Gout Flashcards
Which group of side effects occur in most pts using colchicine?
a. Nausea and diarrhea
b. Headache and dizziness
c. Somnolence and confusion
d. Hyperglycemia, HTN, and insomnia
e. Rash and increased LFTs
a
Nausea and diarrhea occur in ~80% of pts.
Which drug/s can be used to lower uric acid levels in pts with gout?
a. Allopurinol
b. Probenecid
c. Prednisone
d. Febuxostat
e. Naproxen
a, b, d
Allopurinol and febuxostat are xanthine oxidase inhibitors that will decrease uric acid production. Probenecid is an alternative option.
What is the MOA of pegloticase?
a. Inhibits reabsorption of uric acid in the kidneys
b. Xanthine oxidase inhibitor
c. Converts uric acid to allantoin
d. Uricosuric
e. Binds to pyrimidines
c
-Pegloticase is an expensive IV drug used for chronic gout that’s refractory to conventional tx.
-It’s a recombinant uricase, which offers a unique MOA.
-Anaphylactic reactions are common; therefore, pts should be premedicated with antihistamines and corticosteroids.
Which analgesic should NOT be recommended to help with the pain of an acute gout attack as it may increase uric acid levels?
a. Bufferin
b. Motrin
c. Aleve
d. Sulindac
e. Celebrex
a
GH is a 62 y/o obese male (5’9”, 227 lbs). His PMH includes HTN, hypothyroidism, GERD. He was diagnosed with gout in January and presents to his PCP today for follow-up and repeat labs. The pain in his affected joints has declined from an 8/10 to ~6/10.
Meds:
Synthroid 150 mcg daily
Protonix 40 mg daily
Allopurinol 200 mg daily
Amlodipine 10 mg daily
Naproxen OTC 220 mg BID (pt sometimes doubles dose x 48 hrs for gout pain)
All labs are normal except UA = 8.2 (3.5-7.2)
Which of the following recommendations for GH’s gout is most appropriate to make today?
a. Add febuxostat
b. Add probenecid
c. Add pegloticase
d. Add rasburicase
e. Switch allopurinol to lesinurad
b
-The goal in treating gout is to lower the uric acid to < 6 mg/dL.
-Of the answer choices offered, the only acceptable option is to add probenecid to allopurinol. It can be used if XOIs are contraindicated or not tolerated or added when UA level isn’t at goal.
-Adding febuxostat (another xanthine oxidase inhibitor) is a duplication of therapy.
-Pegloticase is reserved for severe, refractory disease.
What is the MOA of allopurinol?
a. Uricosuric
b. Inhibits reabsorption of uric acid in the kidneys
c. Converts uric acid to allantoin
d. Xanthine oxidase inhibitor
e. Binds to pyrimidines
d
Probenecid can reduce the renal clearance of which of the following meds?
a. Azithromycin
b. Clopidogrel
c. Codeine
d. Penicillin
e. Sertraline
d
Probenecid can block renal clearance of beta-lactams, methotrexate, aspirin, and some other drugs. It’s sometimes given with penicillin in neurosyphilis to increase the levels of penicillin.
TL is a 72 y/o Korean male with a hx of gout. His PMH mentions that he’s “positive for the HLA-B*5801.” Which med should be avoided in this pt?
a. Allopurinol
b. Lesinurad
c. Pegloticase
d. Probenecid
e. Rasburicase
a
A pt with gout begins with allopurinol 100 mg daily. The pt should be instructed to watch for this AE and to be seen promptly if it’s serious:
a. Bloody diarrhea
b. Weakness, malaise
c. Rash
d. Mental confusion and dizziness
e. Increased urine output
c
Although uncommon, this drug can cause a rash. The rash can be benign but can rarely develop into more serious reactions, including Toxic Epidermal Necrolysis (TEN) or Stevens-Johnson Syndrome (SJS). These can be fatal.
A hospital received an order for rasburicase for a hospitalized pt with non-Hodgkin lymphoma. What condition is being treated?
a. QT prolongation
b. Hepatotoxicity
c. Toxic epidermal necrolysis
d. Angioedema
e. Tumor lysis syndrome
e
-Tumor lysis syndrome (TLS, or hyperuricemia associated with malignancy) can be fatal.
-Rasburicase (Elitek) IV is approved for the tx of TLS and is used off-label for prophylaxis.
-It’s common for pts to receive oral allopurinol as a prophylactic regimen for TLS.
-IV hydration is an essential component of treating TLS.
A hospital pharmacist receives the following order for a pt with gout: “Methylprednisolone acetate 40 mg via intraarticular injection (left knee). Local anesthesia with lidocaine per unit protocol.” Where should the methylprednisolone be injected?
a. Into the muscle surrounding the knee
b. Into the bone of the knee
c. Into the knee joint
d. Into an artery near the knee
e. Into the wound on the knee
c
Uric acid is produced as an end-product of ___________ metabolism.
purine
Gout attacks have ______ onset.
sudden
T/F: Gout typically occurs in more than one joint.
False; it usually occurs in 1 joint.
Which joint is most commonly affected by gout?
metatarsophalangeal joint (big toe)
