Gout

Question 1

What is gout?

Answer 1

build up of uric acid crystals in the joints = PAINFUL

most common joint = metatarsophalangeal joint (BIG TOE)

Question 2

Drugs that increase uric acid

Answer 2

Loop and thiazides
ASA
CNI (tacrolimus and cyclosporine)
Niacin
Pyrazinamide
chemo with tumor lysis syndrome
selective pancreatic enzyme products

Question 3

Drugs to treat acute gout attack

Answer 3

Colchicine (Colcrys)
Steroids
NSAIDs

Question 4

Drugs to chronically treat gout

Answer 4

Xanthanine Oxidase Inhibitors:
Allopurinol (Zyloprim)
Febuxostat

If not sufficient and UA > 6 mg/dL:
-add probenecid or lesinurad
-replace with IV pegloticase

Question 5

Colcrys

Answer 5

Colchicine
***used for acute egout attacks
SE: diarrhea, nausea, MYOPATHY, MYELOSUPPRESSION , neuropathy

**start within 36 hours of symptom onset

*****increased myelosuppression, neuropathy, and myopathy in elderly with renal impairment

DO NOT combine with strong pgp or CYP inhibitor

Question 6

NSAIDs for gout

Answer 6

Idomethacin (Indocin)
Naproxen (Aleve)
Celecoxib (Celebrex)

***avoid use in severe renal disease
CVD risk

Question 7

Steroids in gout

Answer 7

Prednisone
Prednisolone
Methylprednisolone (Intra-aricular for 1 joint pain)

Question 8

What acute treatment of gout should be avoided with Amiodarone or Diltiazem?

Answer 8

Colchicine (Colcrys)

Question 9

When starting urate lowering therapy (ULT) after an acute flare, what should you take into consideration?

Answer 9

RISK OF ANOTHER ATTACK
- prophylaxis with colchicine, NSAIDs, or steroids while starting ULT treatment!!!!!!
-overlay should be for the first 3-6 months to prevent another attack

Question 10

What is the target level of UA?

Answer 10

< 6 mg/dL

Question 11

What is the first line ULT?

Answer 11

Allopurinol (xanthine oxidase inhibitor)

**risk for hypersensitivity rxn in HLA-B*5801 allele of Asian decent

Warning: hepatotoxicity

Question 12

What is an alternative if allopurinol is contraindicated?

Answer 12

Febuxostat
Probenecid

Question 13

Probenecid MOA

Answer 13

inhibits reabsorption of UA from kidneys

**need kidney function to work

Question 14

Allopurinol MOA

Answer 14

Xanthine Oxidase Inhibitor
blockers production of UA === will NOT breakdown UA that is already made :(

Question 15

Febuxostat

Answer 15

BW: CV disease patients === death
CI: do NOT use with mercaptopurine or azathioprine

Warning: Hepatotoxicity and SJS

Question 16

What drugs should be avoided with XOI?

Answer 16

Azathioprine
Mercatopurine

Question 17

What is a potential treatment for tumor lysis syndrome?

Answer 17

Rasburicase

CI: G6PD deficiency