Therapeutics - Gout 1

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kyleannkelsey
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281818
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Therapeutics - Gout 1
Updated:
2014-09-01 14:37:35
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Therapeutics Gout
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Therapeutics - Gout 1
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Therapeutics - Gout 1
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  1. What level of Urate in the body exceeds the limit of solubility?
    > or = to 7 mg/dL
  2. How does Hyperurecemia differ from gout?
    Gout is Hyperurecemia and arthritis
  3. Uric acid follows what ion in excretion/reabsorbtion?
    Na
  4. What main drugs cause Drug-induced uric acid accumulation?
    • Diuretics
    • Nicotinic acid
    • Salicylates
    • Alcohol
    • Pyrazinamide
    • Levodopa
    • Ethambutol
    • Cytotoxic drugs
    • Cyclosporine
  5. What is the name for the first Gouty attack?
    Podagra
  6. If gout is left untreated, what would the peak and duration of the attack be?
    • Peak: 24-48 hours
    • Duration: 3-14 days
  7. What is the first line medication for acute Gout?
    NSAIDs
  8. How do NSAIDs and Cholcicine compare for Gout treatment?
    • Equal in efficacy
    • NSAIDs are less toxic
  9. What are the MOAs for NSAID treatment of acute gout?
    Inhibits pain Decreases inflammation
  10. Describe the treatment commencement, cessation and duration for acute gout:
    • Start w/in 24 hours of attack onset
    • Continue until symptoms resolve
    • Taper if hepatic/renal dysfunction
  11. How long until acute gout resolution after an acute attack is treated with NSAIDs?
    Up to 1 week
  12. Which drugs are FDA approved for acute Gout treatment?
    • Indomethacin (Indocin)
    • Naproxen (Naprosyn)
    • Naproxen Na (Anaprox)
    • Sulindac (Clinoril)
  13. Brand name indomethacin
    Indocin
  14. What is the dose of Indomethacin for acute Gout?
    50 mg PO TID
  15. What concomitant disease should be monitored if you are using an NSAID for acute Gout?
    CV disease
  16. What is the brand name for Naproxen
    Naprosyn
  17. What is the brand name for Naproxen Na?
    Anaprox
  18. What is the brand name for Sulinidac?
    Clinoril
  19. Which NSAIDs are not FDA approved for Gout but are used at times?
    Celecoxib
  20. When would you use Celecoxib for acute Gout?
    If other NSAIDs are not tolerated
  21. Under what conditions is Celecoxib equivalent to Indomethacin for acute Gout?
    • When Celecoxib is given at 800 mg
    • (2x greater than a normal dose)
  22. What classes of drugs are used to treat gout?
    • NSAIDs
    • Corticosteroids
    • Colchicine
    • Xanthine oxidase inhibitors
    • Uricosuric agents
    • Carbonic anhydrase inhibitors
  23. How do Corticosteroids treat acute gout?
    • Bind to receptors
    • Alter gene expression
    • Decrease inflammation
  24. How do Corticosteroids and NSAIDs compare for treatment of acute gout?
    Comparable
  25. What corticosteroids are FDA approved to treat acute gout?
    • Predinosine (Deltasone)
    • Methylprednisone (Solu-Medrol)
    • Triamcinolone hexacetamide
    • Cortisone
    • Dexamethasone (Decadon)
  26. What is the brand name for Predinosine
    Deltasone
  27. What is the brand name for Methylprednisone
    Solu-Medrol
  28. What is the brand name for Dexamethasone
    Decadon
  29. What are the AE with long term use of corticosteroids in the treatment of acute gout?
    • Osteoporosis
    • Cataracts/glaucoma
    • Muscle deconditioning
    • Endocrine disorders (HPA-axis)
  30. Use Corticosteroids for acute gout with caution with what disorders?
    • DM
    • GI
    • Bleeding disorders
    • CV (HTN, fluid retention)
    • Psychiatric disorders
  31. What is the MOA of Colchicine in the treatment of acute gout?
    • Prevents phagocytosis of urate crystals by leukocytes
    • Reduces release of lactic acid from leukocytes stopping disposition of urate crystal formation
  32. What I sthe brand name of Colchicine?
    Colcrys
  33. When must you give Colchicine after the cessation of an acute gouty attack?
    Within 36hours
  34. What drug classes are available for Acute Gout?
    • NSAIDs
    • Corticosteroids
    • Colchicine
  35. What is the dose of Colchicine (Colcrys) for acute gout?
    • 1.2 mg once
    • 0.6 mg 1 hour later
    • In 12 hours start giving a prophylactic dose of 0.6 mg PO QD or BID
  36. Why does Colchicine have many AEs?
    • Substrate for intestinal CYP3A4
    • Limited absorption due to Pgp
  37. If a patient is on Colchicine and has renal or hepatic insufficiency, what precautions should you take?
    Avoid pgp and CYP3A4 inhibitors

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