Mss-Drugs For Treatment Of Gout

Front 1

What causes gout?

Back 1

inbalance between uric acid production and renal excretion, producing hyperuricemia

Front 2

Where does uric acid usually come from?

Back 2

breakdown product of nucleic acids

Front 3

What are some symptoms of gout?

Back 3

1. acute inflammatory arthritis
2. fever
3. tophi-usually at big toe
4. kidney stones

Front 4

What causes the acute inflammatory arthritis seen in gout?

Back 4

deposition of crystals of monosodium urate in and around joints and tendons

Front 5

How do gout attacks progress?

Back 5

short duration periodically at first, but if left untreated, become more frequent and last longer periods

Front 6

What is a tophi?

Back 6

large deposit of uric acid

Front 7

What is the pathophysiology of gout?

Back 7

synoviocytes phagocytize urate crystals->secrete IL-1 and PG->attract neutrophils and macrophages->neuts secrete LTB4 and PG; macros secrete PG and IL-1

Front 8

Who is primarily affected by gout?

Back 8

mid-life males (drinking wine and eating steaks)

Front 9

What are 3 pharmacologic treatments for gout?

Back 9

1. inhibit uric acid synthesis
2. increase uric acid elimination
3. inhibit immune responses to uric acid

Front 10

What is the MOA of colchicine?

Back 10

binds to intracellular protein tubulin, preventing polymerization into microtubules->this prevents leukocyte migration and phagocytosis

Front 11

What drugs inhibit metabolism of colchicine?

Back 11

cimetidine and erythromycin

Front 12

What is an adverse effect of colchicine?

Back 12

narrow TI; can cause GI problems and hair loss

Front 13

Symptoms of acute oral overdose of colchicine?

Back 13

burning throat, bloody diarrhea, renal shutdown

Front 14

Chronic toxicity of colchicine includes:

Back 14

agranulocytosis and aplastic anemia; teratogenesis

Front 15

What is the first line drug for treatment of acute gouty arthritis? What is the first line drug for prevention of acute gouty arthritis?

Back 15

1. NSAIDs
2. colchicine

Front 16

What is the main difference in NSAIDS vs. cochicine in gouty treatment?

Back 16

NSAIDS work faster by inhibiting PG synthesis

Front 17

Why can't NSAIDS be used as a prophylactic against gout?

Back 17

chronic adverse effects

Front 18

What are the 3 A's of NSAIDs?

Back 18

antipyretic, antiinflammatory, analgesic

Front 19

What NSAID is traditionally used to treat acute gouty arthritis? What are some problems with its use?

Back 19

indomethacin; GI and CNS effects

Front 20

Aside from indomethacin, what other NSAIDs can be used to treat gout?

Back 20

phenylbutazone and ibuprofen

Front 21

Although not normally used due to toxicities, what drugs can be used in resistant acute cases of gout?

Back 21

adrenal corticosteroids

Front 22

What are 2 inhibitors of uric acid synthesis?

Back 22

allopurinol and febuxostat (investigational)

Front 23

What is the MOA of allopurinol?

Back 23

competitively inhibits xanthine oxidase

Front 24

How are hypoxanthine and uric acid related?

Back 24

hypoxanthine comes from purine metabolism; it is converted to xanthine, then to uric acid

Front 25

What enzyme converts hypoxanthine to xanthine and xanthine to uric acid?

Back 25

xanthine oxidase

Front 26

In addition to competitively inhibiting xanthine oxidase, what other effect does allopurinol have on xanthine oxidase?

Back 26

after it binds to xanthine oxidase, it forms alloxanthine, which in turn inhibits xanthine oxidase

Front 27

How is allopurinol removed from the body? Long or short half-life?

Back 27

kidneys; long

Front 28

What effect does allopurinol have on 6 mercaptopurine and azathioprine (immunosuppressants)?

Back 28

inhibits their metabolism by xanthine oxidase

Front 29

What is the main side effect of allopurinol?

Back 29

allergic reactions (2%) like exfoliative dermatitis

Front 30

T or F: allopurinol can actually produce acute gouty arthritis

Back 30

true; give colchicine or NSAID first

Front 31

What is the therapeutic use of allopurinol?

Back 31

chronic treatment of gout (protects kidneys, prevents kidney stones, and eliminates tophi)

Front 32

How can allopurinol be used as a prophylactic?

Back 32

protect kidneys against uric acid precipitation and stone formation in patients with leukemia

Front 33

How do uricosuric drugs work? Should these be given in low or high doses?

Back 33

act at anionic transport sites in renal tubules to cause a net decrease in uric acid reabsorption; high doses

Front 34

What is the main risk in uricosuric drugs?

Back 34

formation of uric acid crystals in urine and deposition of UA in renal tissue

Front 35

What is a complication of uricosuric drugs? What should be given prior to this?

Back 35

until therapeutic dose is reached, they may cause acute attacks of gout; NSAIDs and colchicine

Front 36

What are the uricosuric drugs?

Back 36

probenecid (more common) and sulfinpyrazone

Front 37

What drug should NOT be used to treat gout if the patient’s daily urinary output of uric acid is greater than 600 mg/24 hours or if renal function is significantly compromised?

Back 37

probenecid

Front 38

What are some possible adverse effects of probenecid?

Back 38

allergic reaction, nephritic syndrome, and aplastic anemia,

Front 39

Therapeutic uses for probenecid?

Back 39

1. after acute gouty attacks
2. when allopurinol is not tolerated
3. when tophi appear

Front 40

Probenecid should not be used to manage hyperuricemia associated with what?

Back 40

cancer chemotherapy

Front 41

What drugs can inhibit probenecid effects by interfering with active secretion of uric acid?

Back 41

salicylates

Front 42

What is a common adverse effect of Sulfinpyrazone?

Back 42

greater GI irritation than probenecid

Front 43

Why would you choose sulfinpyrazone over probenecid?

Back 43

less allergic reactions

Front 44

What is the general treatment algorithm for acute gouty attacks?

Back 44

NSAIDs 1st; colchicine 2nd

Front 45

What is the general treatment algorithm for chronic gout?

Back 45

allopurinol first; uricosurics second