Therapeutics - Gout 2

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Therapeutics - Gout 2
2014-09-01 14:38:27
Therapeutics Gout
Therapeutics - Gout 2
Therapeutics - Gout 2
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  1. Pgp and CYP3A4 inhibitors should be avoided in what group of patients taking Colchicine?
    Renal or Hepatic dysfunction
  2. 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
  3. What concomitant disorders are cautioned with Colchicine use?
    • GI
    • Hepatic
    • Cardiac
    • Renal
  4. Is Colchicine dialyzable?
  5. What are the AE of Cochicine?
    • Bone marrow suppression
    • Neutropenia
    • Renal disorders
    • Hepatic disorders
    • Tissue necrosis
    • DIC = Disseminated intravascular coagulation
  6. What drugs are given for Intercritical gout?
  7. Can NSAIDs be given for intercritical gout?
    Lacking evidence
  8. Can Corticosteroids be given for intercritical gout?
    Lacking eveidence
  9. What is the dose of Cochicine for intercritical gout?
    0.6 mg PO QD or BID
  10. When should a patient be started on urate lowering therapy?
    • After first gout attack
    • Especially if having > or = to 2 attacks/year
  11. What is the goal of urate lowering therapy?
    < 6 mg/dL uric acid (5 is ideal in a persistent case)
  12. How do xanthine oxidase inhibitors lower uric acid?
    • Inhibition of uric acid synthesis
    • Inhibits hypoxanthine from forming xanthine
    • Inhibits xanthine form forming uric acid
  13. What are the xanthine oxidase inhibitors?
    Allopurinol and Febuxostat
  14. Can you give xanthine oxidase inhibitors to people with hepatic or renal dysfunction?
    Yes, no dose adjustments needed (because it wasn’t evaluated)
  15. What are the AE for xanthine oxidase inhibitors?
    • Increased frequency nd duration of attacks
    • GI
    • Drowsiness
    • Severe rash
    • Hepatitis
    • Nephritis
    • Eosinophila
  16. Can you use Xanthine oxidase inhibitors for acute gout?
    No, may worsen the situation
  17. What is the MOA of uricosuric agents?
    Inhibit renal tubular reabsorption of uric acid
  18. What are the AE of uricosuric agents?
    • GI
    • Hypersensitivity
    • Exacerbation fo gout attacks
    • Kidney stones
  19. How can you prohpylactically prevent kidney stone with uricosuric agents?
    Give: HCO3 or Shohl’s solution
  20. What are the uricosuric agents?
    • Probenecid (Benemid)
    • Pegloticase (Krystexxa)
  21. What is the brand name for Probenecid?
  22. Probenecid should not be given with what other drugs?
    • PCN
    • ASA
    • NSAIDs
  23. What are the CIs for Probenecid?
    • Allergic reaction or hypersensitivity
    • CrCl <50 mL/min
  24. If Probenecid is CI, what other drug would you consider for a urate lowering therapy?
  25. What drugs can be used for urate lowering therapy?
    • Xanthine oxidase inhibitors
    • Uricosuric drugs
  26. What is the brand name for Pegloticase?
  27. What is the MOA for Pegloticase (Krystexxa)?
    • Recombinant uricase
    • Catalyzes oxidation of uric acid to allantoin
    • Increases Allantoin renal excretion
  28. What is pegloticase (Krystexxa) sued for?
    Chronic gout when refractory to conventional therapy
  29. 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
  30. What are the treatment options for Nephrolithiasis?
    • Hydration
    • Avoidancew of purine rich foods
    • Urine alkalization to >6-6.5
  31. 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))
  32. What is the mainstay drug for treatment of recurrent Nephrolithiasis?
    Allopurinol (Zyloprim)
  33. What is the carbonic anyhydrase inhibitor for treatement of nephrolithiasis?
    Acetazolamide (Diamox)
  34. What is the MOA of acetazolamide (Diamox)?
    • Increases reabsorption of H+ and increases secretion of HCO3-
    • Urinary alkylization
  35. What is the brand name of Acetazolamide?