E4 gout Flashcards by Cole O'Connor

hyperuricemia classification is uric acid level > _ AND?

6.8 AND symptomatic

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T or F:
women are more likely to have gout

false duh

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uric acid is the main end product in ______ degradation

purine

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what is the soluble byproduct from uric acid breakdown

allatoin

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4 things under underexcretion for hyperuricemia

dehydration
insulin resistance
acute etoh intake
meds

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3 main med classes that can cause hyperuricemia (at least the ones she said)

diuretics
cytotoxic
salicylates

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first clinical presentation thing for acute gouty arthritis

podagra -> first metatarsal joint involved

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s + s/sxs of acute gouty arthritis

fever
intense pain
edema/warmth/inflam/erythema

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2 lab tests for acute gouty arthritis

uric acid levels (>6.8 bad)
WBC >11,000

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3 complications for acute gouty arthritis

tophi
kidney stones
gout nephropathy (CKD and shit)

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1 way to diagnose gout

synovial fluid aspiration (getting fluid from site of gout)

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3 drug/classes used in pharmacologic therapy for acute gout

NSAIDs
corticos
Colchicine

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MOA of colchicine

disrupts cytoskeletal functions by inhibiting B-tubilin polymerization into microtubules -> prevents activation and migration of neutrophils

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recommended to administer colchicine within how long of acute attack

24 hours

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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

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5 colchicine AEs

N
V
D
neutropenia
axonal neuromyopathy

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when to renally adjust colchicine

CrCl <30

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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

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colchicine dosing for dialysis

Single 0.6 mg dose; treatment course should be repeated no more than once every 2 weeks

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hepatic dose adjustment for colchicine

there isn’t one

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2 things to look out for regarding drug interactions with colchicine

3A4 and pgp*

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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

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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

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