Day 7 Gout/Osteoarthritis. Flashcards
What are normal urea levels?
What conditions are associated with hyperuricemia?
What drugs cause hyperuricemia?
Men <7, Women <6.
Hypertension, obesity, metabolic syndrome, Type 2 DM, CKD, Acute alcoholism.
Diuretics, Niacin, Aspirin, ethanol, ethambutol, pyrazinamide, cytotoxic drugs, levodopa, cyclosporin and tacrolimus.
Where is gout clincally manifested?
What foods do you avoid in gout?
What foods do you limit in gout?
inflammatory monoarthritis, elevated serum uric acid, response to colchicine. Often shows in toe, rapid onset excruciating pain.
Organ meats(liver, kidney, sweetbreads), high fructose corn syrup, alcohol overuse, alcohol use during gout episodes.
Beef,lamb,pork,sardines,shellfish, naturally sweetened fruit juices, table sugar, desserts, table salt including salts and gravies, alcohol, especially beer.
What are pain scores?
How do you treat mild/moderate acute gout attacks?
How do you treat severe acute gout attacks?
<4 is mild, 5-6 is moderate, >7 is severe.
Start within 24 hours. Monotherapy(nsaid, colchcine, systemic corticosteroid)–> if successful prevent recurrent attacks. If inadequate switch to alternate monotherapy and if not good again try off label therapies in development interleukin 1-inhibitor.
Initiate combination therapy and if inadequate go to off label therapies.
What to know about NSAID dosing in gout?
What is colchicine’s MOA and common A/E’s?
What clinical pearls do we need to know about Colchicine?
Higher doses than normal.
Antimitotic, Common A/E’s are GI disturbance myelosuppresion, neuromyopathy. Take 1.2 mg initially follow by 0.6 1 hour later. For prophylaxis dosing is started 12 hours or later 0.6 mg QD-BID until resolves.
Start within 36 hours of acute gout attack, dose reduction needed in moderate-severe CKD and concurrent use with CYP 3A4 and P-GP inhibitor. Expensive.
Can you do intraarticular injections?
What to do in gout if patient is NPO?
Do we treat someone who has hyperuricemia but is asymptomatic?
Yes you can, may be considered if gout is severe and localized to 1 or 2 large joints.
Can consider use of ACTH at a dose of 25-40 IU SQ.
NOTHING.
How do you handle chronic gouty arthritis?
What is your 1st line ULT initiation therapy?
What is 1st line antiinflammatory gout prophylaxis during ULT initiation?
1)establish patient has gout–> 2) provide patient education on nonpharmacologic recommendations for gout, consider secondary causes, consider elimnation of non essential prescrtiption meds that cause hyperuricemia, clinically evaluate gout disease burden. 3) Use pharmacologic if they have gout and tophus, frequent attacks, CKD 2 or worse, past urolithiasis.
XOI, Allopurinol, Febuxostat. If don’t achieve titrate ULT to max dose or add stuff(fenofibrate, losartan), if still no add lesinurad or probenecid, if no switch to pegloticase. Goal is <6 mg.
Low dose Colchcine, low dose NSAID. 2nd line is low dose steroid.
What is allopurinols dose?
What are common A/E’s of allopurinol?
What special pearls to know about allopurinol?
100 mg/day. Has renal dosing.
Rash, acute gout attacks, nausea, diarrhea, increased LFT’s, and headache.
Hypersensitivity reactions have occurred. Consider HLAB*5801 allele testing in certain people. Take after meals to decrease nausea.
What is Febuxostat’s dose?
What are some side effects of probenecid?
What are some side effects of lesinurad?
40 mg/day. No necessary dose reduction in kidney impairment.
Hypersensitivity reactions, hemolytic anemia. Increase fluid intake, C/I if hx of urolithiasis, do not use in bad kidney function.
BBW of acute renal failure when used in absence of XOI therapy. SCr elevation, urticaria.
What to know about pegolicase?
What are the risk factors for osteoarthritis?
What is the clinical presentation of OA?
PEGylated form of uricase, watch for aniphylactic reactions, can cause gout flare, infusion reactions, nausea, pruritis, expensive, for refractory gout only, DO NOT USE in combo with allopurinol.
Obesity is most important.
Hands, hips, and knees are most affected. Resolves with motion (<30 min in duration), pain, local tenderness, crepitus. deformity.
What is some non pharmacologic treatment for osteoarthritis?
What is 1st line therapy for OA in hand if patient is older than 75?
What is 1st line therapy for OA in hand if patient is younger than 75?
Used of fitted knee braces, lateral patellar taping, passive exercise is minimal, moderate is use of an assertive device, heat application, shoe insoles, strong is exercise, weight loss, patient education.
Topical NSAID, topical Capsaicin and or tramadol. IF not effective combine therapy with two first line agents.
Oral NSAID or topical capsaicin and/or tramadol. If not effective combine therapy with 2 first line agents.
What is 1st line therapy for hip and knee?
What are A/E’s of tramadol?
What are the A/E’s of the topical analgesics?
If patient isn’t allergic to acetaminophen then give them acetaminophen. If contraindicated give topical NSAIDS, and/or intraarticular corticosteroids and/or tramadol and/or oral NSAIDS(if <75). If not working can try opioids, surgery, duloxetine(knee only), intraarticular hyaluronates.
Lowers seizure threshold, do not use in kidney failure, N/V dizziness, HA, dry mouth, drowsiness.
Skin irritation, burning, wash hands after each applicaion, GI bleeding or renal impairment for diclofenac.
What are the oral NSAID common A/E’s?
Renal dysfunction, gastritis, fluid retention, HTN, dizziness, cognitive impairment.
