2014 Jan - Sheet1 Flashcards
2 inhibitors of XO
allopurinol and febuxistat (Uloric)
when use which XO inhibitor?
use febuxistat with CDK of 3 or higher
mechanism of probenecid?
reduce reabsorption of urate in proximal renal tubule
target of UA?
<5-6 (depending on tophi and crystal burden)
dose to start allopurinol and why? Target dose?
with normal renal fx, start at 100 and go up every 1-2 months. Reduces hypersensitivity and reduces flares; usual maint dose is 300.
foods to avoid for gout
purine rich: organs, red meat, beer, shellfish, high fructose corn syrup, (purine rich foods no problem)
what crystals in gout?
monosodium urate precipitation; needle shaped bright negative birefringence on polarized light micro preferably intracellular
which joint in foot in gout:
mid tarsal, knees, fingers, ankles, wrists, elbows, 1st metatarsal phylangeal,
when use Serum urate–lowering therapy
two flares per year (one if stage 2 or greater CKD), tophi, or h/o nephrolithiasis
how long to continue urate lowering rx
3-6 mo after flare and stop if no other sx
meds and gout
thiazide, loop diuretics, asa; losartan and fibrates helps and ca channel blockers may also
ethnic groups and allopurinol
Han chinese, thai, and koreans with stage 3 ckd: check for HLA B5801 genotype
colchicine for gout prevention: dose and adverse effects,
0.6-1.2 per day; rare reversible axonal neuropathy (stop if leg weakness), rhabdo in elderly or those with ckd on statins or clarithromycin
probenecid: risks
increases mtx and ketorlac levels; kidney stones – take w meals and alkalinize urine (potassium citrate)
what is Pegloticase
pegylated uricase for refractory gout given every 2 weeks IV; $5K/dose
