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drugs used in gout
drugs
42
Medical
Graduate
04/05/2012

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Term
gout result of metabolism of
Definition
purines.
Term
gout diseasei sm ot commonly dueto
Definition
lack of clearance , (as opposed to overproduciton)
Term
colchicine moa
Definition
inhibits tuublin polyermization into microttubules, , inhibitsl uekocyte miraiton nad phagocytosis
Term
colchicine method of takign
Definition
oral. used for acute attacks
Term
colchiicine toxciity
Definition
lots (not mentioned: nause vomitting abdmoinal pain, burning throat patin , blodo idarrhea, shock hematuria, and oliuria).

no logner first lien agnets due to toxicities.
Term
frontlineagents or gout
Definition
nsaids
Term
Indomethacin use
Definition
used for acute gout, msot popular nsaid.
Term
indomethacin moa
Definition
inhbits cox mediated PG syntehsis
Term
oxaprozin moa
Definition
nsaid that also icnerases uric acid excreiton in urine
Term
oxaprozin adverse effects
Definition
will make kdiney stones worst if you dont be careful
Term
probenecid
Definition
uricouric agent
Term
sulfinpyrazone
Definition
uricosuric agent
Term
uricouric agent moa
Definition
increase sectiona nd decerase reabsortion of uric acid (organic acids haat act at the anion tranprot sites of proximal tubules
Term
uricosuric agetns advantags
Definition
in tophagcoues depsotis iwl lstimualte rebosrption of the tophi.
Term
uricosuric agents interactions
Definition
aspirin- inhibits secretory urate transporter
Term
uricosuric agnets indications
Definition
for CHronic NOT acute. expectation tobe taken for a long period. used in aptients iwth frequent attacks, patients with tophaceous gouts- excellent for this, but useful only for udnerexcretors.
Term
uricosuric agents adverseeffects
Definition
dont use in patients who over excrete or even excrete nromal elvels of urate, otherwise will predispose to uric acid stones. NEed to keep ph alkaline and urinate frequently.

no basis for choosing on drug over antoehr. Irritating to gut. Take with food and divided dose
Term
allpurnol
Definition
irreversible antagonist of xanthien oxidase (purine analog)
Term
febuxostat
Definition
irreversible antagonist of xanthien oxidase (nonpurine)
Term
xanthine oxidase inbhitior
Definition
intercrises agent, the preffered agent for chronic gout therapy. Chronic tohgacous gout (can dissovle tophi more rapidly than uricosurics). These will cork with renal stoen aptients. also useful for patients with renal impairement.

taken for years and life.
Term
aloppurinol blocker adverse effects
Definition
acute gouty attacks due to intial flare occuring when urate crystals are beign withdran form tissues. Initaited with colchicine or an nsaid (indomeathicn , until steady state seru mruaret e is nromalized to lese than 6 mg/dl. Gi irriation, take with foodas
Term
allopurinol specific s9de effects
Definition
allopurinol is less preferred to febuxostat due to unique adverse effects.

necrotizing vasculitis, aplastic anemia, hepatic toxicity, itnerstial neprhitis. rarely cataracts.

MSOT COMMON: ALLERGIC SKIN REACTIONS: toxic epidermal necrolysis. - STevens johnsons syndrome.

Drug itneractions: ltos of drus inlucindg mercapturopine, warfarin.
Term
febuxsostat vs. allopurinol
Definition
febuxostat much better tolerated in patients with allpuoruinol intoelrance.
Term
aspirin unique advatnage
Definition
inhibits cox IRREVERSIBLY. platelet is inactivated for hte lifetime of the platelet.
Term
cox 1 vs. cox 2 in thrombosis
Definition
cox 1 is foudn in paltelets , inhibit cox-1 and formaiton of thormobxan a 2 and thrombosis.

this shifts balance to cox-2 in endothelium. Cox 2 in endothelium leads to prostacyclin produciton which reduces thrombosis.
Term
cox 2 inbhiitors problems
Definition
you inhibit, cox2= upregulatio nfo cox1 leadign to thormbosis
Term
pharm properties of nsaids
Definition
antiinflammtory=- mediated primarily through cox-2 inhibition of prostaglandin biosyntehsis.

Anaglesic activity- mediated thorugh inhibition of prostaglandin biosyntehsis centrally and locally.

antipyrertic activity- prverntion of pge2 syntehsis.

prolongation fo bleeding time- inbhition fo cox-1 i npaltelets = decrsaed txa2
Term
naproxen/ibuprofen vs aspirin
Definition
iburporfen has logenr halflives
Term
methotrexate moa
Definition
dhfr inhbitior. inhibting producers of dna syntehsis, reducing inflammatory cells
Term
methotrexate adverse effects
Definition
foalte deficiency, folic acid supplemeantion, contraindicatedi n rpegnancy
Term
methotrexate uses
Definition
rhumeatoid arhtiritis as wel las other inflammatory disorders
Term
lflunoamide moa
Definition
pyrimidien syntehsis inbhitiors
Term
leflunomide pharamcokientics
Definition
LOGN halflife of 19 days
Term
leflunomide adverse effects
Definition
teratogenic, stop 2 yeears prior pregnancy
Term
hydroxycloroquine adverse effects
Definition
requries 3-6 months for benefit, may due retinal damage
Term
hydroxychloqouine
Definition
Term
glucoritcoids
Definition
usefulf or RA but litmited use logn term due to toxicity.
Term
etanrecept moa and mode of adminsitration
Definition
protein so has to be adminsitered IV. Binds to TNF alpha with high affinity. (it is a receptor nto an antibody)
Term
etanrecept use
Definition
synergistic with methotrexate
Term
ifnluximab
Definition
antibody to tnfalpha. reduces blodo elvel of tnfalpha.
Term
adalimumab
Definition
fully human antibody to tf as opposed to inflixmab, decreawsed immuen resposne of host.
Term
glucorticoicds vs. nsaids
Definition
glucocorticoids inhibit formation fo aarachidonate from phospholipids, (vi inhibtion o PLA2).

NSAIDs= inhibition of formaiton of arachidonate to prostaglandin vis inhibition of cox
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