E4 gout Flashcards
hyperuricemia classification is uric acid level > _ AND?
6.8 AND symptomatic
T or F:
women are more likely to have gout
false duh
uric acid is the main end product in ______ degradation
purine
what is the soluble byproduct from uric acid breakdown
allatoin
4 things under underexcretion for hyperuricemia
dehydration
insulin resistance
acute etoh intake
meds
3 main med classes that can cause hyperuricemia (at least the ones she said)
diuretics
cytotoxic
salicylates
first clinical presentation thing for acute gouty arthritis
podagra -> first metatarsal joint involved
s + s/sxs of acute gouty arthritis
fever
intense pain
edema/warmth/inflam/erythema
2 lab tests for acute gouty arthritis
uric acid levels (>6.8 bad)
WBC >11,000
3 complications for acute gouty arthritis
tophi
kidney stones
gout nephropathy (CKD and shit)
1 way to diagnose gout
synovial fluid aspiration (getting fluid from site of gout)
3 drug/classes used in pharmacologic therapy for acute gout
NSAIDs
corticos
Colchicine
MOA of colchicine
disrupts cytoskeletal functions by inhibiting B-tubilin polymerization into microtubules -> prevents activation and migration of neutrophils
recommended to administer colchicine within how long of acute attack
24 hours
dosing of colchicine ** in acute gout
Day 1:
Day 2:
day 1: 1.2 mg po once, then 0.6 1 hour later
day 2: 0.6 mg BID until attack resolves
5 colchicine AEs
N
V
D
neutropenia
axonal neuromyopathy
when to renally adjust colchicine
CrCl <30
Colchicine dosing in CrCl <30
1.2 mg at onset, 0.6 mg 1 hour later (once)
*Treatment course should be repeated no more than once every 2 weeks
colchicine dosing for dialysis
Single 0.6 mg dose; treatment course should be repeated no more than once every 2 weeks
hepatic dose adjustment for colchicine
there isn’t one
2 things to look out for regarding drug interactions with colchicine
3A4 and pgp*
what are two abortive agents for gout symptom onset (this was clinical pearl slide)
NSAIDs or colchicine, this also said something about “pill-in-pocket” method
what is ULT
urate lowering therapy
who is not a candidate for ULT? (2)
- asymptomatic with no prior gout flares or tophi
- first gout attack without risk factors
some indications for starting ULT (this is for chronic not acute)
- frequent gout flares
- ≥1 tophus
- evidence of damage from gout
- ≥1 prior flare
- pts experiencing 1st flare with CKD 3-5, uric acid >9, urolithiasis
1 monitoring thing for ULT
serum uric acid at baseline (target <6)
1st line for chronic gout
xanthine oxidase inhibitors (allopurinol and febuxostat)
max dose/day allopurinol
800mg
max dose/day febuxostat
120mg
T or F:
slowly titrate both xanthine oxidase inhibitors
true, allo 2-4 weeks, febux daily
drug interactions with allopurinol
loop/thiazides
warfarin
AZA, 6-MP
5 AEs with allopurinol
skin rash
headache
urticaria
hepatotox
hypersens
big scary AE with allopurinol
SJS*
can test for what for risk of SJS
HLA-B*5801
3 monitoring things for allopurinol
uric acid 2-5 weeks
renal function
LFTs
2 counseling points allopurinol
drink a lot
take meds even without gout sxs
T or F:
febuxostat has a black box warning
true, for increased CV mortality
3 AEs febuxostat
nausea
arthralgias
rash
T or F:
Febuxostat is renally adjusted
true, CrCl <30
when is febuxostat indicated
pt cant tolerate allopurinol
2nd line chronic gout
uricosurics
(probenecid and lesinurad)
but really we only use probenecid and we can ignore the other*
T or F:
you also titrate with probenecid
true, every 1-2 weeks
3 AEs probenecid
GI irritation
rash
Urolithiasis*
when is probenecid CI’d
pts with hx of urolithiasis
2 cautions for use of probenecid
G6PD deficiency
EGFR <60
MOA of uricosuric drugs (2nd line for chronic gout)
increase renal excretion by inhibiting reabsorption of uric acid
3rd line chronic gout
uricase agents
(pegloticase)
MOA of uricase agents (pegloticase)
converts uric acid to more soluble metabolite allantoin*
3 indications for pegloticase
ONLY IN SEVERE GOUT/HYPERURICEMIA
>3 gout flares in last 18 months
>1 tophi
- joint damage from gout
what is the dosage form of pegloticase
IV
pegloticase black box warning
anaphylaxis and the G6PD thing
3 AEs pegloticase
N/V/C
chest pain
nasopharyngitis *
2 pearls for pegloticase
immunogenicity -> pts may develop antibodies
G6PD deficiency screening
3 agents for gout attack prophylaxis
NSAIDs at lowest effective dose
prednisone <10mg/day
colchicine
duration of gout attack prophylaxis
during initiation of ULT, 3-6 months or longer if indicated
dosing of colchicine for prophylaxis
just half of normal so 0.6 and 0.3 instead of 1.2 and 0.6
risk factors for gout/hyperuricemia
male
post-meno women
elderly
obese
diet+alcohol intake
sedentary lifestyle
renal impairment
cool they are all easy
