C1: gout / osteoarthritis Flashcards
modifiable risk factors
obesity, hypertension, hyperlipidemia, diabetes mellitus
signs & symptoms of gout
intense pain / swelling / redness / heat
gout flares start suddenly & can last for days/weeks
treatment to resolve gout flares?
colchicine
oral NSAIDs
oral/IV/IM corticosteroids
OA risk factors
age > 45, joint injury, obesity etc
OA symptoms
- deep, achy joint pain
- reduced range of motion
- morning joint stiffness usually lasting < 30mins
OA non-pharm tx?
glucosamine; discontinue if no improvement after 3-month trial
- contra: shellfish allergy
OA pharm tx? hint: knee
topical NSAID initiated before oral NSAID, especially in elderly
OA topical NSAIDs?
- ketoprofen gel / patch
- diclofenac cream
OA topical NSAID caution?
not to be used with occlusive dressings = to prevent the increase in risk of SE
OA: other pharm tx?
- paracetamol > use as monotherapy maybe ineffective, receive on a regular basis, max dosage of 3 gm daily
- tramadol
topical capsaicin
gout: first line drugs?
- colchicine
- oral NSAIDs, including COX-2 inhibitors
- oral corticosteroids
g: pharm classes of 2 important drugs
colchicine etc = plant alkaloid anti-gout agent)
allopurinol = xanthine oxidase inhibitor
g: caution of colchicine
avoid grapefruit; juice during tx
g: pharm class, indication and side effect of colchicine
plant alkaloid anti-gout agent
acute gout
diarrhoea (excessive dose)
what is gout
inflammatory arthritis
increased uric acid level in blood = hyperuricemia
cause of hyperuricemia
underexcretion / over production of uric acid
g: uric acid target
< 360 umol/L (6mg/dL) in non-tophaceous gout
g: NSAID full dosage for control of acute attack
5 - 7 days
g: combination tx
everything except for NSAIDs + corticosteroid (no allopurinol involved)
g: SE of allopurinol
rashes -> withdraw tx
if rash is mild, re-introduce cautiously but discontinue promptly if recur
g: contra & dose of allopurinol
HLA-B*58:01-positive patient
initially 100mg daily, preferably after food
usual maintenance dose in mild conditions is 100-200mg daily
g: CP of allopurinol
- 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
g: non-pharm advice
maintain a healthy diet = avoid excessive alcohol, sugar drinks and excessive high-purine foods such as seafood or meat
OA: pharm tx examples of topical NSAIDs
oral -> topical (ketoprofen gel or patch / diclofenac cream)
not to be used with occlusive dressings -> to prevent increase risk of SE
OA: other
paracetamol -> use as monotx maybe ineffective
receive on a regular basis, max dosage of 3mg daily
