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Gout
N/A
37
Pharmacology
Professional
04/29/2011

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Cards

Term
What NSAIDs are used for the treatment of gout?
Definition
indomethacin
ibuprofen
ketorolac
Term
What drug used to treat gout comes from periwinkles and blocks microtubules which move things into cells?
Definition
colchinine
Term
two types of hyperuricemia
Definition
uric acid overproduction
uric acid underexcretion
Term
What is an important event for developing acute crystal-induced synovivtis?
Definition
influx of neutrophils
Term
lab finding for aspiration of gouty joint
Definition
negatively birefringent crystals
Term
Why might the ESR be elevated during gout attack?
Definition
inflammation
Term
therapeutic goals of pharmacologic treatment of gout
Definition
-terminating attacks
-providing control of pain/inflammation
-preventing future attacks
-preventing complications (renal stones, tophi, destructive arthropathy)
Term
most commonly used treatment for gout
Definition
NSAIDs
Term
When do you d/c NSAID use for acute gout?
Definition
pain and inflammation resolved for 48 hours
Term
treatment for acute gout which inhibits microtubule aggregation which disrupts chemotaxis and phagocytosis and inhibits crystal-induced production of chemotactic factors
Definition
colchicine
Term
colchicine adverse effects
Definition
GI discomfort
nausea
cramping
Term
How is colchicine administered?
Definition
oral hourly doses until pain/inflammation have resolved or GI effects prevent further use

also can do IV loading dose, then every 6 hours until max dose reached at 24 hrs
Term
Why should colchicine not be used in CHF patients?
Definition
causes fluid retention
Term
What treatment is used for patients who cannot tolerate NSAIDs or have failed NSAID/colchicine therapy?
Definition
corticosteroids
Term
What is the corticosteroid used for treatment of gout?
Definition
prednisone
Term
How long does it take to see improvement with prednisone?
Definition
12-24 hours
Term
ACTH promotes the release of _________.
Definition
cortisol
Term
ACTH mechanism of action
Definition
peripheral anti-inflammatory effects and induction of adrenal glucocorticoid release
Term
What type of patients are intra-articular steroid injections beneficial for?
Definition
-1-2 large joints affected
-elderly with renal disease, PUD, etc.
Term
What drugs are used for intra-articular steroid injections in the treatment of gout?
Definition
triamcinolone
dexamethasone

(with or without lidocaine)
Term
non-pharmacologic treatments of gout
Definition
-immobilization of joint
-ice pack
-abstinence of alcohol
-dietary modification!
Term
What drugs contribute to hyperuricemia?
Definition
-thiazide and loop diuretics
-low dose salicylates
-niacin
-cyclosporine
-ethambutol
Term
What drugs can be used as gout prophylaxis?
Definition
losartan
colchicine
allopurinol
probenecid (sulfinpyrazone)
Term
losartan mechanism of action in preventing gout
Definition
promotes urate diuresis and may even normalize urate levels
Term
What prophylactic medication is useful in elderly patients with HTN and gout?
Definition
losartan
Term
Why is colchicine usually used in combination with a urate lowering drug in gout prevention?
Definition
prophylaxis without urate lowering drug may allow tophi to develop
Term
What are the urate lowering drugs?
Definition
allopurinol
probenecid (sulfinpyrazone)
Term
What drugs are used for urate overproducers?
Definition
allopurinol
probenecid (sulfinpyrazone)
Term
goal serum urate level
Definition
6 mg/dL or less
Term
What can happen when starting a urate lowering drug?
Definition
acute gout attack (may need to use colchicine as long as 6 months)
Term
What drug is a xanthine oxidase inhibitor?
Definition
allopurinol
Term
What drug is a uricosuric drug?
Definition
probenecid (sulfinpyrazone)
Term
allopurinol mechanism of action
Definition
blockers conversion of xanthine to uric acid
Term
Which urate lowering drug acts for both overproducers and underexcretors?
Definition
allopurinol
Term
probenecid (sulfinpyrazone) mechanism of action
Definition
increases renal clearance of uric acid by inhibiting tubular absorption
Term
probenecid (sulfinpyrazone) side effects
Definition
GI upset
kidney stones
Term
What do you need to get in a patient starting on probenecid?
Definition
24 hr urine
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