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PHRM 864 > E4 gout > Flashcards

E4 gout Flashcards

1
Q

hyperuricemia classification is uric acid level > _ AND?

A

6.8 AND symptomatic

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2
Q

T or F:
women are more likely to have gout

A

false duh

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3
Q

uric acid is the main end product in ______ degradation

A

purine

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4
Q

what is the soluble byproduct from uric acid breakdown

A

allatoin

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5
Q

4 things under underexcretion for hyperuricemia

A

dehydration
insulin resistance
acute etoh intake
meds

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6
Q

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

A

diuretics
cytotoxic
salicylates

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7
Q

first clinical presentation thing for acute gouty arthritis

A

podagra -> first metatarsal joint involved

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8
Q

s + s/sxs of acute gouty arthritis

A

fever
intense pain
edema/warmth/inflam/erythema

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9
Q

2 lab tests for acute gouty arthritis

A

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

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10
Q

3 complications for acute gouty arthritis

A

tophi
kidney stones
gout nephropathy (CKD and shit)

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11
Q

1 way to diagnose gout

A

synovial fluid aspiration (getting fluid from site of gout)

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12
Q

3 drug/classes used in pharmacologic therapy for acute gout

A

NSAIDs
corticos
Colchicine

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13
Q

MOA of colchicine

A

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

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14
Q

recommended to administer colchicine within how long of acute attack

A

24 hours

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15
Q

dosing of colchicine ** in acute gout
Day 1:
Day 2:

A

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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16
Q

5 colchicine AEs

A

N
V
D
neutropenia
axonal neuromyopathy

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17
Q

when to renally adjust colchicine

A

CrCl <30

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18
Q

Colchicine dosing in CrCl <30

A

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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19
Q

colchicine dosing for dialysis

A

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

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20
Q

hepatic dose adjustment for colchicine

A

there isn’t one

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21
Q

2 things to look out for regarding drug interactions with colchicine

A

3A4 and pgp*

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22
Q

what are two abortive agents for gout symptom onset (this was clinical pearl slide)

A

NSAIDs or colchicine, this also said something about “pill-in-pocket” method

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23
Q

what is ULT

A

urate lowering therapy

24
Q

who is not a candidate for ULT? (2)

A
  • asymptomatic with no prior gout flares or tophi
  • first gout attack without risk factors
25
Q

some indications for starting ULT (this is for chronic not acute)

A
  • 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
26
Q

1 monitoring thing for ULT

A

serum uric acid at baseline (target <6)

27
Q

1st line for chronic gout

A

xanthine oxidase inhibitors (allopurinol and febuxostat)

28
Q

max dose/day allopurinol

A

800mg

29
Q

max dose/day febuxostat

A

120mg

30
Q

T or F:
slowly titrate both xanthine oxidase inhibitors

A

true, allo 2-4 weeks, febux daily

31
Q

drug interactions with allopurinol

A

loop/thiazides
warfarin
AZA, 6-MP

32
Q

5 AEs with allopurinol

A

skin rash
headache
urticaria
hepatotox
hypersens

33
Q

big scary AE with allopurinol

A

SJS*

34
Q

can test for what for risk of SJS

A

HLA-B*5801

35
Q

3 monitoring things for allopurinol

A

uric acid 2-5 weeks
renal function
LFTs

36
Q

2 counseling points allopurinol

A

drink a lot
take meds even without gout sxs

37
Q

T or F:
febuxostat has a black box warning

A

true, for increased CV mortality

38
Q

3 AEs febuxostat

A

nausea
arthralgias
rash

39
Q

T or F:
Febuxostat is renally adjusted

A

true, CrCl <30

40
Q

when is febuxostat indicated

A

pt cant tolerate allopurinol

41
Q

2nd line chronic gout

A

uricosurics
(probenecid and lesinurad)
but really we only use probenecid and we can ignore the other*

42
Q

T or F:
you also titrate with probenecid

A

true, every 1-2 weeks

43
Q

3 AEs probenecid

A

GI irritation
rash
Urolithiasis*

44
Q

when is probenecid CI’d

A

pts with hx of urolithiasis

45
Q

2 cautions for use of probenecid

A

G6PD deficiency
EGFR <60

46
Q

MOA of uricosuric drugs (2nd line for chronic gout)

A

increase renal excretion by inhibiting reabsorption of uric acid

47
Q

3rd line chronic gout

A

uricase agents
(pegloticase)

48
Q

MOA of uricase agents (pegloticase)

A

converts uric acid to more soluble metabolite allantoin*

49
Q

3 indications for pegloticase

A

ONLY IN SEVERE GOUT/HYPERURICEMIA
>3 gout flares in last 18 months
>1 tophi
- joint damage from gout

50
Q

what is the dosage form of pegloticase

A

IV

51
Q

pegloticase black box warning

A

anaphylaxis and the G6PD thing

52
Q

3 AEs pegloticase

A

N/V/C
chest pain
nasopharyngitis *

53
Q

2 pearls for pegloticase

A

immunogenicity -> pts may develop antibodies
G6PD deficiency screening

54
Q

3 agents for gout attack prophylaxis

A

NSAIDs at lowest effective dose
prednisone <10mg/day
colchicine

55
Q

duration of gout attack prophylaxis

A

during initiation of ULT, 3-6 months or longer if indicated

56
Q

dosing of colchicine for prophylaxis

A

just half of normal so 0.6 and 0.3 instead of 1.2 and 0.6

57
Q

risk factors for gout/hyperuricemia

A

male
post-meno women
elderly
obese
diet+alcohol intake
sedentary lifestyle
renal impairment
cool they are all easy

PHRM 864 (28 decks)

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