Gout

Question 1

gout treatment goal serum urate

Answer 1

< 6mg/dL

Question 2

acute gout attack

Answer 2

Abrupt onset of joint inflammation due to urate crystal in synovial fluid

• If affects the big toe Pdogra

IMP!!
URATE lowering med should not be initiated during and acute attack BUT

if pt is already on urate lowering med than medication should be continued

Question 3

acute gout tx

Answer 3

NSAID
- Indomethacin

Colchicine
- (used for tx of acute gout attack and for prevention)

Corticosteroid
- orally or injected directly

Question 4

Long term prevention

Answer 4

Colchicine

Urisouric drugs
- Probenecid

Xanthine oxidase inhib
- allopurinol (Aloprim)
- Febuxostat ( Uloric)

Pegylated uric acid enzyme
- Pegloticase (Krystexxa) IV

Question 5

Medication that inc UA

food that inc UA

Answer 5

A: ASA
B: vitamin B3 (niacin)
C: cyclosporine, Tacrolimus
D: Diuretics (loop/thiazide)
E: Ethambutol, pyrazinamide
* also levadopa

seafood and red meat, alcohol,

Question 6

Colchicne acute tx

Answer 6

2 tablets of 0.6mg followed by 0.6mg in 1hr (Max 1.8mg-3tab)

Side effects
- N/D
- Dec vit B12
- BMS
- Inhibit cell division (hair loss)

Question 7

Indomethacin

Answer 7

Indocin (NSAID)

SE:
Gi toxicity,
Psychiatric: confusion and depression

NSAID CI:
- Crcl <60
- hyperkalemia
- GI ulcer
- Uncontrolled HTN

Avoid use in HF, recent MI or elderly>65.

Question 8

corticosteroids for acute tx

Answer 8

Methylprednisolone
Triamcinolone
Bethamethasone
Prednisone

best option for renal pt if they cannot take NSAID

Question 9

steroid SEd

Answer 9

P: PUD- take with food

R: Rash

E: eyes (glaucoma, cataract)

D: DM (Inc in BS)

N: Neurologic (CNS- HA, insomnia, mood swing, seizure)

I: Immunosuppressant (dec ability to fight inf)

S: swelling (Cushing syndrome)

O: Osteoporosis

N: Nausea (steroid help with nausea)

E: Electrolyte: (Inc Na, Inc BP, Dec K)

Question 10

chronic treatment

Answer 10

colcichine
Probenecid (benemid)
Lesinuard (Zurampic)
Allopurinol (Aloprim, Zyloprim)
Febuxostat (Uloric)
Pegloticase (Krystexxa)

Question 11

colchicine

Answer 11

0.6mg QOD/ QD/BID

strong CYP3A4 substrate

Question 12

Probenicid

Answer 12

SE: kidney stones
- drink lots of water

Avoid in CrCl <50

Decrease renal clearance of ASA, MTX, theophylline, PCN

Question 13

lesinuard

Answer 13

only used in comb with xanthine oxidase inhib

Question 14

allopurinol

Answer 14

indication
- gout prevention
- chemo ind hyeruricemia
- manage recurrent calc oxalate calculi

Max 800mg/day
- used in renal failure but dose adjust

SE: rash

Avoid if HLA5801 allele positive

DUR:
- decrease Azahiopurine and
6-MP by 75%
- Inc warfarin effect

Question 15

Febuxostat

Answer 15

not purine analog unlike allopurinol

SE: rash, LFT

Question 16

Pegloticase

Answer 16

Krystexxa (IV infusion) option for advanced gout

SE
- anaphylaxis
- infusion reaction
- gout flare
- CHF

*Premeditate with antihistamine, corticosteroid

Contraindication
- IF G6PD def
- CHF
- Do not combine with zyloprim or uloric