Gout

Question 1

Acute gout

Answer 1

anti-inflammatory

DOC: NSAIDs- all except Aspirin and Paracetamol

resistant- Colchicine

still resistant - corticosteroid (intrarticular inj)

Question 2

Colchicine

Answer 2

1. acute gout (inhibits microtubules and prevents migration of wbcs)
2. karyotyping (spindle poison which arrests cell cycle at metaphase)

SE- git ulcer and diarrhoea, bone marrow suppression

Question 3

Chronic gout

Answer 3

reduce uric acid in blood

1. xanthine oxidase inhibitor - Allopurinol, Oxypurinol, Febuxostat
2. degrades uric acid in blood: uric acid oxidase enzyme (degrades into allantoin)- Rasburicase, Pegluticase
3. inhibits OATP(organic anion transport protein)/ URAT 1( uric acid transporter) transporter - uricos uric drugs - Probenecid (contraindicated in renal failure), Benzbromarone (safe in renal failure, contraindicated in liver failure), Sulfinpyrizone(additional NSAID like activity and can be given for acute attack also), Lesinurad
   SE- uric acid stones (given with plenty of water)

Question 4

conditions which cause hyperuricemia

Answer 4

CKD
cancer or tumour lysis syndrome
drug induced gout - loop/thiazide diuretics , niacin

Question 5

Allopurinol

Answer 5

historically, treatment of kala azar (Leishmania)

oral, iv

competitive inhibitor

SE:
hypersensitivity in HLA B 1502 patients
hepatotoxic
bone marrow suppression

CYP inhibitor

increases toxicity of Warfarin(CYP inhibito), azathioprine, 6 mecaptopurine (xanthine oxidase inhibitor)

Question 6

Febuxostat

Answer 6

non competitive inhibitor

adv- no hypersensitivity

Question 7

Allopurinol hypersensitivity

Answer 7

DOC - Febuxostat

Question 8

Allopurinol resistance

Answer 8

DOC - Pegloticase/Rasburicase

Question 9

Drugs causing gout

Answer 9

Pyrazinamide (antitubercular drug)
Aspirin (low dose <2g per day)
Cyclosporin
Niacin
Ethambutol
Diuretics - loop/thiazide

Question 10

Drugs beneficial in gout

Answer 10

Fenofibrate
Aspirin (high>5g per day)
Losartan
Statins