Chapter 60: Gout Flashcards

1
Q

Uric acid is produced as an end-product of

A

purine metabolism

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2
Q

Which joint does gout typically occur in

A

MTP (big toe)

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3
Q

Foods to avoid in gout

A

Organ meats, high-fructose corn syrup and alcohol

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4
Q

asymptomatic hyperuricemia is treated with what drugs

A

it is not treated

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5
Q

Once a gout attack occurs, UA should be lowered to

A

< 6 mg/dL

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6
Q

Drugs that increase uric acid

A
Aspirin (lower doses)
Calcineurin inhibitors (tacro and cyclosporine)
Loop and thiazide diuretics
Niacin
Pyrazinamide
Select chemo (with TLS)
Select pancreatic enzyme products
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7
Q

Which drugs can be used for an acute gout attack

A

NSAID, steroid or colchicine

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8
Q

If the gout attack is localized to one or two joints, what can be helpful

A

An intra-articular steroid injectiion

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9
Q

Colchicine brand name

A

Colcrys

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10
Q

Dosing for colchicine

A

Two 0.6 mg tabs followed by 0.6 mg in 1 hr

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11
Q

colchicine max dose

A

do not exceed 1.8 mg in 1 hr

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12
Q

Colchicine CI

A

Do not us in combination with a P-gp or strong 3A4 inhibitor

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13
Q

colchicine warnings

A

GI symptoms (decrease dose if anorexia, N/V/D), myopathy risk

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14
Q

colchicine side effects

A

Diarrhea, nausea, myelosuppression, myopathy, neuropathy

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15
Q

colchicine should be started within __ hrs of symptoms onset for treatment

A

36

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16
Q

With colchicine, wait __ hrs after a treatment dose before resuming ppx dosing

17
Q

Indomethacin brand name

18
Q

Which NSAIDs can be used in gout

A

Indomethacin, Naproxen, Celecoxib

19
Q

Which steroid can be given intraacticularly if 1-2 large joints are involved

A

Methylprednisolone

20
Q

If XOI do not work well enough and UA remains > 6 mg/dL in acute gout flare, what can be done

A
  • add probenecid or lesinurad

- Replace XOI with IV pegloticase (Krystexxa)

21
Q

When starting chronic uric acid lowering therapy, which drugs should be used as ppx for 3-6 months to reduce the risk of attacks

A

Colchicine or NSAIDs

22
Q

Patients who are at high risk of a severe allopurinol hypersensitivity reaction should be screened for which allele prior to use

A

HLA-B*5801

23
Q

Which drug can be used as a second-line agent if XOI are CI or not tolerated or can be added when the UA level is not at goal

A

Probenecid

also, lesinurad when XOI is inadequate, but must be used with XOI

24
Q

Probenecid MOA

A

Inhibits the reabsorption of UA in the proximal tubule of the nephron, which increases UA excretion

25
Probenecid requires adequate ______ to be effective
renal function
26
Which drug is reserved for severe, refractory gout cases
Pegloticase
27
MOA of pegloticase
Increases UA conversion to allantoin
28
Xanthine Oxidase Inhibitor MOA
decrease UA production
29
Allopurinol warnings
Hypersensitivity reactions including severe rash; HLA-B*5801 testing prior to use & do not use drug if positive, hepatotoxicity
30
Allopurinol SE
Rash, acute gout attacks, nausea
31
Febuxostat is limited to which population
Those who cannot tolerate allopurinol or allopurinol is not effective
32
Febuxostat warnings/SE
Increased LFTs, hepatotoxicity, increased thromboembolic events, serious skin reactions
33
Probenecid can be used to increase ____ levels
beta-lactam
34
How is pegloticase administered
IV
35
Pegloticase BW
anaphylactic reactions - monitor and premedicate with antihistamines and steroids
36
Pegloticase CI
G6PD deficiency
37
T/F: Pegloticase cannot be used in combination with allopurinol, febuxostat or probenecid d/t increased risk of infection
True
38
Allopurinol and febuxostat increase the concentration of ____, the active metabolite of ____
mercaptopurine | azathioprine