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Let’s start our USMLE Review with Drugs of Choice from the Gold Standard USMLE Step 2 Audio Review program.
Play USMLE Audio MP3 20 04 Drugs of Choice Gout Below
In terms of therapy for an acute attack of gout, in patients who have normal renal function, and who are not elderly, what class of drugs is probably the class of choice for immediate acute treatment?
- The NSAIDs, and in particular, what is the NSAID of choice? Indomethacin.
And the trade name for Indomethacin?
There are many other NSAIDs that can also be used. Unfortunately, there are way too many to try to memorize. I’ll just pick out a few that I have seen preceptors use quite frequently.
What is the NSAID for which the brand name is Motrin?
- This is Ibuprofen.
What is the NSAID for which the brand name is Lodine?
- This is Etodolac.
And what is the NSAID for which the brand name is Naprosyn?
- This is Naproxen.
And the NSAID for which the brand name is Voltaren?
- This is Diclofenac.
And the NSAID for which the trade name is Daypro?
What is the drug of choice for injecting into a gouty joint, where there is not arthritis?
- This is methylprednisolone.
And the trade name for methylprednisolone?
For patients that NSAIDs should not be given to, including those with renal insufficiency.
What other agent may be used instead of NSAIDs in a gel formation injected intramuscularly or subcutaneously?
What does ACTH stand for?
- Adrenocorticotropic hormone.
And what structure does it work on?
- The adrenal cortex.
And what does it cause to be released?
- Endogenous corticosteroids.
In patients that can be given NSAIDs, but where corticosteroids are contraindicated, including ACTH, what stronger forms of NSAIDs can you use?
- NSAIDs that are in combinations with opioids.
What is probably the best known and most popular combination?
- Acetaminophen with Propoxyphene.
And the trade name for the combination Acetaminophen with Propoxyphene?
If Darvocet is not sufficient, a stronger dose of opioid can be used instead. What are 2 popular choices?
- Propoxyphene or Meperidine.
What is the trade name for Propoxyphene by itself?
By the way, there is a Darvon compound including salicylates, that’s a different drug. And what is the trade name for Meperidine by itself?
What older drug used to be the drug of choice for the initial treatment of acute gout, but is now used much less frequently due to its toxic side effects?
What is the trade name of a combination drug combining Colchicine with a uric acid lowering drug?
What are the 3 common side effects that can occur with Colchicine?
- Nausea, vomiting, diarrhea.
What is the serious side effect that can occur with Colchicine, especially when it is administered intravenously?
- Marrow suppression.
What class of drugs may you wish to put the patient on if they are subject to recurrent episodes of gout, despite the treatments already described?
- Uric acid lowering agents.
In general, what are the 2 types of uric acid lowering agents? Those that increase excretion of uric acid by decreasing the tubular reabsorption of uric acid, and those that lower serum uric acid levels by preventing the production of uric acid by inhibiting what enzyme?
- Xanthene oxidase.
What is the term for the class of uric acid lowering agents which decrease tubular reabsorption?
- These are the uricosuric agents.
And what are 2 uricosuric drugs presently in use?
- Probenecid and Sulfinpyrazone.
What is the trade name for Probenecid?
And the trade name for Sulfinpyrazone?
Which is the drug of choice?
If the patient has renal insufficiency, or other renal problems such as nephrolithiasis, the uricosuric agents are contraindicated.
What alternative agent may be used?
And what type of agent is Allopurinol?
- A Xanthene oxidase inhibitor.
And what is the trade name for Allopurinol?
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