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PHRM 864: Therapeutics IV > Gout > Flashcards

Gout Flashcards

1
Q

What is Gout?

A
  • Inflammatory response toward an Increase in uric acid crystals in the Joints
  • Hyperuriemia [>6.8mg/dL] & Symptomatic
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2
Q

What is the epidemiology of Gout?

A
  • Genetics, Diets, Economic Factors
  • 9.2 millon people have it
  • increased age & obesity
  • Men
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3
Q

What is the Pathophysiology of Gout?

Breif Description?

A
  • Uric Acid is the last step of the degredation
  • Humans lack uricase
  • Elevated by Overproduction & Underexcreation
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4
Q

In Hyperuricemia, what are some of the Underexcreation and Overproduction?

A

Underexcreation: Dehydration, Insulin Resistance, Acute Alcohol Intake, MEDICATION
Overproduction: Enzymatic Abnormalites, Cytotoxic Medications, Excessive Dietary Intake of Purines, Chronic Alochol Use

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5
Q

What are some of the Medications that are able to cause Hyperuricemia & Gout?

A
  • Thiazide, Ethanol, Ethambutol, Nicotinic Acid, Pyrazinamide, Cytotoxic Drugs, Low Dose Aspirin, Testosterone, Cyclosporine
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6
Q

What are some of the Risk Factors that are in Gout?

A
  • Obesity, Elderly, Male, Post-Menupasual Women, Diet, CKD, Alcohol, Medications
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7
Q

What are some of the Clinical Presentations of Gout?

Presentation? Signs and Symptoms? Labs? Complications?

A
  • Mono-arthritis main involving Podagra [Big Toe]
  • Sxs: Fever, Pain, Redness, Swelling, Warmth
  • Labs: Increased Uric Acid & ** Leukocytes**
  • Complications: Kidney Stones, Tophi [Deforming Joints]
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8
Q

What does the differentail diagnoses mean for Gout?

A
  • Can present as a lot
  • Pseudogout, Rheumatoid, Septic Arthritis, Celluitis, Unrelated hyperuricemia…
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9
Q

What is the Diagnostic Criteria for Gout?

A
  • Aspiration of Synoival Fluids
  • Symptoms
  • Imaging

Based from the European League Against Rheumatism [EULAR]

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9
Q

What is important to know about the Aspiration fo Synovial Fluids in Diagnostic Criteria in Gout?

A
  • Definitive Diagnosis
  • Looking for those crystals
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10
Q

What is important to know about the Symptoms for the Diagonstic Criteria in Gout?

A
  • Monoarthicular of foot or ankle
  • Previous Episodes
  • Rapid Onset
  • Male
  • Hyperuricemia
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11
Q

What is important to know about Imaging in Diagnostic Criteria in Gout?

A
  • X-ray for Crystals
  • Ultrasound for Tophi
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12
Q

What is the Nonpharmacologic treatments for Acute Gout?

A
  • Not too much for Acute Gout
  • Maybe using a Local Ice Pack –> decrease inflammation
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13
Q

What are the Pharmacology Therapies that are used in Acute Gout?

A
  • NSAIDs
  • Colchicine
  • Steroids
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14
Q

What is the MOA for NSIADS in Acute Gout?

A
  • MOA: Inhibtion of COX 1/2; decreaseing Prostaglandins; decreaseing Inflammation
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15
Q

What are the NSAIDS that are used in Acute Gout?

Know Dosing!

A
  • Indomethacan 50 mg TID
  • Naproxen 750 mg; then 250 mg q8h
  • Sulindac 200 mg BID

ALL used until flares resolve!!

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16
Q

What are some of the Side Effects for NSAIDS in Acute Gout?

A
  • GI Effects, Kidney Injury, CV Effects, Bleeding, Fluid Retention, CNS Effects
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17
Q

What is the MOA and Typical Dosing for Colchicine in Acute Gout?

A
  • MOA: Inhibits B-tubulin polymerization into mircotubules
  • Day 1: 1.2 mg; then 0.6 mg 1h later & Day 2: 0.6 mg BID
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18
Q

What are some of the Side Effects of Colchicine in Acute Gout?

