Updated: 10/14/2020

Gout Drugs

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
3 3
0
0
0%
0%
Evidence
1 1
0
0
Topic
Overview

Snapshot
  • A 50-year-old man presents 4 months after an acute gout flare to his primary care physician. Since then, he has had 2 more episodes of minor flares that resolved on its own. He reports wanting better control of this disease. His physician describes several options for chronic gout and suggests allopurinol as a good first-line option.
Introduction
  • Chronic gout drugs
    • mechanism of action
      • prevents the build up of uric acid
    • drugs
      • allopurinol
      • febuxostat
      • pegloticase
      • probenecid
  • Acute gout drugs
    • mechanism of action
      • reduces inflammation
    • drugs
      • nonsteroidal anti-inflammatory drugs (NSAIDs)
      • glucocorticoids (oral, intra-articular, and parenteral)
      • colchicine
  • Drugs to avoid
    • low-dose salicylates
      • decreases uric acid excretion, which may precipitate gout
Allopurinol
  • Mechanism of action
    • competitive inhibition of xanthine oxidase, which decreases production of urate  
  • Clinical use
    • chronic gout
    • prevention of urate nephropathy from tumor lysis syndrome in lymphoma and leukemia
  • Toxicity
    • ↑ accumulation of azathioprine and 6-mercaptopurine (MP)
      • both are metabolized by xanthine oxidase
    • drug rash
Febuxostat
  • Mechanism of action
    • inhibition of xanthine oxidase
  • Clinical use
    • chronic gout
  • Toxicity
    • ↑ accumulation of azathioprine and 6-MP
    • some hepatotoxicity
Pegloticase
  • Mechanism of action
    • pegloticase is a recombinant uricase
      • catalyzes metabolism of uric acid to allantoin, which is more water-soluble
  • Clinical use
    • chronic gout
  • Toxicity
    • risk of new gout flare
    • infusion reactions
Probenecid
  • Mechanism of action
    • inhibition of proximal convoluted tubule resorption of uric acid
  • Clinical use
    • chronic gout
  • Toxicity
    • uric acid calculi
      • this should only be used in uric acid underexcreters and should be avoided in patients who are uric acid overproducers 
      • a history of prior uric acid stones is a contraindication for initiating this agent
    • prolonged penicillin serum levels
      • inhibition of proximal convoluted tubule secretion of penicillin
Colchicine
  • Mechanism of action
    • inhibition of microtubule polymerization by binding to tubulin, which impairs neutrophil chemotaxis and degranulation and decreases inflammation
  • Clinical use
    • acute and chronic gout
  • Toxicity
    • gastrointestinal irritation
Topic Rating

Please rate topic.

Average 4.9 of 7 Ratings

 

Questions (3)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M1.MK.17.4740) A 45-year-old male presents to the emergency room for toe pain. He reports that his right great toe became acutely painful, red, and swollen approximately five hours prior. He has had one similar prior episode six months ago that resolved with indomethacin. His medical history is notable for obesity, hypertension, and alcohol abuse. He currently takes hydrochlorothiazide (HCTZ). On physical examination, his right great toe is swollen, erythematous, and exquisitely tender to light touch. The patient is started on a new medication that decreases leukocyte migration and mitosis, and his pain eventually resolves; however, he develops nausea and vomiting as a result of therapy. Which of the following underlying mechanisms of action is characteristic of this patient’s new medication? Tested Concept

QID: 108658
1

Inhibits microtubule polymerization

38%

(105/274)

2

Prevents conversion of xanthine to uric acid

30%

(81/274)

3

Decreases phospholipase A2-induced production of arachidonic acid

6%

(16/274)

4

Decreases cyclooxygenase-induced production of prostaglandins

19%

(53/274)

5

Metabolizes uric acid to water-soluble allantoin

4%

(12/274)

M 1 B

Select Answer to see Preferred Response

(M1.MK.15.4666) A 54-year-old male has a history of gout complicated by several prior episodes of acute gouty arthritis and 3 prior instances of nephrolithiasis secondary to uric acid stones. He has a serum uric acid level of 11 mg/dL (normal range 3-8 mg/dL), a 24 hr urine collection of 1300 mg uric acid (normal range 250-750 mg), and a serum creatinine of 0.8 mg/dL with a normal estimated glomerular filtration rate (GFR). Which of the following drugs should be avoided in this patient? Tested Concept

QID: 107094
1

Naproxen

12%

(9/73)

2

Colchicine

14%

(10/73)

3

Allopurinol

14%

(10/73)

4

Indomethacin

14%

(10/73)

5

Probenecid

47%

(34/73)

M 3 E

Select Answer to see Preferred Response

Evidence (1)
Topic COMMENTS (27)
Private Note