Gout

• what medications (3) risk for gout?

  ASA, diuretics, cyclosporine
• what race is high risk for gout?

  polynesian race
• what is tophi?


  monosodium urate cyrstal- containing deposits in subq tissue of antihelix of ears and extensor aspect of elbow
• what are the first line of treatment for gout?

  NSAIDs, Cholchine, steroids, Interleukin-1 inhibitors, adrenocorticotropic hormone
• what three NSAIDs used for gout?

  Indomethacin, Naproxen, and Diclofenac
• what two metabolizers metabolize cholchine?

  CYP3A4 and CYP450
• does cholchine decrease or remove urate production?

  no
• what is the MOA of cholchine?

  inhibiting leukocyte infiltration that prevents lysosomal enzymes
• what are drug interactions with cholchine?

  statins, PGP inhibitors, and inhibitors of CYP3A4
• what should you test for in southeast asian or african american decent before starting allopurinol?

  HLA-B*5801
• what drug is the drug of choice for chronic gout?

  allopurinol
• what are the uses of allopurinol?

  reduces blood uric level

  prevents new tophus formation and regresses current tophi

  allows joint function to improve

  decrease the risk of nephropathy from urate crystals
• allopuruinol reduces hyperuricemia in what conditions?

  chemotherapy

  polycythemia vera

  myeloid metaplasia

  leukemia
• What enzyme does allopurinol inhibit?

  xanthine oxidase (XO)
• what medications have drug interactions does allopurinol have?

  warfarin, ampicillin, mercaptopurine, and theophyllin
• what drug interactions does allopurinol have?

  inhibits metabolism of warfarin, cause increase of warfarin in the body

  high incidence of rash with ampicillin

  causes azathiprine leves to increase with mercaptopurine

  inhibits metabolism of theophyllin, causing in theophyllin
• what is the MOA of Febuxostat?

  inhibits Xanthine oxidase
• Do not give Febuoxstat if they have this condition

  cardiovascular issues
• what is Probenecid MOA?

  acts on renal tubules to inhibit reabsorption of uric acid

  prevents formation of new tophi and diminish existing tophi
• how can you minimize kidney damage with Probenecid?

  alkalinizing urine

  drinking 2.5-3L per day in the first days of treatment
• What drug interactions are with Probenecid?

  Aspirin lessens the benefits of Probenecid
• What medication is given IV and last resort for gout?

  Pegloticase