Therapeutics - Gout 1
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What level of Urate in the body exceeds the limit of solubility?
> or = to 7 mg/dL
How does Hyperurecemia differ from gout?
Gout is Hyperurecemia and arthritis
Uric acid follows what ion in excretion/reabsorbtion?
What main drugs cause Drug-induced uric acid accumulation?
- Nicotinic acid
- Cytotoxic drugs
What is the name for the first Gouty attack?
If gout is left untreated, what would the peak and duration of the attack be?
- Peak: 24-48 hours
- Duration: 3-14 days
What is the first line medication for acute Gout?
How do NSAIDs and Cholcicine compare for Gout treatment?
- Equal in efficacy
- NSAIDs are less toxic
What are the MOAs for NSAID treatment of acute gout?
Inhibits pain Decreases inflammation
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
How long until acute gout resolution after an acute attack is treated with NSAIDs?
Up to 1 week
Which drugs are FDA approved for acute Gout treatment?
- Indomethacin (Indocin)
- Naproxen (Naprosyn)
- Naproxen Na (Anaprox)
- Sulindac (Clinoril)
Brand name indomethacin
What is the dose of Indomethacin for acute Gout?
50 mg PO TID
What concomitant disease should be monitored if you are using an NSAID for acute Gout?
What is the brand name for Naproxen
What is the brand name for Naproxen Na?
What is the brand name for Sulinidac?
Which NSAIDs are not FDA approved for Gout but are used at times?
When would you use Celecoxib for acute Gout?
If other NSAIDs are not tolerated
Under what conditions is Celecoxib equivalent to Indomethacin for acute Gout?
- When Celecoxib is given at 800 mg
- (2x greater than a normal dose)
What classes of drugs are used to treat gout?
- Xanthine oxidase inhibitors
- Uricosuric agents
- Carbonic anhydrase inhibitors
How do Corticosteroids treat acute gout?
- Bind to receptors
- Alter gene expression
- Decrease inflammation
How do Corticosteroids and NSAIDs compare for treatment of acute gout?
What corticosteroids are FDA approved to treat acute gout?
- Predinosine (Deltasone)
- Methylprednisone (Solu-Medrol)
- Triamcinolone hexacetamide
- Dexamethasone (Decadon)
What is the brand name for Predinosine
What is the brand name for Methylprednisone
What is the brand name for Dexamethasone
What are the AE with long term use of corticosteroids in the treatment of acute gout?
- Muscle deconditioning
- Endocrine disorders (HPA-axis)
Use Corticosteroids for acute gout with caution with what disorders?
- Bleeding disorders
- CV (HTN, fluid retention)
- Psychiatric disorders
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
What I sthe brand name of Colchicine?
When must you give Colchicine after the cessation of an acute gouty attack?
What drug classes are available for Acute Gout?
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
Why does Colchicine have many AEs?
- Substrate for intestinal CYP3A4
- Limited absorption due to Pgp
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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