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Advanced Immunology > gout > Flashcards

gout Flashcards

1
Q

gout is a result of ___

A

overproduction and underexcretion of uric acid

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2
Q

the enzyme that converts purines to uric acid

A

xanthine oxidase

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3
Q

non modifiable risk factors gout

A

male, elderly, living in developed countries, genetics

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4
Q

modifiable risk factors gout

A

diet high in purine (red meat, organ meat, shrimp)
high fructose corn syrup
alcohol (beer, wine)
medications
obesity
HTN, HLD, CKD

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5
Q

what drug INCREASES uric acid excretion

A

losartan

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6
Q

what drugs cause UNDEREXCRETION of uric acid

A

low dose ASA
thiazide and loop diuretics
levodopa
tacrolimus and cyclosporine

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7
Q

what, other than drugs, causes underexcretion of uric acid

A

renal impairment, HTN, alcohol, dehydration

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8
Q

what causes overproduction of uric acid

A

diet, cytotoxic medications, psoriasis, sickle cell disease, lympho/myeloproliferative diseases

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9
Q

what is the gold standard for gout diagnosis

A

aspiration of synovial fluid or tophi

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10
Q

serum uric acid > __ is gout

A

6.5-6.8 mg/dL

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11
Q

when is the best time to check serum uric acid

A

2 weeks after a flare

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12
Q

clinical presentation gout

A

usually presents as an acute flare; intense joint pain that comes on suddenly/middle of night; joints are swollen, painful, red, warm to touch

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13
Q

____ is a sign of chronic gout

A

tophi

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14
Q

what are the 4 stages of gout

A

-asymptomatic
-acute gouty arthritis
-inter critical gout
-chronic recurrent gout

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15
Q

what are the points of asymptomatic gout

A

serum uric acid levels are >6.8 but no history of gouty attack

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16
Q

does asymptomatic gout warrant treatment

A

no

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17
Q

what is inter critical gout

A

the asymptomatic period between attacks

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18
Q

what characterizes chronic recurrent gount

A

the presence of tophi, persistent joint stiffness and inflammation, radiographic erosions

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19
Q

complications of gout

A

joint damage and deformity
kidney stones
kidney disease/failure
psychological and emotional problems

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20
Q

goal serum uric acid level

A

<6 mg/dL

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21
Q

initiate pharmacological therapy within __ hours of an acute gout attack

A

24

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22
Q

first line agents for acute gout attack

A

NSAIDs, colchicine, steroids

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23
Q

true or false: you should stop established urate lowering therapy during an acute gout attack

A

false

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24
Q

which NSAIDs are rec in acute gout attack

A

sulindac
indomethacin
naproxen

25
Q

box warning NSAIDs

A

increase risk of CV thrombotic events including MI/stroke

26
Q

___ doses of NSAIDs are needed for gout to treat inflammation and pain

A

higher

27
Q

naproxen dose

A

500 BID

28
Q

indomethacin dose

A

50 TID

29
Q

sulindac dose

A

200 BID

30
Q

colchicine mech

A

interferes w/ migration of neutrophils to sites of inflammation that have been induced by deposits of urate crystals in synovial fluid

31
Q

colchicine dosing regimen

A

1.2 mg initially followed by 0.6 mg one hour later
0.6 mg BID until flare resolves

32
Q

adverse effects of colchicine

A

n/v/d, abdominal pain, muscle pain/weakness

33
Q

drug interactions colchicine

A

CYP3A4 inhibitors and p-glycoprotein inhibitors

34
Q

disease interactions colchicine

A

severe hepatic impairment or CrCL<30 + dialysis

35
Q

prednisone dose

A

30-40 mg/d until resolution then taper 5 mg each day for 7-10d

36
Q

intraarticular steroid for gout

A

triamcinolone 10, 30 or 40 mg
IM triamcinolone 60 mg followed by PO corticosteroid if multiple joints

37
Q

when is chronic urate lowering therapy indicated

A

1 or more subcutaneous tophi
2 or more attacks per year
evidence of radiographic damage

38
Q

first line urate lowering therapy

A

allopurinol

39
Q

alternative XOI

A

febuxostat

40
Q

alternative to XOI

A

probenicid

41
Q

add on therapy

A

lesinurad

42
Q

allopurinol dosing

A

start 100 mg/day (50 if CrCL<60)
increase by 50-100 every 4 weeks (max 800)

43
Q

what to tell the patient when starting XOI

A

acute gout flares during initiation

44
Q

monitoring for allopurinol

A

rash, diarrhea, nausea, LFTs, neutropenia

45
Q

allopurinol hypersensitivity syndrome

A

TEN and SJS concern

46
Q

febuxostat dosing

A

40 mg daily
if uric acid still >6 mg/dL after 2 weeks, increase to 80 mg daily

47
Q

cautions with febuxostat

A

ischemic heart disease or CHF

48
Q

allopurinol and febuxostat can precipitate a ___

A

gout attack

49
Q

when starting XOI, you should

A

add one of the following:
colchicine
low dose NSAID
low dose glucocorticoid

50
Q

probenecid mechanism

A

inhibits tubular urate reabsorption in kidneys

51
Q

probenecid dosing

A

250 mg po bid
increase every 4 weeks up to max 1000 mg BID until goal urate

52
Q

counseling probenecid

A

increase fluid intake to prevent kidney stones

53
Q

probenecid contraindications

A

history of urolithiasis (can increase kidney stones)
CrCL<50

54
Q

lesinurad main point

A

must be used in combo with a XOI

55
Q

lesinurad mech

A

inhibits the function of renal apical transporters that facilitate reabsorption of uric acid

56
Q

lesinurad dosing

A

200 mg daily with food, water, XOI

57
Q

last line agent gout

A

pegloticase

58
Q

pegloticase when to use

A

if goal of SU<6 is not achieved, d/c the other therapies. only if gout dx burden is severe and refractory/intolerant to other options

59
Q

pegloticase dosing

A

8 mg IV q2 weeks

Advanced Immunology (6 decks)

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