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23 Cards in this Set
- Front
- Back
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Acute attacks of gouty arthritis
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Colchincine
NSAIDs (DOC) |
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NSAIDs: DOC for acute gout
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Ibuprofen
Naproxen Indomethacin Adrenal corticosteriods and corticotrophin (ACTH) |
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Chronic gout
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Uricosuric agents:
Probenecid Sulfinpyrazole Allopurinol Febuxostat |
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Gout Treatment:
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(1) Terminate inflammatory process of an acute attack;
(2) Reduce hyperuricemia: prevent formation of urate deposits and recurrent attacks, resolution of tophi |
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Untreated Gout
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(1) Asymptomatic hyperuricemia: undersecretion of uric acid, hyperuricemia
(2) Acute gouty arthritis: inflammation, urate deposits in synovial space, “hot toe” (3) Asymptomatic inter-critical period (4) Chronic tophaceous gout (tophi: aggregates of MSU in joints, cartilage, tendon, bursa), destructive arthropathy, Nephrolithiasis (urate stones in kidney), ulceration |
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Colchine: MOA
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1. Binds tubulin
2. Inhibits microtubule formation 3. dec Phagocytosis by PMN |
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Colchicine: uses
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given PO until pain relief or diarrhea
1. Acute gouty arthritis 2. Acute gout 3. Chronic gout 4. Adjunctive: Prevent flare up by urate mobilization from tophi |
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Prednisone
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last resort for Acute Gout
(NSAIDS/Colchicine no good) |
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Colchicine: contraindications
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1. Serious GI, renal, hepatic, cardiac disease
2. Bone marrow depression |
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NSAIDs: MOA
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1. ↓ mucosal protective effects of PG
2. Local irritation 3. ↓ PG → ↓Renal blood flow → ↑ Na & water retention → Edema, hyperkalemiaia, interstitial nephritis |
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NSAIDs: contraindications
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1. GI irritation, bleeding, peptic ulceration (Note: concurrent use of MISOPROSTOL (PG analog or H+ pump inhibitor such as PRILOSEC can decrease GI toxicity of NSAIDs)
2. CNS effects 3. Mild liver toxicity 4. Renal toxicity (chronic use of high doses) → interstitial nephritis 5. ↑CV risk |
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Ibuprofen: unique ft.
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NSAID w/less GI side effects
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Naproxen
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NSAID associated w/ high incidence of diarrhea
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Indomethacin
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most commonly used NSAID;
Provides effectively short-term treatment of acute attacks; relieves pain rapidly; anti-inflammatory, analgesic |
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Uricosuric Agents
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Probenecid
Sulfinpyrazole |
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Uricosuric: MOA
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Blocks REABSOPTION of uric acid;
May inhibit tubular secretion of weak acids at low doses e.g. penicillin, naproxen. |
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Probenecid: adverse+contra
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Adverse Reactions
1. GI irritation 2. Hypersensitivity reactions- rash, pruritis 3. inc Risk of renal stones contra:Drug interactions inc plasma levels of salicylates, indomethacine, penicillin, metrotrexate |
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Probenecid: effects
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1. ↑ Excretion of uric acid
2. ↓ Total body pool of uric acid 3. Tophaceous deposits of urate are reabsorbed 4. ↓ Plasma uric acid levels (Probenecid also ↑ blood levels of penicillins when administered together) Block tubular reabsorption --> inc excretion |
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Allopurinol: MOA
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Inhibits XO & urate synthesis
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Allopurinol: adverse+contra
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Adverse reactions:
1. Attacks of acute gout arthritis initially 2. Headache 3. NVD 4. Drowsiness 5. Hypersensitivity reaction: rash, pruitus, dermatitis, urticaria Drug interactions: 1. DO not use during acute attack |
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Allopurinol: effects
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1. ↓Plasma uric acid level
2. ↓ Total body pool of uric acid 3. Tophi are reabsorbed and formation inhibited 4. ↓ Urinary excretion of uric acid 5. ↓ Uric acid stone formation |
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Febuxostat (compared to Allopurinol)
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More effective than allopurinol in dec uric acid and gout
**NO hypersensitivity reactions |
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Febuxostat: adverse
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Adverse reactions
1. inc Liver enzymes 2. Arthralgia 3. Nausea 4. CV events (MI, strokes) |
