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NAPLEX 2024 > 60. Gout > Flashcards

60. Gout Flashcards

1
Q

Gout is a type of arthritis caused by a buildup of____ primarily in the joints

A

uric acid (UA) crystals

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2
Q

Uric acid is produced as an end-product of ____ metabolism

A

Purine

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3
Q

Gout typically occurs in 1 joint, most often the ___ joint

A

Metatarsophalangeal joint (MTP, the big toe)

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4
Q

In addition to a uric acid level, ___ can be evaluated to identify if UA crystals are present

A

sample of synovial (joint) fluid

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5
Q

Risk factors for gout

A

Male sex
Obesity
Excessive alcohol consumption (particularly beer)
Others: HTN, CKD, lead intoxication, advanced age, and using meds that increase UA levels

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6
Q

Drugs that increase uric acid

A

Aspirin, lower doses
Calcineurin inhibitors (tacrolimus, cyclosporine)
Diuretics (loop and thiazides)
Niacin
Pyrazinamide
Select chemotherapy (with tumor lysis syndrome)
Select pancreatic enzyme products

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7
Q

Foods to avoid to lower risk of gout

A

Organ meats
High-fructose corn syrup
Alcohol

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8
Q

T/F: treat hyperuricemia with drugs even if asymptomatic

A

False - asymptomatic hyperuricemia is not to be treated with drugs

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9
Q

Ppx gout drugs are used to lower UA levels, with a goal UA level of < ___

A

6mg/dL

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10
Q

What meds can be used to treat gout acute pain

A

Colchicine
Steroids (often intra-articular injections)
NSAIDs (often high starting dose)

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11
Q

What meds can be used as gout ppx?

A

Xanthine oxidase inhibitor (XOI): allopurinol (preferred) or febuxostat

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12
Q

An acute gout flare can occur when an XOI is started so give initially with ___ or ___

A

colchicine or an NSAID

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13
Q

If XOI didn’t work well enough and UA remains > 6 mg/dL, what can you add on?

A

Add on probenecid or lesinurad to daily XOI
Replace XOI with IV pegloticase (Krystexxa)

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14
Q

Colchicine (Colcrys) treatment dosing

A

Two 0.6mg tablets followed by 0.6mg in 1 hr (do NOT exceed total of 1.8mg in 1 hr)

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15
Q

When using colchicine, do NOT exceed total of ___mg in 1 hr

A

1.8mg in 1 hr

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16
Q

Contraindications for colchicine

A

Do NOT use in combo with P-gp or strong CYP3A4 inhibitor with renal and/or hepatic impairment

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17
Q

Warnings for colchicine

A

Myelosuppression
Do not use with cyclosporin, diltiazem, verapamil, gemfibrozil, or statins – increase myopathy risk

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18
Q

Side effects for colchicine

A

Diarrhea, nausea, myopathy, neuropathy (dose-dependent), decrease vit B12

19
Q

Use colchicine within ___hrs of symptom onset (for treatment)
Wait ___ hrs after treatment dose before resuming prophylaxis dosing

A

36 hrs
12 hrs

20
Q

Which NSAIDs are used in gout?

A

Indomethacin (Indocin)
Naproxen (Aleve)
Celecoxib (Celebrex)

21
Q

Which steroids are used in gout?

A

Prednisone, prednisolone
Methylprednisolone (Medrol, Solu-Medrol)

22
Q

Methylprednisolone (Medrol, Solu-Medrol) can be used intra-articular if ___large joints are involved

A

1-2

23
Q

Acute side effects of steroids

A

Increased BG, BP, insomnia, appetite

24
Q

Fatal toxicity can occur if colchicine is combined with strong CYP ___ inhibitors or strong P-gp inhibitor

A

3A4
Colchicine is major substrate of 3A4 and p-gp

25
Q

When starting chronic uric acid lowering treatment, ____ should be used as prophylaxis to reduce risk of attacks

A

colchicine, steroids, or NSAIDs

26
Q

Pharmacogenomic consideration with allopurinol use

A

HLA-B*5801 allele screening should be done for pts at high risk of severe hypersensivity reaction (including certain Asian groups)

27
Q

____ is a uricosuric and a second-line treatment that can be used if XOIs are contraindicated or not tolerated or added when UA level is not at goal

A

Probenecid
Alternative lesinurad (taken WITH XOI)

28
Q

Probenecid MOA

A

inhibits reabsorption of UA in the proximal tubule of the nephron (increase UA excretion)
Requires adequate renal function to be effective

29
Q

____ a recombinant uricase enzyme, is reserved for severe, refractory disease

A

Pegloticase

30
Q

Xanthine oxidase inhibitors MOA

A

decrease uric acid production

31
Q

Warnings for allopurinol (Zyloprim, Aloprim)

A

Hypersensitivity reactions, including severe rash (SJS/TEN, DRESS)
HLA-B*5801 testing prior to use if high risk (esp for Asian pts), do not use drug if + )
Hepatotoxicity, bone marrow suppression

32
Q

Side effects of allopurinol (Zyloprim, Aloprim)

A

Rash, acute gout attacks, nausea, diarrhea, increased LFTs

33
Q

D/t high rate of gout attacks when beginning allopurinol or febuxostate, use with colchicine (0.6mg once or twice daily) or an NSAID for the first ____

A

3-6 months

34
Q

Febuxostat (Uloric) Boxed warning

A

Increased risk of CV death compared to allopurinol in pts with established CV disease
Use should be limited to those who cannot tolerate allopurinol or if not effective

35
Q

Uricosurics MOA

A

inhibit reabsorption of uric acid in the kidneys, increase UA excretion

36
Q

Probenecid can be used to (increased/decrease) beta-lactam levels

A

Increase levels by decreasing beta-lactam renal excretion

37
Q

Recombinant uricase MOA

A

Converts uric acid to allantoin (excreted)

38
Q

Pegloticase (Krystexxa) dosing frequency

A

IV every 2 weeks

39
Q

Boxed warning for pegloticase (Krystexxa)

A

Anaphylactic reactions - premedicate with antihistamines and steroids (higher risk with UA > 6)
Life-threatening hemolytic reactions and methemoglobinemia may occur with G6PD deficiency

40
Q

Contraindications for pegloticase (Krystexxa)

A

G6PD deficiency

41
Q

Do NOT use pegloticase (Krystexxa) in combo with ____ (increased risk of anaphylaxis)

A

allopurinol, febuxostat, or probenecid

42
Q

Do not use ___ or ___ with febuxostat and use caution combining these with allopurinol

A

Mercaptopurine (active metabolite of azathioprine) or azathioprine

Allopurinol and febuxostat increase conc of mercaptopurine

43
Q

___ is a urate-oxidase enzyme used in the treatment of tumor lysis syndrome (TLS). Contraindicated with ___ deficiency.

A

Rasburicase (Elitek)
G6PD

NAPLEX 2024 (74 decks)

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