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16 Cards in this Set
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Symptoms for acute gout attack?
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Abrupt onset of inflammation (mostly the big toe or ankle)
Podagra Urate crystals in synovial fluid of involved joint. |
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Tx for acute gout?
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***C-SIN
Colchicine Steroids Indomethacin NSAIDS |
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Tx of hyperuricemia? MoA?
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Uricosuric Drugs - competitively inhibits active reabsorption of uric acid at the proximal convoluted tubule; this is for prevention.
Xanthine Oxidase Inhibitors - lowering xanthine oxidase results to lower production of uric acid. |
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What are the Uricosuric drugs?
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Probenecid (Benemid)
Sulfinpyrazone |
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What are the Xanthine Oxidase Inhibitors drugs?
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Allopurinol
Febuxostat (Uloric) |
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MoA for Colchicine? Dosing? Contraindications?
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MoA: Inhibits cell division in the metaphase
Dose: TWO (0.6mg) tabs followed by 1 tab an hour later for a gout flare Max: 3 tabs total Contraindicateds: Inhibitors, Renal/Hepatic impairment, grapefruit/grapefruit juice |
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Cochicine SE?
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Colchicine (Colchrys)
***GRAB-Me GI - N/V/D Renal Alopecia Bone Marrow Suppression (monitor for bleeding/bruising, infections) Malabsorption - B12, fat, sugar |
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What is an alternative Gout medication for patients with poor renal function? Dosing?
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Corticosteroids
Injection: - Methylprednisolone: 5-25mg/joint - Triamcinolone: 8-10mg/joint - Betamethasone: 3-6mg Oral: - Prednisone 30-50mg/day, tapering within 7-10 days |
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Steroid SE
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***PREDNISONE
PUD Rash Eye (glaucoma) Diabetes Neurologic (CNS) Immunosuppresant Swelling (Cushing's) Osteoporosis Nausea Electrolyte changes (Increases Na+, Decreases K+) |
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What is Benemid? Dose? Avoid in what kind of patients?
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Probenecid (Benemid)
Dose: 250mg BID 1st week, then 500mg BID Max: 2g/day Not effective in patients with CrCl <50mL/min. Avoid in patients with h/o of renal stones, who excrete >1000mg of uric acid/day |
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How do you avoid risk of uric acid deposition in the renal tubules?
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Drink lots of water
Maintain alkaline urine (Sodium Bicarbonate 1gram TID) |
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Allopurinol dosing? With or without food?
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Allopurinol is taken with food to decrease GI effects.
Start: 50 - 100mg/day and increase every 3-4 days Max: 800mg/day |
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What is the Allopurinol dosing for renally impaired patients?
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CrCl >60mL/min, 300mg/day
CrCl 10 - 20mL/min, 200mg/day CrCl <10mL/min, 100mg/day |
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Allopurinol drug interactions
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Azathioprine
6-MP: Warfarin: increases effects of warfarin Thiazide & ACEi: increase hypersensitivity risk Vitamin C: urine acidification |
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What is Uloric? Dose?
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Uloric (febuxostat)
Start: 40mg then increase to 80mg/day after 2 weeks if uric acid is not below 6mg/dL |
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What do you monitor with Uloric?
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LFT's
Renal - it is eliminated by hepatic and renal route |
