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Pharm Spring 2023 > Gout > Flashcards

Gout Flashcards

1
Q

what are the treatment guidelines for an acute gouty attack?

A

monotherapy with:
1. NSAIDs
2. low dose colchicine
3. corticosteroids

if pain does not resolve:
- combo therapy (NSAIDS, low dose colchine)

if pain does not resolve:
- interleukin inhibitors (not often)

adjuncts: ice

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2
Q

when to start pharmacotherapy for an acute gouty attack?

A
  • initiate therapy within 24 hours
  • ongoing urate lowering therapy should not be interrupted during acute treatment
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3
Q

when is combination therapy for an acute gouty attack used?

A

if failed monotherapy

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4
Q

what are acceptable combination therapy for an acute gouty attack?

A
  1. Colchicine and NSAID
  2. Oral corticosteroids and colchicine
  3. Intraarticular steroids with all other modalities
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5
Q

we should not used NSAIDs and systemic corticosteroids in combination. why?

A

similar MOA, will not increase the effect

increasing side effects

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6
Q

which NSAIDs to use for an acute gouty attack?

A

all are considered effective when given at an anti-inflammatory dose
- stop after 2-3 days after clinical signs ends

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7
Q

what is the most used NSAID for an acute gouty attack?

A

indomethacin
- lots of SEs: CNS, GI bleed

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8
Q

when is colchicine recommended?

A

within 36 hours of gouty attack onset

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9
Q

when to adjust the dose for colchicine?

A
  • renal insufficiency
  • hepatic insufficiency
  • use with caution or strong CYP 34A inhibitors
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10
Q

what are adverse effects of colchicine?

A
  • GI effects (N/V/D, abdominal pain)
  • Bone marrow suppression
  • Myotoxicity (including rhabdomyolysis)
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11
Q

when is colchicine CI?

A
  • CrCl < 10ml/min
  • Neutropenia
  • Treatment of gout flare with colchicine is not recommended in patients receiving prophylactic colchicine and CYP3A4 inhibitors
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12
Q

what is the dose of corticosteroids for gout?

A

Oral: prednisone 0.5mg/kg/day for 5 days
- might not need to taper

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13
Q

when are corticosteroids used for gout?

A

Typically reserved for patients who do not tolerate or have CI to colchicine or NSAIDs

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14
Q

what are long term adverse effects of corticosteroids?

A
  • HPA suppression
  • OP
  • Cataracts
  • Muscle deconditioning
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15
Q

why are interleukin 1 inhibitors used for gout?

A

reduces infalmmation associated with gout
- off-label use

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16
Q

What are the different interleukin 1 inhibitors

A
  1. Anakinra
  2. Canakinumab
    *used if combo therapy doesnt work
17
Q

when is long-term urate lowering therapy used for gout?

A

Any patient with established diagnosis of gouty arthritis AND one or more of the following:
- Tophus or tophi by clinical exam or imaging study
- Frequent attacks of acute gouty arthritis (≥2 attacks/yr)
- CKD stage 2 or worse
- Past urolithiasis

18
Q

what are the treatment guidelines for urate lowering therapy?

A
  1. allopurinol
    - if allopurinol in CI –> febuxostat (both XOI)
  2. febuxostat
  3. probenecid with XOI
  4. pegloticase if 1, 2, and 3 do not work
19
Q

what is the dose of allopurinol?

A

Starting dosage should be no greater than 100 mg/day for any patient
- Start at 50 mg/day with CrCl <60ml/min
- with renal impairment: monitor for toxicity

20
Q

what are the SEs of allopurinol?

A
  • Nausea
  • Diarrhea
  • Rash (rare, can lead to Stevens-Johnson syndrome)
  • Bone marrow suppression
  • Allopurinol hypersensitivity syndrome (AHS)
21
Q

what drug can be used if there is a hypersensitivity to allopurinol?

A

febuxostat

22
Q

What are the Xanthine oxide inhibitors

A
  1. Allopurinol
  2. Febuostat
23
Q

What are the uricosuric therapy meds

A
  1. Probenecid
  2. Lesinurad
24
Q

When is Pegloticase used

A
  1. In patient with severe gout disease burden and refractory to or an intolerance to oral ULT options
25
Q

what is the disadvantage of pegloticase?

A

expensive! $32,000 per dose

26
Q

What are the ADRs of Pegloticase

A
  1. Infusion reactions
27
Q

when is prophylactic anti-inflammatory therapy recommended?

A

for all case scenarios of gout when ULT is initiated
- crystals shift inside joints and might cause pain

28
Q

what are the drugs recommended for prophylactic anti-inflammatory therapy?

A
  • Colchicine 0.6mg BID
  • Low-dose NSAIDs (e.g. naproxen 250mg BID)
  • Low-dose prednisone or prednisolone (<10mg daily)
29
Q

what is long-term management for gout?

A
  • gout prophylaxis
  • monitor serum urate and ULT
  • urate levels under 6 mg
  • look for causes: meds, obesity, cancer, alcohol
30
Q

how to treat kidney stones that develop as a result of gout?

A
  1. hydration (2 to 3L)
  2. alkalize urine: potassium citrate or potassium bicarbonate
  3. acetazolamide (250)

Pharm Spring 2023 (27 decks)

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