Gout

Question 1

MOA: COX inhibition: reduced prostaglandin synthesis. Inhibit urate crystal phagocytosis. Decreased leukocyte migration

Answer 1

NSAIDs

Question 2

indication: Acute gout attack within 24 hours of symptom onset and continue until pain absent for 24 hrs

Answer 2

NSAIDs

Question 3

should aspirin be used for gout

Answer 3

no

Question 4

MOA: down regulation of multiple inflammatory pathways. Interferes w/ function of mitotic spindles in neutrophils. Impedes leukocyte migration and phagocytosis

Answer 4

colchicine

Question 5

indications: Acute gout attack START within 12-24 hours of symptom onset for max effect. Calcium Phosphate Crystal Arthritis, pericarditis, Behcet’s, Familial Mediterranean Fever, PREVENTION of gout attacks in certain patients

Answer 5

colchicine

Question 6

AEs: GI – severe diarrhea (23%),nausea, vomiting, abdominal pain. Myopathy, Bone marrow suppression

Answer 6

colchicine

Question 7

colchicine interactions

Answer 7

It is a CYP3A4 substrate- so avoid use with strong CYP3A4 inhibitors (diltiazem, verapamil,clarithromycin, grapefruit). Statins are substrates and therefore DO interact so consider stopping the statin for a few days

Question 8

colchicine special pop concerns

Answer 8

Adjust dose or avoid in severe renal dysfunction (CrCl<30)

Question 9

PO steroids for gout for minimum of ___ days

Answer 9

10

Question 10

indications: For pts w/ contras to NSAIDs and cochicine. Polyarticular attacks, systemic for widespread

Answer 10

corticosteroids

Question 11

MOA: Stimulates production of cortisol by adrenal corte

Answer 11

Corticotropin

Question 12

anakinra, canakinumab

Answer 12

IL-1 inhibitors

Question 13

indications for urate lowering therapy

Answer 13

2+ attacks / yr, tophus, stage 2 CKD or worse, past urolithiasis (uric acid kidney stones)

Question 14

AE: can cause acute attack

Answer 14

urate lowering therapies

Question 15

“Allopurinol (Zyloprim®, Aloprim®)
Febuxostat (Uloric®)”
class

Answer 15

Xanthine Oxidase Inhibitors

Question 16

turns off the facet - reduces uric acid production. Inhibits xanthine oxidase

Answer 16

“Allopurinol (Zyloprim®, Aloprim®)
Febuxostat (Uloric®)”

Question 17

1st line urate lowering agents for gout

Answer 17

allopurinol

Question 18

AEs: diarrhea, nausea, rash, pruritis, urticaria

Answer 18

allopurinol

Question 19

AEs: transaminitis, nausea, arthralgia, rash

Answer 19

Febuxostat (Uloric®)

Question 20

interactions of allopurinol

Answer 20

A: increases warfarin, theophylline

Question 21

allopurinol adjust dose for whom

Answer 21

renal impaired

Question 22

monitoring: “Allopurinol (Zyloprim®, Aloprim®)

Answer 22

monitor uric acid Q2-5 wks, then Q6 mo after target is reached

Question 23

co-prescribe w/ allopurinol

Answer 23

NSAID or colchicine

Question 24

MOA: empties the tub with a bucket. Decreases reabsorption in Proximal tubule. Reduces uric acid retention. Tophaceous deposits may be reabsorbed

Answer 24

“Probenecid

Question 25

indication: Patients intolerant to or ineffective use of xanthine oxidase inhibitors

Answer 25

“Probenecid

Question 26

“Probenecid
class

Answer 26

Uricosurics

Question 27

AEs: “Headache, N/V, aplastic anemia (rare)
Precipitate kidney stone formation “

Answer 27

Probenecid

Question 28

Probenecid
interactions

Answer 28

Aspirin, penicillins, methotrexate

Question 29

Probenecid pt counseling

Answer 29

encourage hydration to prevent kidney stones

Question 30

drains the tub. Metabolises uric acid. IV infusion Q2 wks

Answer 30

Pegloticase (Krystexxa®)

Question 31

indication: Refractory chronic gout

Answer 31

Pegloticase (Krystexxa®)

Question 32

Pegloticase (Krystexxa®)
contra

Answer 32

Contraindication: G6PD deficiency

Question 33

AEs: anaphylaxis, infusion reactions, possible gout flares

Answer 33

Pegloticase (Krystexxa®)

Question 34

MOA: Uric acid transporter 1 (URAT1) inhibitor. Increases renal secretion of uric acid

Answer 34

Lesinurad (Zurampic®)

Question 35

FDA approved for co-administration with Xanthine Oxidase Inhibitor (if serum uric acid levels not achieved)

Answer 35

Lesinurad (Zurampic®)

Question 36

BBW and AEs for Lesinurad (Zurampic®)

Answer 36

“BBW: Risk of renal failure when administered as monotherapy
Headache, influenza, SCr increase, GERD”