Gout medication

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  1. Gout is a term for
    collection of disorders that result from deposition of monosodium urate crystals in body tissue
  2. Gout can be primary or secondary

    Primary affects ____ 10 times more often

    Secondary is associated with ______?

    hyperuricemia- from diseases or drugs that interfere with secretion of uric acid, can be endocrine disorder, lead poisoning, or high doses of salicylates
  3. 90% of gout patients are _________ of uric acid?
    under excretors of uric acid.

    overproduction is less common and is usually from another disease
  4. hyperuricemia is serum urate level in men?
    in women?
    men > 6mg/dl

    women > 7 mg/dl
  5. acute gouty arthritis definition
    painful monoarthropathy of usually metatarsophalangeal joint of great toe.
  6. Intercritical period (between attacks)
    2nd episode usually within 6 months to 2 years after first attacks.
  7. tophi
    sodium urate crystals that are deposited in soft tissue occurs in 50% of patients.
  8. key risk factors for gout

    These factors are additive in terms of risk
    • HTN
    • thiazide and loop diuretics
    • obesity
    • alcoholism (moonshine is worse due to lead content) beer and spirits- not wine
    • age > 60
    • intake of meat and seafood increase the risk
  9. most important diagnosis of gout is exclusion of  _____ joint ?
    septic joint

    -get synovial fluid for WBCs and diff, crystal analysis and gram stain with culture
  10. Uricosuric (probenecid) agents MOA
    increase secretion of uric acid

    Tubular blocking agents, increase secretion by blocking reabsorption of urate

    Increase risk of stones, increase fluids
  11. Colchicine MOA
    • and NSAIDs- decreases or stops the inflammatory process.
    • unknown but affects leukocyte fx to reduce lactic acid production.

    Not an analgesic and has no effect on uric acid metabolism
  12. NSAIDS and Colchicine MOA
    decreases or stops the inflammatory process.
  13. MOA of allopurinol
    decrease the synthesis of uric acid

    inhibit xanthine oxidase, the enzyme that converts xanthine to uric acid. Reduces uric acid production.

    Does not promote uric acid secretion, so level in renal tubules in not increased
  14. Prevention of gout reoccurrence use what meds?
    Allopurinol, colchicine, and sulfinpyrazone
  15. First line tx to reduce uric acid levels

    what can be added if these meds are not working?
    xanthine oxidase inhibitors- allopurinol or febuxostat

    Urocosuric agents probenecid, fenofibrate, or losartan can be added if xanthine oxidase inhibitors are not sufficient to achieve target serum urate levels.  

  16. Gene testing for gout
    HLA-B*5801 allele
  17. Acute flairs may be treated with what
    NSAIDS and glucocorticoids
  18. prevention of attacks
    First line
    2nd line
    long term
    first line is colchicine (decreases inflammatory response)

    2nd line- Uricosuric (increase secretion) if undersecreter, allopurinol (decreases synthesis of uric acid) if over producer

    Long term treatment for urate lowering drugs
  19. How often to monitor serum uric acid levels?
    baseline then every 2-3 months
  20. Men serum uric acid level when monitoring drug response should be
    2-7 mg/dl
  21. women serum uric acid level when monitoring drug response should be
    2-6 mg/dl
  22. Monitoring colchicine

    First time administration
    first time- monitor weekly for toxicity (weakness, nausea, vomiting, diarrhea, and anorexia)

    Periodic- LFTs and blood counts (every 3-6 months)

    Can cause reversible malabsorption of B12
  23. Monitoring Uricosuric agents

    baseline CBC
  24. Allopurinol hypersensitivity syndrome
    • Includes Steven Johnson Syndrome, usually present with rash.
    • This is life threatening
    • occurs rarely and is dose dependent.

    Presents with fever, renal failure, and vasculitis, Mortality around 20%
  25. Geriatrics and treatment
    • diminished renal fx and risk of adverse effects increased.
    • -begin with lowest dosage
    • -monitor renal fx
  26. Colchicine adverse reactions
    • have caused death.
    • Gastrointestinal toxicity in 80%
    • -bone marrow suppression, blood dyscrasias, hepatic necrosis, and seizures most common in elderly.
  27. Pediatrics
    safety not established for colchicine and sulfinpyrazone.
  28. What drug is contradicted in children under 2 years old
  29. Pregnancy
    • B- probenecid
    • C- colchicine, allopurinol
    • C/D- sulfinpyrazone
  30. Patient education on all gout therapies
    • educate on triggers, lifestyle, changes and use of various drugs
    • -maintain adequate fluid intake
    • -take meds with food to prevent GI upset
    • -Report and S&S of GI distress
    • -Lose weight slowly, to fast can cause gout attack
    • -Stress compliance
  31. Patient education on colchicine
    notify of skin rash, sore throat, fever, unusual bleeding, bruising, tiredness, weakness, numbness, or tingling
  32. Pt education and Uricosuric agents
    • avoid aspirin or other salicylates can cancel drug
    • -increase fluid to prevent stones
    • -notify if rash develops
  33. Allopurinol patient education
    notify for what

    Large doses of what may increase?

    take meds with?

    How long for optimal benefit?
    • notify if rash, painful urination, blood in urine, irritation of eyes or swelling of lips and mouth.
    • -large doses of vitamin C may increase kidney stones
    • -take with fluid and food
    • may take 6 weeks for optimal benifit
  34. Death has occurred with as little as ___ mg of colchicine
    7 mg
  35. Bone marrow suppression has occurred with long term tx of _______?
  36. Allopurinol has been known to  cause  ___ toxicity
  37. Acute gouty arthritis sx with out peptic ulcer, treat with?
  38. Acute gouty arthritis sx with peptic ulcer tx with
  39. Acute gouty arthritis sx with kidney liver or bone marrow disease tx with
  40. recurrent and chronic gout- overproducer tx
    allopurinol and colchicine
  41. recurrent and chronic gout- undersecretor
    Uricosuric agent- probenecid
  42. hypersensitivity to allopurinol
    includes Steven Johnson syndrome.  Skin rash is earliest sign of reaction
  43. colchicine is contradicted with what disease processes
    heart disease, gi, renal and hepatic, and blood dyscrasias
Card Set:
Gout medication
2013-10-31 16:27:12

pharm fall 2013
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