exam 4 lecture 8

Question 1

What causes over production of uric acid

Answer 1

Regulatory enzyme variability
Cytotoxic meds
Uncrease dietary intake of purines
Chronic alcohol intake

Question 2

What causes under excretion of uric acid

Answer 2

Dehydration
Unsulin resistance
Acute alcohol intake
Medications

Question 3

meds that cause underexcretion of uric acid

Answer 3

Thiazides (common), loop diuretics
cytotoxic agents
Salicylates

Question 4

risk factors for gout

Answer 4

male
post menopausal women
obesity
elderly
diet and alcohol
sedentary lifestyle
renal impairement

Question 5

clinical presentation? S/s?

Answer 5

acute inflammatory monoarthiritis
podagra- 1st metatarsal joint involved

S/S
- intense pain
Fever
Erythema, warm edema

Question 6

uric acid indicative of gout

Answer 6

> 6.8

Question 7

complications of gout

Answer 7

Tophi- deposits of monosodium urate
Nephrolithiasis- kidney stones

Question 8

Diagnosis of gout

Answer 8

check synovial fluid

Question 9

pcol therapy for acute gout

Answer 9

NSAIDs
Colchicine
corticosteroids

Question 10

NSAIDs for gout

Answer 10

Indomethacin
Naproxen
Ibuprofen
Sulindac

Question 11

NSAIDs adverse effects

Answer 11

Kidney injury
GI bleed
CV effects
CNS effects
Bleeding risk

Question 12

When to administer colchicine? dose? (know dose)

Answer 12

administer within 24 hrs of acute attack

day 1- 1.2 mg PO once, then 0.6 mg one hour later
Day 2- 0.6 mg BID until resolves

Question 13

adverse effets of colchicine

Answer 13

N/V/D

Question 14

renal dose adjustments of colchicine

Answer 14

CRCL<30
1.2 mg onset and 1 mg 1 hour afterwards (once)

Question 15

What to do if inadequate initial response

Answer 15

Switch agent

or

add on another therapy (do not use NSAIDs and corticosteroids together)

Question 16

Non pcol gout therapy

Answer 16

Weight loss
DASH diet
alcohol restriction
Limiting purine rich food

Question 17

Indications to start ULT (urate lowering therapy) for chronic gout? Who is not a candidate?

Answer 17

Frequent gout flares > 2 per year
Patients experiencing first flare with either CKD, uric acid > 9 or urolithiasis

Who is not a candidate?
Asymptomatic hyperuricemia with no prior gout flares or tophi

Question 18

When to initiate ULT? duration?

Answer 18

may be initiated during acute attack, indefinitely

Monitor uric acid and

Question 19

Pcol therapy for chronic gout

Answer 19

xanthine oxidase inhibitor (1st line)
Uricosurics (2nd)
Uricase agents (3rd)

Question 20

xanthine oxidase inhibitor drugs? Titration of the drugs (exam)

Answer 20

allopurinol( titrate every 2-4 wks in < 100 mg increments as needed to achieve uric acid < 6)

Febuxostat (titarte if uric acid > 6)

Question 21

renal adjustment of allopurinol

Answer 21

eGFR > 60, initial dose 100 mg PO daily
eGFR < 60, initial dose 50 mg daily (titrate slowly and in small increments)

Question 22

How does allopurinol HS syndrome present? WHat to test for in pts with SE asian decent or african decent?

Answer 22

Presents as SJS (steven johnson syndrome) and toxic eidermal necrolysis (TEN)

HLA B 5801 allele increases SJS risk. If positive do not initiate allopurnol

Question 23

febuxostat use? Black box?

Answer 23

Only used if CI to allopurinol

Has black box for CV events

Question 24

Uricosuric drugs

Answer 24

Probenecid
Lesinurad

Question 25

probenecid contraindication

Answer 25

Urolithiasis
G6PD deficiency

Question 26

uricase agents drugs? Indication

Answer 26

Pegloticase

Used in SEVERE gout

pre medication required for infusion related rxns

Question 27

What to do to prevent flare from occuring while giving allopurinol in ULT

Answer 27

start NSAIDs, steroids or colchicine for 3-6 months while ULT is happening

overall lower doses than normal acute doses

Question 28

Colchicine dose for prophylaxis

Answer 28

0.6 mg PO QD