DCPA Gout Pharm
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| Gout S&S | Sudden Onset. Monarticular - most common = MTP. Familial & associated with foods & drinks high in Purines (ETOH). Tophus - Crystals in joint. High Uric Acid level (Metabolic-overproduction or renal - underexcretion)
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| Gout Tx - Acute Arthritis | NSAIDs (Indocin &/or COX-2 Inhibitor), Colchicine, Steroirds, Opiod & Bed Rest
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| Gout Tx - Hyperuricemia | Colchicine, Probenecid & allopurinol
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| Gout Type - Metabolic | Overproducer > 800mg uric acid in urine
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| Gout Type - Renal | Underexcretion < 800 mg uric acid in urine
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| Colchicine MOA | Decreases leukocyte motility, phagocytosis, & deposition of uric acid in joints.
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| Colchicine Pregnancy Category | C
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| Colchicine Response time | 24-48 hours - oral & 6-12 hours IV.
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| Colchicine Contraindications | Liver or Renal Dz.
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| Colchicine SE | N/V, anorexia, diarrhea & allopecia
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| Colchicine decrease absorption... | B12
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| Colchicine avoid... | Alcohol & ASA
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| Probenecid | Benemid, Probalan
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| Probenecid (Benemid, Probalan) MOA | Inhibits reabsorption of uric acid = increased excretion.
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| Probenecid (Benemid, Probalan) Form & Onset | Tablet - 2 hours
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| Probenecid (Benemid, Probalan) Contraindications | Children < 2 y.o., uric acid stones, Creatinine > 2mg/dl.
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| Probenecid (Benemid, Probalan) Pregnancy Category | B
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| Probenecid (Benemid, Probalan) SE | HA, Fever, Anorexia, Flushing, Itching, Renal Calculi & Leukopenia
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| Probenecid (Benemid, Probalan)avoid | DM, ASA, PCN (penicillin) & Indocin
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| Allopurinol | Zyloprim
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| Allopurinol (Zyloprim) MOA | Inhibits Xanthine Oxidase - decrease uric acid production (Reduces uric acid without affecting purines & DNA synthesis)
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| Allopurinol (Zyloprim) Contraindications | Acute gouty attack, allergy, pregnancy & lactation
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| Allopurinol (Zyloprim) Pregnancy Category | C
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| Allopurinol (Zyloprim) Form & Onset | Tablet: 1-2 days
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| Allopurinol (Zyloprim) SE | Pruritic Rash, Vasculitis, hepatitis & drug rash with ampicillin. Drowsiness
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| Allopurinol (Zyloprim) affected by... | alcohol decreases the effectivness
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| Febuxostat | Uloric
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| Febuxostat (Uloric) MOA | Inhibits Xanthine Oxidase - decrease uric acid production (Reduces uric acid without affecting purines & DNA synthesis)
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| Febuxostat (Uloric) Initially Response | Increase gout flare ups
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| Febuxostat (Uloric) SE | Cardiac/thrombolitic events, increases LFTs, Nausea & Rash
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| Febuxostat (Uloric) Pro vs. Allopurinol (Zyloprim) | Less DI - None with Warfarin
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