Chapter 60: Gout

Question 1

What is gout?

Answer 1

buildup of uric acid (UA) crystals in the joints

Question 2

Uric acid is produced as an end-product of

Answer 2

purine metabolism

Question 3

Name for uric acid crytals in the joint

Answer 3

tophi

Question 4

Which joint does gout typically occur in

Answer 4

Metatarsophalangeal joint (MTP = big toe)

Question 5

Risk factors for gout

Answer 5

male sex, obesity, excessive alcohol consumption

Question 6

Drugs that can increase uric acid and exacerbate gout

Answer 6

aspirin (lower doses)
CNIs
Diuretics
Niacin
pyrazinamide
some chemos and pancreatic enzymes

Question 7

Foods to avoid in gout

Answer 7

Organ meats, high-fructose corn syrup and alcohol

limit fruit juices, table sugar, sweetened drinks, lamb, pork, seafood

Question 8

asymptomatic hyperuricemia is treated with what drugs

Answer 8

it is not treated

Question 9

Once a gout attack occurs, UA should be lowered to

Answer 9

< 6 mg/dL

Question 10

Which drugs can be used for an acute gout attack

Answer 10

NSAID, steroid or colchicine

targeting pain and inflammation

Question 11

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

Answer 11

An intra-articular steroid injection

Question 12

Colchicine brand name

Answer 12

Colcrys

Question 13

Dosing for colchicine

Answer 13

Two 0.6 mg tabs followed by 0.6 mg in 1 hr

(max 1.8mg in 1 hr or 2.4 mg/day)

Question 14

colchicine max dose

Answer 14

do not exceed 1.8 mg in 1 hr

or 2.4 mg in one day

Question 15

Colchicine CI

Answer 15

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

FATAL toxicity can occur

Question 16

colchicine warnings

Answer 16

myelosuppression, myopathy risk

Question 17

colchicine side effects

Answer 17

Diarrhea, nausea, myopathy, neuropathy

Question 18

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

Answer 18

36

Question 19

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

Answer 19

12

Question 20

Indomethacin brand name

Answer 20

Indocin

Question 21

Which NSAIDs can be used in gout

Answer 21

Indomethacin, Naproxen, Celecoxib

Question 22

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

Answer 22

Methylprednisolone

Question 23

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

Answer 23

• add probenecid or lesinurad
• Replace XOI with IV pegloticase (Krystexxa)

Question 24

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

Answer 24

Colchicine or NSAIDs

Question 25

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

Answer 25

HLA-B*5801

Question 26

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 26

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

Question 27

Probenecid MOA

Answer 27

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

Question 28

Probenecid requires adequate ____ to be effective

Answer 28

renal function

Question 29

Which drug is reserved for severe, refractory gout cases

Answer 29

Pegloticase

Question 30

MOA of pegloticase

Answer 30

Increases UA conversion to allantoin | recombinant uricase enzyme

Question 31

Xanthine Oxidase Inhibitor MOA

Answer 31

decrease UA production | allopurinol and febuxostat

Question 32

Allopurinol warnings

Answer 32

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

Question 33

Allopurinol SE

Answer 33

Rash, acute gout attacks, nausea

Question 34

Febuxostat is limited to which population

Answer 34

Those who cannot tolerate allopurinol or allopurinol is not effective

Question 35

Febuxostat warnings/SE

Answer 35

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

Question 36

Probenecid can be used to increase ____ levels

Answer 36

beta-lactam

Question 37

How is pegloticase administered

Answer 37

IV

Question 38

Pegloticase BW

Answer 38

anaphylactic reactions - monitor and premedicate with antihistamines and steroids

Question 39

Pegloticase CI

Answer 39

G6PD deficiency

Question 40

Pegloticase cannot be used in combination with what other gout drugs due to increased risk of anaphylaxis

Answer 40

allpurinol, febuxostat, probenecid

Question 41

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

Answer 41

mercaptopurine azathioprine

Question 42

allopurinol brand name

Answer 42

Zyloprim, Aloprim

Question 43

What drug is used for tumor lysis syndrome?

Answer 43

rasburicase

Question 44

contraindications of rasburicase

Answer 44

G6PD deficiency

Question 45

mechanism of tumor lysis syndrome (TLS)

Answer 45

chemo --> lysed cells --> increased purines --> increased uric acid --> acute gout and significant electrolyte abnormalities --> renal failure, cardiac arrhythmias, seizures, death