C1: gout / osteoarthritis

Question 1

modifiable risk factors

Answer 1

obesity, hypertension, hyperlipidemia, diabetes mellitus

Question 2

signs & symptoms of gout

Answer 2

intense pain / swelling / redness / heat
gout flares start suddenly & can last for days/weeks

Question 3

treatment to resolve gout flares?

Answer 3

colchicine
oral NSAIDs
oral/IV/IM corticosteroids

Question 4

OA risk factors

Answer 4

age > 45, joint injury, obesity etc

Question 5

OA symptoms

Answer 5

• deep, achy joint pain
• reduced range of motion
• morning joint stiffness usually lasting < 30mins

Question 6

OA non-pharm tx?

Answer 6

glucosamine; discontinue if no improvement after 3-month trial
- contra: shellfish allergy

Question 7

OA pharm tx? hint: knee

Answer 7

topical NSAID initiated before oral NSAID, especially in elderly

Question 8

OA topical NSAIDs?

Answer 8

• ketoprofen gel / patch
• diclofenac cream

Question 9

OA topical NSAID caution?

Answer 9

not to be used with occlusive dressings = to prevent the increase in risk of SE

Question 10

OA: other pharm tx?

Answer 10

• paracetamol > use as monotherapy maybe ineffective, receive on a regular basis, max dosage of 3 gm daily
• tramadol
  topical capsaicin

Question 11

gout: first line drugs?

Answer 11

• colchicine
• oral NSAIDs, including COX-2 inhibitors
• oral corticosteroids

Question 12

g: pharm classes of 2 important drugs

Answer 12

colchicine etc = plant alkaloid anti-gout agent)

allopurinol = xanthine oxidase inhibitor

Question 13

g: caution of colchicine

Answer 13

avoid grapefruit; juice during tx

Question 14

g: pharm class, indication and side effect of colchicine

Answer 14

plant alkaloid anti-gout agent
acute gout
diarrhoea (excessive dose)

Question 15

what is gout

Answer 15

inflammatory arthritis

increased uric acid level in blood = hyperuricemia

Question 16

cause of hyperuricemia

Answer 16

underexcretion / over production of uric acid

Question 17

g: uric acid target

Answer 17

< 360 umol/L (6mg/dL) in non-tophaceous gout

Question 18

g: NSAID full dosage for control of acute attack

Answer 18

5 - 7 days

Question 19

g: combination tx

Answer 19

everything except for NSAIDs + corticosteroid (no allopurinol involved)

Question 20

g: SE of allopurinol

Answer 20

rashes -> withdraw tx
if rash is mild, re-introduce cautiously but discontinue promptly if recur

Question 21

g: contra & dose of allopurinol

Answer 21

HLA-B*58:01-positive patient
initially 100mg daily, preferably after food
usual maintenance dose in mild conditions is 100-200mg daily

Question 22

g: CP of allopurinol

Answer 22

• take w plenty of water (2-3L of water a day) unless dr advised to restrict fluid intake
• very rarely, bad skin condition SJS or TENs = cause serious health problems = stop med and see dr immediately = signs of face swelling, blisters or peeling on skin, skin rashes that spread within hrs to days

Question 23

g: non-pharm advice

Answer 23

maintain a healthy diet = avoid excessive alcohol, sugar drinks and excessive high-purine foods such as seafood or meat

Question 24

OA: pharm tx examples of topical NSAIDs

Answer 24

oral -> topical (ketoprofen gel or patch / diclofenac cream)
not to be used with occlusive dressings -> to prevent increase risk of SE

Question 25

OA: other

Answer 25

paracetamol -> use as monotx maybe ineffective
receive on a regular basis, max dosage of 3mg daily