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CPJE > Gout > Flashcards

Gout Flashcards

1
Q

What are risk factors for gout?

A
  1. Male sex
  2. Obesity
  3. Excessive alcohol consumption (beer)
  4. HTN
  5. CKD
  6. Lead intoxication
  7. Advanced age
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2
Q

What are drugs that increase uric acid?

A
  1. ASA (lower doses)
  2. Tacrolimus, cyclosporine
  3. Diuretics (loops & thiazides)
  4. Niacin
  5. Pyrazinamide
  6. Select chemo
  7. Select pancreatic enzyme products
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3
Q

What drugs are used to treat acute gout?

A

Colchicine (Colcrys)
Steroids
NSAIDs

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4
Q

Colchicine dose for tx?
Renal dysfunction?

A

1.2 mg PO, followed by 0.6 mg in 1 hr. Max: 1.8 mg/1 hr or 2.4 mg/day
2.CrCl <30: same dose but do not give again x 2 weeks

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5
Q

Colchicine dose for prophy? Renal dose?

A

0.6 mg qd or bid
CrCl <30: 0.3 mg/day

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6
Q

Colchicine

Side effects & warnings

A
  1. Myelosuppression
  2. GI: diarrhea, nausea
  3. Myopathy, neuropathy
  4. Vit B12 decrease
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7
Q

Which meds should you not use colchicine with?

A

CYP3A4i & Pgpi
(cyclosporine, dilt, verap, gemfibrozil or statins)

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8
Q

When should you start colchicine for tx?

A

Within 36 hours of sx onset

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9
Q

When should you resume prophy dose of colchicine after tx?

A

12 hours

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10
Q

What should you do if using colchicine with strong CYP3A4i? Mod CYP3A4i?

A

Strong: dose is reduced, repeated no earlier than 3 days
Mod: max dose of tx 1.2 mg (2 tabs)

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11
Q

What is the usual & max dose of allopurinol (Zyloprim, Aloprim)? Renal dose?

A

Usual: 100 mg daily, doses >300 mg can be necessary
Crcl <30: start at 50 mg daily, increase to 300 mg/day

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12
Q

Allopurinol & febuxostat side effects?

A
  1. Rash
  2. Acute gout attacks (take with colchicine prophy dose or NSAID x 3-6 months when starting)
  3. Nausea, diarrhea
  4. Increased LFTs
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13
Q

Allopurinol warnings

A
  1. Hypersensitivity rxns
  2. HLA-B5801 testing prior to use if high risk
  3. Hepatotoxicity
  4. Bone marrow suppression
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14
Q

What is the usual, max & renal dose for febuxostat (Uloric)?

A

Usual: 40 mg daily
Max: 120 mg/day
Crcl <30: max 40 mg daily

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15
Q

Boxed warning for febuxostat?

A
  1. Increased risk of CV death
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16
Q

General warnings for febuxostat?

A
  1. Hepatotoxicity
  2. possible MI or stroke
  3. SJS/TEN
17
Q

Which drugs should you not use XOI with?

A
  1. mercaptopurine
  2. azathioprine
  3. didanosine
  4. Antacids (lower allopurinol absorption)
18
Q

Uricosurics (can be added with XOI)

What is usual & renal dose for Lesinurad (Zurampic)?

A

Usual: 200 mg daily
CrCl <30: CI, only initiate with CrCl at least 45

19
Q

Boxed warnings for Zurampic?

A

Acute renal failure

20
Q

Uricosurics used with XOI

What is the usual & renal dose for Probenecid (Probalan)?

A

Usual: 250 mg BID
Max: 2 g/day
CrCl <30: avoid

21
Q

What are CI for probenecid?

A

Do not use in ASA therapy, blood dyscrasias, UA kidney stones, children <2, initiation in acute gout attack

22
Q

What are SE of probenecid?

A

Hypersensitivity rxns, hemolytic anemia

23
Q

Trivia of probenecid

A
  1. Do not use in G6PD deficiency
  2. Can be used to increase beta lactam levels by decreasing beta lactam excretion
  3. Also can increase MTX, ASA levels
  4. Decreases efficacy of loops, increases risk of loop toxicity
24
Q

Recombinant uricase: converts uric acid to allantoin

What is Pegloticase (Krystexxa)?

A

Injection given 8 mg IV q2 weeks

25
Q

Boxed warning for Krystexxa

A

Anaphylactic reactions. Pre-medicate with antihistamines & steroids. Highest risk with UA >6. Do not use with XOI or probenecid
Life-threatening hemolytic rxns & methemoglobinemia may occur with G6PD deficiency (which is a CI for use)

26
Q

What are side effects to expect with Krystexxa?

A
  1. antibody formation
  2. Gout flare (give with NSAID/colchicine 1 week prior to infusion & continue for at least 6 months)
  3. Infusion rxn
  4. Nausea
  5. Bruising
  6. Urticaria
  7. Erythema
  8. Pruritis

CPJE (13 decks)

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