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29 Cards in this Set
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Who do u treat for hyperuricemia?
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3-4 attack in a year, tophi, nephropathy, nephrolitiasis NOT ASYMPTOMATIC HYPERURICEMIA
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Tmt goals for hyperuricemia?
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uric acid <6 mg/dl, prevent complications, prevent gouty attacks
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What drugs are used to treat symptomatic hyperuricemia?
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allopurinol, probenacid, feboxostat (not yet approved) rasburicase (ELITEK)
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moa allopurinol?
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xanthine oxidase inhibitor-good for overproducers and underexcretors
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Dose of allopurinol?
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300 mg daily adjusting for renal dysfuntion b/c metabolite oxypurinol is renally excreted and is myelosuppressive
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Monitoring of allopurinol?
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uric acid, crcl, rash (top 5 drugs causing SJS-if pt has rash must DC b/c TENS could develop)
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Drug interactions with allopurinol?
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6MP/azithroprine must be dec by 50% due to BMS; ACE- hypersensitivity; warfarin incr anticouagulant effects; Cyclophosphamide BMS, AlOH3 antacids dec absorption of allopurinol; ampicillin rash & hyoersensitivity, theophylline conc incr
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pt education with allopurinol?
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drink 10-12 glasses of h20 daily, avoid etoh & purine rich food, compliance, report rash
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probenacid moa?
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increases urate excretion by preventing renal tubular reabsorption
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probenacid CI?
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clcr< 50 ml/min; renal calculi
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dose of probenacid?
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250 mg BID for 1-2 weeks; incr by 500 mg q 1-2 weeks until satisfactory control achieved or max of 3 g/day is reached
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monitoring probenacid?
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uric acid
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Drug interactions with probenacid?
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MTX, zidovudine, penicillin/ b-lactam concentrations are increased; salicylates reduce uricosuric efffects of probenacid
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pt education probenacid?
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compliance, drink 10-12 glasses h20 daily, avoid etoh/ purine rich foods
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Febuxostat moa, dose?
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non-purine selective inhibitor of xanthine oxidase not yet approved for the treatment of symptomatic hyperuircemia dosed at 80-120 mg po qd no renal adjustment necessary, hepatic elim
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Rasburicase brand name?
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elitek
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rasburicase (elitek) indication?
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chemotherapy induced hyperuricemia generally for the ped pop in childhood leukemias
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rasburicase (elitek) moa?
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biosynthetic form of urate oxidase which is an enzyme that oxidizes uric acid to an inacative metabolite called allantoin
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rasburicase (elitek) dosing?
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0.15-0.2 mg/kg IVP ofr 5-7 days
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rasburicase adverse effects?
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hemolytic anemia, methemeglobinemia, anaphylaxis, N/V/F/D
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rasburicase (elitek) CI?
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G6PD DEFICIENCY
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What are the goals of therapy for the treatment of gout?
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terminate acute gout attack, prevent recurrent attacks of gout, prevent complications
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What durgs are used to treat acute gout attacks?
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colchicine, NSAIDS, corticosteroids
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colchicine dosing?
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1.2 mg po initially,then 0.6 mg q 2 hr until pain relief or abdominal discomfort develops. MAX TOTAL DOSE IS 8 MG PO NO MORE COLCHINE FOR 3 DAYS AFTER MAX IS REACHED!!!
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IV colchicine?
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NEW RECOMMENDATION SAYS TO AVOID IV COLCHICINE ALTOGETHER
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SES of colchicine?
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myopathy, neurotoxcity, rhabdomyalysis
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NSAID DOSING?
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indomethacin 50 mg TID for 2-3 days then taper over 5-7 days (any nsaid can be used)
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nsaid counseling?
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take with food, milk, or antacids
call doc if any unusual bleeding, bruising, sever stomach pain, bloody vomit, black/tarry/bloody stools |
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corticosteroid dosing?
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intra articular methylprednisolone
10-20 mg small joints 20-60 mgg for large joint PO prednisone 30-60 mg daily then taper over 7-10 days |
