Therapeutics - Gout 2
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Pgp and CYP3A4 inhibitors should be avoided in what group of patients taking Colchicine?
Renal or Hepatic dysfunction
Pgp and CYP3A4 inhibitors can be given at a lower dose in what group of patients taking Colchicine?
Any patients with normal hepatic or renal function
What concomitant disorders are cautioned with Colchicine use?
Is Colchicine dialyzable?
What are the AE of Cochicine?
- Bone marrow suppression
- Renal disorders
- Hepatic disorders
- Tissue necrosis
- DIC = Disseminated intravascular coagulation
What drugs are given for Intercritical gout?
Can NSAIDs be given for intercritical gout?
Can Corticosteroids be given for intercritical gout?
What is the dose of Cochicine for intercritical gout?
0.6 mg PO QD or BID
When should a patient be started on urate lowering therapy?
- After first gout attack
- Especially if having > or = to 2 attacks/year
What is the goal of urate lowering therapy?
< 6 mg/dL uric acid (5 is ideal in a persistent case)
How do xanthine oxidase inhibitors lower uric acid?
- Inhibition of uric acid synthesis
- Inhibits hypoxanthine from forming xanthine
- Inhibits xanthine form forming uric acid
What are the xanthine oxidase inhibitors?
Allopurinol and Febuxostat
Can you give xanthine oxidase inhibitors to people with hepatic or renal dysfunction?
Yes, no dose adjustments needed (because it wasn’t evaluated)
What are the AE for xanthine oxidase inhibitors?
- Increased frequency nd duration of attacks
- Severe rash
Can you use Xanthine oxidase inhibitors for acute gout?
No, may worsen the situation
What is the MOA of uricosuric agents?
Inhibit renal tubular reabsorption of uric acid
What are the AE of uricosuric agents?
- Exacerbation fo gout attacks
- Kidney stones
How can you prohpylactically prevent kidney stone with uricosuric agents?
Give: HCO3 or Shohl’s solution
What are the uricosuric agents?
- Probenecid (Benemid)
- Pegloticase (Krystexxa)
What is the brand name for Probenecid?
Probenecid should not be given with what other drugs?
What are the CIs for Probenecid?
- Allergic reaction or hypersensitivity
- CrCl <50 mL/min
If Probenecid is CI, what other drug would you consider for a urate lowering therapy?
What drugs can be used for urate lowering therapy?
- Xanthine oxidase inhibitors
- Uricosuric drugs
What is the brand name for Pegloticase?
What is the MOA for Pegloticase (Krystexxa)?
- Recombinant uricase
- Catalyzes oxidation of uric acid to allantoin
- Increases Allantoin renal excretion
What is pegloticase (Krystexxa) sued for?
Chronic gout when refractory to conventional therapy
Describe the mandatory administration procedure of Pegloticase (Krystexxa):
- Administered over no less than 2 hours by gravity feed or pump in a HC seting
- Premedicate with an antihistamine AND corticosteroid
What are the treatment options for Nephrolithiasis?
- Avoidancew of purine rich foods
- Urine alkalization to >6-6.5
How can you alkalize the urine in a case of nephrolithiasis?
- Give HCO3 or K-citrate 60-80 mEq/day
- Avoid sodium
- Allopurinol (Zyloprim)
- Carbonic anhydrase inhibitor (Acetazolamie (Diamox))
What is the mainstay drug for treatment of recurrent Nephrolithiasis?
What is the carbonic anyhydrase inhibitor for treatement of nephrolithiasis?
What is the MOA of acetazolamide (Diamox)?
- Increases reabsorption of H+ and increases secretion of HCO3-
- Urinary alkylization
What is the brand name of Acetazolamide?
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