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PHM702 > Exam 4 - Gout > Flashcards

Exam 4 - Gout Flashcards

1
Q

What are risk factors for gout? (6)

A

age (less for females post-menopause), sex (males), co-morbid conditions, diet, meds, renal urate transporter genotypes

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2
Q

What is uric acid a metabolite of?

A

purines (via diet or tissue breakdown)

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3
Q

What enzyme do humans not have in the purine breakdown pathway? What does it produce?

A

urase; allantoin (from uric acid)

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4
Q

Explain the pathophsyiology of hyperuricemia and gout?

A

uric acid (at saturating concentrations) precipitates into crystals and these deposit in joints to trigger immune response

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5
Q

What comorbidities promote hyperuricemia? (7)

A

DM, CKD, CHF, HTN, hyperlipidemia, obesity, organ transplantation

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6
Q

What foods are hyperuricemic? (5)

A

meat, seafood, beer and liquor, soft drinks, fructose

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7
Q

What foods are uricosuric? (3)

A

coffee, dairy, vitamin C

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8
Q

What medications are hyperuricemic? (4)

A

thiazide diuretics, loop diuretics, nicotinic acid, aspirin (<1 g/day)

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9
Q

What medications are uricosuric? (2)

A

losartan, fenofibrate

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10
Q

What is podagra (classic acute gout)?

A

a gout flare (attack) that generally affects the first metatarsophalangeal joint

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11
Q

What are tophi?

A

masses of urate deposits in bone, cartilage, joints or tissues

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12
Q

Which NSAIDs have FDA-approved labeling for gout? (3)

A

indomethacin, naproxen, and sulindac

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13
Q

What are contraindications for NSAIDs? (5)

A

renal insufficiency/failure, bleeding disorders/anticoagulated patients, peptic ulcer disease, CHF, age 75+

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14
Q

What is the MOA of colchicine?

A

inhibition of beta-tubulin polymerization into microtubules, hinders neutrophil chemotaxis

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15
Q

How is colchicine dosed (general)?

A

1.2 mg (2 tabs) PO, then 0.6 mg 1 hr later

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16
Q

What are AEs of colchicine? (4)

A

GI (diarrhea), hematologic abnormalities, rhabdomyolysis (in renal dysfunction and elderly), myopathy (concomitant use of 3A4 and P-gp inhibitors, statins and fibrates)

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17
Q

What are contraindications for colchicine? (2)

A

CrCl <30 mL/min, hepatic impairment

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18
Q

What are examples of strong CYP3A4 inhibitors (4)

A

clarithromycin, darunavir/ritonavir, itraconazole, ketoconazole

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19
Q

What are examples of moderate CYP3A4 inhibitors? (4)

A

diltiazem, verapamil, erythromycin, fluconazole

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20
Q

What are examples of P-glycoprotein inhibitors? (3)

A

cyclosporine, amiodarone, ranolazine

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21
Q

What is the colchicine regimen for acute gout flares while on a strong CYP3A4 inhibitor?

A

0.6 mg, then 0.3 mg 1 hr later

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22
Q

What is the colchicine regimen for acute gout flares while on a moderate CYP3A4 inhibitor?

A

1.2 mg , then again after at least 3 days

23
Q

What is the colchicine regimen for acute gout flares while on a P-gp inhibitor?

A

0.6 mg, then again after at least 3 days

24
Q

What is the colchicine regimen for gout flare prophylaxis while on a strong CYP3A4 inhibitor?

A

0.3 mg eod to qd

25
Q

What is the colchicine regimen for gout flare prophylaxis while on a moderate CYP3A4 inhibitor?

A

0.3-0.6 mg qd

26
Q

What is the colchicine regimen for gout flare prophylaxis while on a P-gp inhibitor?

A

0.3 mg eod to qd

27
Q

What corticosteroid is used IA?

A

triamcinolone

28
Q

How are corticosteroids in large (knee), medium (wrist, ankle, elbow), and small (toe, finger) joints dosed, respectively?

A

40, 30, and 10 mg

29
Q

What are AEs of corticosteroids? (4)

A

leukocytosis, hyperglycemia, increased appetite, mood changes

30
Q

What are the goals of chronic therapy in gout? (2)

A

prevent future attacks and hyperuricemic sequelae (arthropathy, tophus formation, joint damage) by maintaining SUA <6.0

31
Q

What is the MOA of allopurinol and febuxostat?

A

xanthine oxidase inhibitor (prevents conversion of purines to uric acid)

32
Q

What are AEs of allopurinol? (2)

A

rash (potential SJS), DRESS

33
Q

What are DDIs for allopurinol? (7)

A

warfarin, 6-mercaptopurine/azathioprine/theophylline, amox/ampicillin, thiazides, ACE-i

34
Q

How is allopurinol dosed?

A

50-100 mg/day titrated up to achieve SUA <6 mg/dL

35
Q

How is febuxostat dosed?

A

40 mg/day up to 80 to achieve SUA <6 mg/dL

36
Q

What are AEs of febuxostat? (3)

A

HA/dizziness, arthralgias, GI

37
Q

What is a boxed warning for febuxostat?

A

cardiovascular death

38
Q

What is a contraindication for febuxostat?

A

concurrent 6-MP/azathioprine/theophylline

39
Q

What is the MOA of probenecid?

A

competitive inhibitor for reabsorption of uric acid at proximal convoluted tubule

40
Q

How is probenecid dosed?

A

250 mg bid, up to 500 mg

41
Q

What are contraindications for probenecid? (2)

A

CrCl <50 mL/min, Hx of nephrolithiasis

42
Q

What are DDIs for probenecid? (4)

A

penicillin, methotrexate, carbapenems (dori/meropenem), salicylates

43
Q

What is the MOA of pegloticase?

A

pegylated recombinant uricase substitute

44
Q

What is a boxed warning for uricase agents (pegloticase)?

A

infusion-related reactions

45
Q

What are the indications for chronic pharmacologic gout therapy?

A

1+ subcutaneous tophi, radiographic evidence of gout damage; or 2+ flares/year

46
Q

When else might one consider chronic pharmacologic gout therapy? (4)

A

Hx of >1 attack (w/<2/year), those with first flare who have CKD Stage 3+, [UA] >9 mg/dL, urolithiasis

47
Q

What is the goal serum urate level?

A

<6 mg/dL

48
Q

What are first-line for chronic pharmacologic gout therapy? (2)

A

low-dose colchicine or NSAIDs

49
Q

What is second-line for chronic pharmacologic gout therapy?

A

low-dose prednisone/olone

50
Q

How long should chronic pharmacologic gout therapy be? (3)

A

at least 6 months, OR achieving target serum and 3 months (no tophi) or 6 months (1+ tophi)

51
Q

What is first-line for acute pharmacologic gout therapy? (3)

A

NSAIDs, systemic corticosteroids, colchicine

52
Q

If patient is already on prophylactic colchicine during a gout flare?

A

if within 14 days, use NSAID or corticosteroid, otherwise use colchicine

53
Q

When should intraarticular corticosteroids be considered for gout flares?

A

1-2 large joint involvements

54
Q

What medications should not be co-administered in gout? (2)

A

NSAIDs and steroids

PHM702 (19 decks)

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