Gout medication.txt

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Author:
Corissa.Stovall
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244023
Filename:
Gout medication.txt
Updated:
2013-10-31 11:46:16
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Pharm Final
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Week 11
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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 ______?
    men

    Primary--overproduction or underexcretion

    secondary ---from other source ---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. What is the Intercritical period of gout?
    2nd episode usually within 6 months to 2 years after first attacks.
  7. What are tophi?
    sodium urate crystals that are deposited in soft tissue occurs in 50% of patients.
  8. What are the 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 agents MOA
    increase secretion of uric acid

    probeneid

    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. 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.  



  15. Gene testing for gout
    HLA-B*5801 allele

    determines risk for allopurinol hypersensitivity
  16. Acute flairs may be treated with what
    NSAIDS and glucocorticoids
  17. prevention of attacks
    First line:?
    2nd line:?
    first line is colchicine (decreases inflammatory response)

    2nd line- Uricosuric (increase secretion) if undersecreter, allopurinol (decreases synthesis of uric acid) if over producer
  18. How often to monitor serum uric acid levels?
    baseline then every 2-3 months
  19. Men serum uric acid level when monitoring drug response should be
    2-7 mg/dl
  20. What is the ideal uric acid level for patients with gout??
    5-6
  21. women serum uric acid level when monitoring drug response should be
    2-6 mg/dl
  22. Monitoring colchicine

    First time administration--what should you monitor for??
    What about periodicly??
    first time- monitor weekly for toxicity (weakness, nausea, vomiting, diarrhea, and anorexia)

    Periodic- LFTs and blood counts (every 3-6 months)
  23. Allopurinol hypersensitivity syndrome??
    • life threatening
    • occurs rarely and is dose dependent.

    Presents with fever, renal failure, and vasculitis, Mortality around 20%
  24. What should you remember with geriatrics and treatment of gout???
    • diminished renal fx and risk of adverse effects increased.
    • -begin with lowest dosage
    • -monitor renal fx
  25. Colchicine adverse reactions
    • 1.  Gastrointestinal toxicity in 80%
    • 2.  toxicity from drug s/s --- n/v, abd. discomfort and diarrhea ---these are early signs. 
    • 3.  bone marrow suppression long term
  26. What meds can you not use in peds patients?
    safety not established for colchicine and sulfinpyrazone.
  27. What drug is contradicted in children under 2 years old??
    probenecid
  28. Which drug for gout is preggo cat b?
    probenecid
  29. 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
  30. What should you teach your patients if they are taking Uricosuric agents??
    • avoid aspirin or other salicylates can cancel drug
    • -increase fluid to prevent stones
    • -notify if rash develops
  31. Allopurinol patient education
    Patients should be taught to notify their provider if they develop what symptoms??

    Large doses of what may increase kidney stones??

    Teach your patients to take their meds with ___ and ___ to increase urine output?

    How long does it take for the meds to work well?
    • notify if rash (Stevens-Johnsons syndrome with hypersensitivity), painful urination, blood in urine, irritation of eyes or swelling of lips and mouth.
    • Rash is the earliest sign of allergic reaction!!!

    • -large doses of vitamin C may increase kidney stones
    • -take with fluid and food
    • may take 6 weeks for optimal benifit
  32. Death has occurred with as little as ___ mg of colchicine
    7 mg
  33. Allopurinol has been known to  cause  ___ toxicity
    hepatotoxicity
  34. Hypersensitivity of allopurinol causes what???
    Stevens-Johnson syndrome- skin rash is earliest sign of toxicity
  35. Acute gouty arthritis sx with out peptic ulcer, treat with what??
    NSAIDS
  36. Acute gouty arthritis sx with peptic ulcer ---- tx with what??
    colchicine
  37. Acute gouty arthritis sx with kidney liver or bone marrow disease.. tx it with what???
    corticosteroids
  38. recurrent and chronic gout- overproducer tx
    allopurinol and colchicine
  39. recurrent and chronic gout- underproducer
    Uricosuric agent- probenecid

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