug interactions with Benemid
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-Increases levels of PCNs, cephalosporins, rifampin, nitrofurantoin(enough conc. does not get to the bladder)
-ASA interferes with uric acid secretion-->don't use with probenecid -Patients on sulfonylureas must be monitored for hypo -Increased effect of HCTZ and furosemide |
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Anturane
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-Sulfinpyrazone
- 50-200mg BID with food -Do not take in ASA sensitivity -Same IA as Benemid with Nitrofurantoin and ASA |
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Zyloprim
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-Allopurinol
-Start at 100mg, increase to 300 daily once daily -RASH!! |
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Zyloprim drug-drug interactions
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-azathioprine and 6-MP increased in serum levels
-Concomitant administration with ampicillin and amox increases chance of rash |
