Final Exam - Gout

Question 1

medications that may cause gout

Answer 1

diuretics
salicylates
cytotoxic drugs

Question 2

diagnosing and clinical presentation of gout

Answer 2

uric acid >6.8mg/dL
tophi/podagra
nephrolithiasis

Question 3

non pharm tx

Answer 3

icing affected area to reduce inflammation and pain
wt loss if overweight
DASH diet
alcohol restriction
limit purine rich foods

Question 4

pharm tx options

Answer 4

NSAIDs
corticosteroids
colchicine

Question 5

NSAID options

Answer 5

indomethacin
naproxen
ibuprofen
sulindac

Question 6

corticosteroids options

Answer 6

PO:
methylprednisolone dose pack
prednisone 0.5mg/kg/day tapered

IM and IA options available too

Question 7

colchicine dosing for acute attack

Answer 7

recommended to administer within 24 hrs of an acute attack
day 1: 1.2mg PO once, then 0.6mg one hour later
day 2+: 0.6mg BID until attack resolves

Question 8

colchicine renal dose adjustments

Answer 8

CrCl 30+: no adj.
CrCl <30: 1.2mg at onset, 0.6mg 1 hour later (once)
Dialysis: single 0.6mg dose

Question 9

indications to start ULT

Answer 9

2+ flares per year
1+ tophi
radiographic evidence of damage attributable to gout
pts experiencing first flare in the following:
-CKD stage 3-5
-uric acid >9
-urolithiasis

Question 10

target uric acid level on ULT

Answer 10

<6

Question 11

1st line ULT

Answer 11

xanthine oxidase inhibitors
-allopurinol (most common, 1st dose 100mg up to max of 800mg/day)
-febuxostat

Question 12

allopurinol renal dose adj.

Answer 12

eGFR>60: no adj.
eGFR 60 or less: initially use 50mg daily

Question 13

counseling points for allopurinol

Answer 13

drink lots of fluids
don’t stop taking if sx resolve, continue to take all the time

Question 14

2nd line ULT

Answer 14

uricosurics
-probenecid
-lesinurad

Question 15

3rd line ULT

Answer 15

uricase agents
-pegloticase

Question 16

other ULT

Answer 16

fenofibrate
losartan