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msk 3154 > gout > Flashcards

gout Flashcards

1
Q

pathophysiology of gout

A
  1. imbalances in purine metabolism
  2. deposition of monosodium urate crystals in articular and periarticular tissues
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2
Q

lifestyle risk factors

A

alcohol consumption
sugary beverages
red meat
sedentary lifestyle/obesity
males (gender narrows after menopause)

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3
Q

drugs decreasing uric acid clearance

A

Diuretics (thiazides, loop diuretics)
Low dose salicylates
Ethambutol
Pyrazinamide
Levodopa

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4
Q

diet induced purine/urate overproduction

A

excess ethanol, dietary purine, fructose, cytotoxic drugs

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5
Q

examples of purine rich foods (name 3)

A

anchovies, asparagus, mushrooms, red meat, peanuts, durian, organ meat, cockles, mussels

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6
Q

confirmatory diagnosis for gout

A

presence of uric acid crystals in joint aspirate

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7
Q

treatment goals of gout

A

safe, effective pain relief
reduce future attacks
prevent joint destruction and tophi formation
increase qol

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8
Q

avoid concurrent nsaids with…

A

steroids

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9
Q

colchicine dosage for acute flare

A

1mg LD + 0.5mg 1hr later
or
0.5mg BD/TDS until acute flare resolves

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10
Q

colchicine main AE

A

gi

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11
Q

non pharm for gout

A

topical ice, max 15 mins, do not put directly over

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12
Q

alternative to nsaids/colchicine

A

intra-articular/IM corticosteroids

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13
Q

treatment target for non-tophaceous gout

A

< 360 µmol/L (6mg/dL)

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14
Q

when to initiate ult

A
  • at least two gout flares per year
  • presence of tophus
  • clinical or imaging findings of gouty arthropathy
  • urolithiasis hx
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15
Q

clinical remission means

A

no flares for ≥1 year and no tophi

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16
Q

colchicine moa

A

Anti-mitotic;

Binds to tubulin, prevents polymerisation into microtubules

Inhibits leukocyte migration and phagocytosis

Inhibiting leukotriene B4 and PG production

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17
Q

precautions of colchicine

A

renal impairment (especially when paired with NSAIDs)

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18
Q

colchicine metabolism and common ddi

A

cyp3a4

statins, azoles, macrolides

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19
Q

colchicine ci

A

crcl<30ml/min

20
Q

colchicine adverse reactions

A

GI (NVD), ab pain, muscle weakness, unusual bleeding

21
Q

allopurinol and febuxostat moa

A

Xanthine Oxidase inhibitors, prevent production of uric acid

22
Q

initiation dose of allo

A

maximum 100 mg/d

23
Q

how to titrate allo

A

50 to 100 mg every 2-8 weeks

24
Q

maintenance dose of allo

A

at least 300 mg/d

25
Q

what drugs with allo can increase bone marrow suppression?

A

6 mercaptopurine
Azathioprine
Cyclophosphamide

26
Q

what drugs with allo can increase toxicity of allo?

A

ACEi
Loop/thiazides
Ampicillin
Amoxicillin

27
Q

allopurinol / febuxostat AE

A

Risk of SCAR (Allo>Feb)
NVD, fever, sore throat, dark urine, jaundice
Higher risk of death in patients with gout and major CVS (Feb>Allo)

28
Q

sjs ten symptoms

A

Fever, lesions leading to necrosis and sloughing of epidermis

29
Q

dress symptoms

A

Fever, rash, multiorgan failure

30
Q

gene involved with increased scar risk

A

hlab*-5801(Han Chinese, Thai, Korean)

31
Q

other clinically significant ddi

A

CBZ, Warfarin, Theophylline (increased concentration)

32
Q

initiation of ULT should be accompanied by? and what doses?

A

Anti-inflammatory prophylaxis for 3-6 months

Colchicine 0.5mg OD
PO Celecoxib 200 mg OD
PO Prednisolone 5-7.5 mg OD

33
Q

febuxostat how to initiate

A

max 40mg/d

34
Q

titrate febuxo

A

up to 80mg/d if target not met after 2-4 weeks

35
Q

febuxostat metab

A

liver

36
Q

febuxo caution in

A

hf/chd

37
Q

probenecid moa

A

Uricosuric agents.URAT1 [& GLUT9 inhibitor. Inhibit proximal tubule anion transport and uric acid reabsorption.

38
Q

initiate probenecid

A

250mg BD x 1wk then 500mg BD

39
Q

titrate probenecid

A

500 mg/mth

40
Q

maintain probenecid

A

≤2 g/d

41
Q

probenecid ci

A

Urolithiasis
CrCl <50ml/min (ESRF)

42
Q

probenecid ae

A

NV, painful urination, rash, lower back pain

haemolytic anemia (pts with g6pd)

43
Q

probenecid admin instructions

A

hydrate at least 2L a day to prevent formation of kidney stones
ensure urine pH >6 by administering alkaline

44
Q

are opioids preferred for gout/ra/oa

A

not anti-inflammatory

45
Q

opioids ae

A

gi (nv, constipation)
hormonal effects
depression
respiratory effects
overdose and death
fractures
sedation
tolerance, addiction
opioid-induced hyperalgesia

46
Q

precautions for opioids

A

cns depressants, renal/hepatic insufficiency, >65 yo, pregnancy, hx of substance use disorder

msk 3154 (8 decks)

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