GOUT

Question 1

What is the drug group for Colchicine?

Answer 1

Anti-inflammatory (anti-mitotic agent)

Colchicine is primarily used for its anti-inflammatory properties.

Question 2

What is the mechanism of action (MOA) of Colchicine?

Answer 2

Inhibits phagocytosis; arrests cell division in G1 via microtubule/spindle inhibition; ↓ neutrophil motility; ↓ chemotactic factor release

This mechanism helps reduce inflammation and pain in conditions like gout.

Question 3

List some adverse effects (A/E) of Colchicine.

Answer 3

• Diarrhoea
• Nausea
• Vomiting
• Abdominal pain
• Bone marrow toxicity
• Hair loss

These side effects can vary in severity among individuals.

Question 4

What are the indications for using Colchicine?

Answer 4

• Acute gout (especially if NSAIDs are contraindicated)
• Used with NSAIDs for severe pain
• Prophylaxis in recurrent gout

Colchicine is often considered when other treatments are not suitable.

Question 5

What are the contraindications (CI) for Colchicine?

Answer 5

• Hypersensitivity
• Severe GI, renal, hepatic, or cardiac disease
• Blood dyscrasias

These conditions may worsen with Colchicine use.

Question 6

What is the drug group for NSAIDs such as Indomethacin, Diclofenac, and Ibuprofen?

Answer 6

Non-selective COX inhibitors

These drugs are commonly used to reduce pain and inflammation.

Question 7

What is the mechanism of action (MOA) of NSAIDs?

Answer 7

Inhibit COX → ↓ prostaglandins → ↓ pain & inflammation

This action helps to alleviate symptoms of pain and inflammation.

Question 8

List some adverse effects (A/E) of NSAIDs.

Answer 8

• GI ulcers/bleeding

The reduction of prostaglandins in the gastric mucosa can lead to gastrointestinal issues.

Question 9

What are the indications for NSAIDs?

Answer 9

• Acute gout flares

NSAIDs are often first-line treatments for managing acute pain in gout.

Question 10

What is a contraindication (CI) for NSAIDs?

Answer 10

Avoid Aspirin (low doses worsen gout, high doses uricosuric but toxic)

Aspirin can complicate the management of gout.

Question 11

What is the drug group for COX-2 Inhibitors like Etoricoxib and Celecoxib?

Answer 11

COX-2 Selective inhibitors

These drugs are designed to target inflammation with fewer gastrointestinal side effects.

Question 12

What is the mechanism of action (MOA) of COX-2 Inhibitors?

Answer 12

Selective COX-2 inhibition → anti-inflammatory effect

This selectivity aims to reduce the risk of gastrointestinal toxicity.

Question 13

List some adverse effects (A/E) of COX-2 Inhibitors.

Answer 13

• Gastroduodenal toxicity
• Cardiotoxicity
• Not more effective than NSAIDs

While COX-2 inhibitors are safer for the stomach, they can pose cardiovascular risks.

Question 14

What are the indications for COX-2 Inhibitors?

Answer 14

• Moderate pain & inflammation in gout

These medications can be used when traditional NSAIDs are not suitable.

Question 15

What are the contraindications (CI) for COX-2 Inhibitors?

Answer 15

Pre-existing heart disease (CAD, etc.); GI disease caution

Patients with these conditions require careful assessment before using COX-2 inhibitors.

Question 16

What is the drug group for Allopurinol?

Answer 16

Xanthine oxidase inhibitor

Allopurinol is primarily used to lower uric acid levels.

Question 17

What is the mechanism of action (MOA) of Allopurinol?

Answer 17

Inhibits XO → ↓ uric acid production

This action helps prevent gout attacks by lowering uric acid levels.

Question 18

List some adverse effects (A/E) of Allopurinol.

Answer 18

• Rash
• GIT upset
• Rare bone marrow suppression
• Precipitates acute gout
• Allopurinol Hypersensitivity Syndrome (AHS)

AHS can be severe, leading to complications like renal failure.

Question 19

What are the indications for Allopurinol?

Answer 19

• Chronic gout
• Tumour lysis syndrome prophylaxis

Allopurinol is used for long-term management of hyperuricemia.

Question 20

What are the contraindications (CI) for Allopurinol?

Answer 20

Renal insufficiency (avoid/reduce dose)

Dosing adjustments are necessary in patients with kidney issues.

Question 21

What are some drug interactions (DI) with Allopurinol?

Answer 21

• ↓ clearance of mercaptopurine (6-MP)
• Cyclophosphamide ↑ marrow depression
• ↑ hypersensitivity with thiazides/ACEi
• Rash with ampicillin

These interactions can lead to increased toxicity or reduced efficacy.

Question 22

What is the drug group for Febuxostat?

Answer 22

Non-purine selective XO inhibitor

Febuxostat is an alternative to Allopurinol for managing uric acid levels.

Question 23

What is the mechanism of action (MOA) of Febuxostat?

Answer 23

Inhibits XO → ↓ uric acid production

Similar to Allopurinol, it reduces uric acid levels.

Question 24

List some adverse effects (A/E) of Febuxostat.

Answer 24

• Diarrhoea
• Hypertension
• Neurological symptoms
• Muscle symptoms (dose-related)

Patients may experience varying side effects, particularly at higher doses.

Question 25

What are the indications for Febuxostat?

Answer 25

Chronic management of hyperuricemia in gout ## Footnote It is often used when Allopurinol is not suitable or tolerated.

Question 26

What are some drug interactions (DI) with Febuxostat?

Answer 26

↑ levels/toxicity of mercaptopurine, azathioprine, theophylline (via XO inhibition) ## Footnote These interactions require careful monitoring of drug levels.

Question 27

What is the drug group for Probenecid?

Answer 27

Uricosuric agent ## Footnote Probenecid is used to increase uric acid excretion.

Question 28

What is the mechanism of action (MOA) of Probenecid?

Answer 28

Inhibits uric acid reabsorption in PCT → ↑ urate excretion ## Footnote This mechanism helps lower uric acid levels in the body.

Question 29

List some adverse effects (A/E) of Probenecid.

Answer 29

* GI irritation * Rash * Nephrotic syndrome ## Footnote These side effects can affect patient compliance.

Question 30

What are the indications for Probenecid?

Answer 30

Chronic gout (urate-lowering) ## Footnote It is often used in conjunction with other therapies.

Question 31

What are some drug interactions (DI) with Probenecid?

Answer 31

↓ secretion of weak acids (penicillin, acyclovir → ↑ plasma levels, sometimes beneficial) ## Footnote This effect can be utilized therapeutically in some cases.