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NAPLEX 2023 > Chapter 60: Gout > Flashcards

Chapter 60: Gout Flashcards

1
Q

What is gout?

A

buildup of uric acid (UA) crystals in the joints

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2
Q

Uric acid is produced as an end-product of

A

purine metabolism

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3
Q

Name for uric acid crytals in the joint

A

tophi

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4
Q

Which joint does gout typically occur in

A

Metatarsophalangeal joint (MTP = big toe)

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5
Q

Risk factors for gout

A

male sex, obesity, excessive alcohol consumption

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6
Q

Drugs that can increase uric acid and exacerbate gout

A

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

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7
Q

Foods to avoid in gout

A

Organ meats, high-fructose corn syrup and alcohol

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

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8
Q

asymptomatic hyperuricemia is treated with what drugs

A

it is not treated

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9
Q

Once a gout attack occurs, UA should be lowered to

A

< 6 mg/dL

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10
Q

Which drugs can be used for an acute gout attack

A

NSAID, steroid or colchicine

targeting pain and inflammation

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11
Q

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

A

An intra-articular steroid injection

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12
Q

Colchicine brand name

A

Colcrys

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13
Q

Dosing for colchicine

A

Two 0.6 mg tabs followed by 0.6 mg in 1 hr

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

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14
Q

colchicine max dose

A

do not exceed 1.8 mg in 1 hr

or 2.4 mg in one day

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15
Q

Colchicine CI

A

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

FATAL toxicity can occur

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16
Q

colchicine warnings

A

myelosuppression, myopathy risk

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17
Q

colchicine side effects

A

Diarrhea, nausea, myopathy, neuropathy

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18
Q

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

A

36

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19
Q

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

A

12

20
Q

Indomethacin brand name

A

Indocin

21
Q

Which NSAIDs can be used in gout

A

Indomethacin, Naproxen, Celecoxib

22
Q

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

A

Methylprednisolone

23
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)
24
Q

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

A

Colchicine or NSAIDs

25
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

26
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

27
Q

Probenecid MOA

A

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

28
Q

Probenecid requires adequate ____ to be effective

A

renal function

29
Q

Which drug is reserved for severe, refractory gout cases

A

Pegloticase

30
Q

MOA of pegloticase

A

Increases UA conversion to allantoin

recombinant uricase enzyme

31
Q

Xanthine Oxidase Inhibitor MOA

A

decrease UA production

allopurinol and febuxostat

32
Q

Allopurinol warnings

A

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

33
Q

Allopurinol SE

A

Rash, acute gout attacks, nausea

34
Q

Febuxostat is limited to which population

A

Those who cannot tolerate allopurinol or allopurinol is not effective

35
Q

Febuxostat warnings/SE

A

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

36
Q

Probenecid can be used to increase ____ levels

A

beta-lactam

37
Q

How is pegloticase administered

A

IV

38
Q

Pegloticase BW

A

anaphylactic reactions - monitor and premedicate with antihistamines and steroids

39
Q

Pegloticase CI

A

G6PD deficiency

40
Q

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

A

allpurinol, febuxostat, probenecid

41
Q

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

A

mercaptopurine
azathioprine

42
Q

allopurinol brand name

A

Zyloprim, Aloprim

43
Q

What drug is used for tumor lysis syndrome?

A

rasburicase

44
Q

contraindications of rasburicase

A

G6PD deficiency

45
Q

mechanism of tumor lysis syndrome (TLS)

A

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

NAPLEX 2023 (88 decks)

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