Arthritis Gout (2)

Question 1

5 drugs that can elevate serum urate and precipitate gout

Answer 1

thiazies
loop diuretics
niacin
calcineurin inhibitors
asprin

Question 2

What class of drugs is first line urate-lowering therapy in gout? 2 examples?

Answer 2

Xanthine Oxidase Inhibitors (XOI)

allopurinol or febuxostat

Question 3

allopurinol MOA and indications

Answer 3

reduces uric acid synthesis by inhibiting xo(converts purines to uric acid)

for hyperuricemia of gout or recurrent kidney stones

Question 4

allopurinol considerations

Answer 4

starting dose no greater than 100mg/day
gradually titrate up

starting dose must be less than 100 in pts with kidney disease

Question 5

Pts started on allopurinol should be warned…

Answer 5

an acute gout flare could occur upon starting therapy

HA and somnolence can occur as well as jaundice

Question 6

Hypersensitivity to allopurinol can occur in those of ______ descent with HLA______

Answer 6

asian descent

HLA-B*5801

Question 7

Febuxostat MOA and indications

Answer 7

selectively inhibits XO

for hyperuricemia

Question 8

Febuxostat monitoring

Answer 8

LFT(liver), serum uric acid, and s/s of stroke, MI or hypersensitivity

Question 9

Febuxostat is recommended to be taken with ______ or ______ to prevent acute flares

Answer 9

NSAID or Colchicine

Question 10

If XOI drugs contraindicated what 3 drugs are the alternative

Answer 10

probencid
fenofibrate
losartan

Question 11

Probencid is not recommended as a monotherapy in

Answer 11

gout pts with low creatinine clearance (~50ml/min)

Question 12

Hx of ______ contraindicates probencid monotherapy

Answer 12

urolithiasis (stone forming)

Question 13

Probencid MOA

Answer 13

inhibits reabsorption of urate in prox convoluted tubule (which inc excretion of uric acid)

DONT START UNTIL ACUTE ATTACK HAS SUBSIDED
(may want alkalize urine and drink plenty of H2O to avoid stones)

Question 14

7 ADR of probencid

Answer 14

HA dizzy anemia flushing sore gums, nausea, stones

Question 15

Probencid levels are inc by _____

Answer 15

asprin and other salicylates

Question 16

______ and ______ are appropriate 1st line prophylaxis therapy

Answer 16

colchicine (1st line) and NSAIDs

Question 17

Pegloticase

Answer 17

approp for pts with severe gout and intolerance to oral ULT

Question 18

Pegloticase MOA

Answer 18

recomb urate-oxidase enzyme which converts uric acid to allantoin

discontinue other oral antihyperuricemic agent 1st

premedicate with antihist and corticosteroids

Question 19

Pegloticase monitoring and ADRs

Answer 19

serum uric acid levels s/b less than 6mg

antibody formation
acute gout flare

Question 20

3 therapies that you should treat acute gout with 1st

Answer 20

NSAIDs (or COX-2 inhibitor)
systemic corticosteroids
colchicine

Question 21

_________ are contraindicated in acute gout

Answer 21

Asprin and other salicyclates (bc inhibit uric acid excretion)

Question 22

Colchicine MOA and ADRs

Answer 22

moa: prevents leukocyte chemotaxis and phagocytosis
(NO effect on uric acid levels or analgesic effect

adr: N/v/d bone marrow dep with chronic use

Question 23

with gout you may consider _________ if large joints are involved

Answer 23

intraart injection of corticosteroids

Question 24

__________, ________, and ________ are all FDA approved NSAIDs for acute gout

Answer 24

indomethacin
naproxen
sulindac

Question 25

________ is the cox 2 inhib approved for acute gout

Answer 25

celecoxib

Question 26

Indomethacin adr

Answer 26

may aggravate depression or other cns disterbances such as epilepsy and parkinsonism

Question 27

______ and _______ are oral steroids you might give for gout.

Answer 27

predinsone and methylprednisone

Question 28

________ is an IM steroid for gout

Answer 28

triamcinolone