Gout

Question 1

Colchicine
(Lengout)

MOA

Answer 1

Antimitotic – tubulin inhibitor

• stops cell division
• ↓ Mast cell histamine release
• ↓neutrophils & chemotaxis
• ↓body tempt/ respiratory centre

-anti-inflammatory only (symptoms only)

Question 2

Colchicine

Dose and use

Answer 2

• Acute gout attacks ONLY
• Prophylaxis of acute gout attacks

1mg, then 0.5mg 1 hr later (1.5mg Max) Do not repeat within three days → These directions are new- be careful of old doctors

Question 3

Colchicine

Adverse/caution

Answer 3

GIT adverse - can make people quite sick

• renal/liver impairment makes S/E worse
• avoid with statins

Question 4

Allopurinol

MOA

Answer 4

Xanthine Oxidase inhibitor
-↓ uric acid production
-indicated for >2 attacks in 1 year
-stops conversion of xanthine to uric acid
-initially:
100mg daily WITH colchicine 0.5mg 6 months
THEN increase to 300mg if needed

Question 5

Probenecid

MOA

Answer 5

Uricosuric agents
-↑ excretion of uric acid
-stops uric acid passing back into the kidney tubule
250mg bd for 1 week, then 500mg -2g bd

-increases methotrexate in body for longer
-need to drink a lot of water
=doesnt work for lower than 50% Crcl

Question 6

Rasburicase

MOA

Answer 6

Urate-oxidase enzyme

• converts uric acid to allantoin
• a soluble form, doesn’t accumulate in joints

Question 7

Types of gout attacks

Answer 7

1. Acute gouty arthritis
   - severe pain, red, hot swollen
2. Chronic tophaceous gout
   - ongoing low grade inflammation
3. gouty nephropathy
   - uric acid build up in renal tubules
   - proteinuria

Question 8

Diet modifications

Answer 8

Food high in purines:
Alcohol, fish, seafood (shellfish)

Foods high in protein
-nuts, meat

avoid processed foods

exercise

Question 9

target serum uric acid levels

Answer 9

0.36 mmol/L