Chapter 60: Gout

Question 1

Uric acid is produced as an end-product of

Answer 1

purine metabolism

Question 2

Which joint does gout typically occur in

Answer 2

MTP (big toe)

Question 3

Foods to avoid in gout

Answer 3

Organ meats, high-fructose corn syrup and alcohol

Question 4

asymptomatic hyperuricemia is treated with what drugs

Answer 4

it is not treated

Question 5

Once a gout attack occurs, UA should be lowered to

Answer 5

< 6 mg/dL

Question 6

Drugs that increase uric acid

Answer 6

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

Question 7

Which drugs can be used for an acute gout attack

Answer 7

NSAID, steroid or colchicine

Question 8

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

Answer 8

An intra-articular steroid injectiion

Question 9

Colchicine brand name

Answer 9

Colcrys

Question 10

Dosing for colchicine

Answer 10

Two 0.6 mg tabs followed by 0.6 mg in 1 hr

Question 11

colchicine max dose

Answer 11

do not exceed 1.8 mg in 1 hr

Question 12

Colchicine CI

Answer 12

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

Question 13

colchicine warnings

Answer 13

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

Question 14

colchicine side effects

Answer 14

Diarrhea, nausea, myelosuppression, myopathy, neuropathy

Question 15

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

Answer 15

36

Question 16

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

Answer 16

12

Question 17

Indomethacin brand name

Answer 17

Indocin

Question 18

Which NSAIDs can be used in gout

Answer 18

Indomethacin, Naproxen, Celecoxib

Question 19

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

Answer 19

Methylprednisolone

Question 20

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

Answer 20

• add probenecid or lesinurad

- Replace XOI with IV pegloticase (Krystexxa)

Question 21

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

Answer 21

Colchicine or NSAIDs

Question 22

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

Answer 22

HLA-B*5801

Question 23

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

Answer 23

Probenecid

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

Question 24

Probenecid MOA

Answer 24

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

Question 25

Probenecid requires adequate ______ to be effective

Answer 25

renal function

Question 26

Which drug is reserved for severe, refractory gout cases

Answer 26

Pegloticase

Question 27

MOA of pegloticase

Answer 27

Increases UA conversion to allantoin

Question 28

Xanthine Oxidase Inhibitor MOA

Answer 28

decrease UA production

Question 29

Allopurinol warnings

Answer 29

Hypersensitivity reactions including severe rash; HLA-B*5801 testing prior to use & do not use drug if positive, hepatotoxicity

Question 30

Allopurinol SE

Answer 30

Rash, acute gout attacks, nausea

Question 31

Febuxostat is limited to which population

Answer 31

Those who cannot tolerate allopurinol or allopurinol is not effective

Question 32

Febuxostat warnings/SE

Answer 32

Increased LFTs, hepatotoxicity, increased thromboembolic events, serious skin reactions

Question 33

Probenecid can be used to increase ____ levels

Answer 33

beta-lactam

Question 34

How is pegloticase administered

Answer 34

IV

Question 35

Pegloticase BW

Answer 35

anaphylactic reactions - monitor and premedicate with antihistamines and steroids

Question 36

Pegloticase CI

Answer 36

G6PD deficiency

Question 37

T/F: Pegloticase cannot be used in combination with allopurinol, febuxostat or probenecid d/t increased risk of infection

Answer 37

True

Question 38

Allopurinol and febuxostat increase the concentration of ____, the active metabolite of ____

Answer 38

mercaptopurine

azathioprine