A
  • N/V/D
  • Rare: Mylosuppression and Neuromyopathy
19
Q

In what way do we dose adjust for Renal, Hepatic and Interactions for Colchicine in Acute Gout?

A
  • Renal: CrCl > 30 = NO ADJUSTMENT & CrCl < 30 = Wait 2 weeks to repeat
  • Hepatic: Mild/Mod = NO ADJUSTEMENT & Severe - = Wait 2 weeks to repeat
  • Interactions: 3A4 & PgP
20
Q

What is the MOA for Steroids in Acute Gout?

A
  • MOA: Decreased inflammation by suppressing Leukocytes

Considerations: TAPER, Limt Use, IA not for Joint Sepsis

21
Q

What are some of the Steroids that are used in Acute Gout?

A
  • Oral: Methyprednisolone or Prednisone
  • IM: Triamcinolone Acetonide or Methylprednisolone
  • IA: Triamcinolone Acetonide
22
Q

What are the Side Effects for Steroids in Acute Gout?

A
  • N/V/D, Incresaed BP, Insomia, Hyperglycemia, Edema…

LIke in RA, Lupus, IBD…

23
Q

When there is an inadequate inital response to Acute Gout Therapy, what should be done?

A
  • Switch Agents
  • Add Agents [NO NSAIDS with Steroids]
24
Q

What is the Nonpharmacologic Therapies for Chronic Gout?

A
  • Weight Loss, Dash Diet, Avoid fats and sweets, Decrease Alcohol
25
Q

What are the Medications that are used in Urate Lowering Therapy in Chronic Gout?

A
  • Xanthine Oxidase Inhibitors [1st line]
  • Uricosurics [2nd Line]
  • Uricase Agents [3rd Line]
26
Q

What is important to know about the Urate Lowering Therapy in Chornic Gout?

Who doesnt need? When to Start? How long & Monitoring?

A
  • Who dosen’t need: 1st Attack WITHOUT risk factors
  • When: NOW; when having flare
  • How Long: ULT forever
  • Monitoring: Uric Acids < 6 mg/dL
27
Q

What is the MOA of the Xanthine Oxidase Inhibitors in Chronic Gout?

A
  • MOA: Reduces uric acid by imparing the abiility of Xanthine Oxidase to convert Hypoxantine to Xanthine to Uric Acid
28
Q

What are the two Xanthine Oxidase Inhibitors that are used in Chronic Gout?

A
  • Allopuiniol 100mg daily; titrate up to 800 mg/day
  • Febuxostat: 40 mg daily; titrate up to 80 mg/day
29
Q

What are some of the Side Effects of Allopurinol in Chronic Gout?

A
  • Rash
  • Possible Fatal Hypersensitivity Reactions [Stevens-Johnsons Syndrome or Toxic Epidermal Nerolysis] –> Highest risk during first 3 months
30
Q

What is something that you should test for before taking Allopurinol in Chronic Gout?

A
  • HLA-B 5801: + will increase risk of SE
31
Q

What are some important counseling points for Allopurinol in Chronic Gout?

A
  • Drink plenty of Fluids
  • Take medication even when NO SYMPTOMS
32
Q

What are some of the Side Effects for Febuxostat in Chronic Gout?

A
  • Liver Enzyme Elevations, N, Arthralgias, rash
  • BLACK BOX: Cardio issues = DEATH
33
Q

What is the MOA of the Uricosuric Drugs in Chronic Gout?

A
  • MOA: Inhibiting post-secretory renal tubular reabsorption of uric acid
34
Q

What are the two Uricosuric Drugs that are used in Chronic Gout?

A
  • Probenecid 250 mg BID X 1-2w [Titrating up to 6 mg/dL uric acid]
  • Lesinurad 200 mg once daily [ONLY taken with Xanthines]
35
Q

What is important to know about Probenecid in Chronic Gout?

ADRs? Cautions? interactions?

A
  • ADR: GI issues, Rash, Urolithiasis
  • Caution: G6PD Deficiency, CKD Stage > 3
36
Q

What is important to know about Lesinurad in Chronic Gout?

BLACK BOX? ADRs? Pearls?

A
  • BLACK BOX: Nephrotoxicity; must be used WITH Allopurinol >300mg
  • ADRs: Headache, GERD
  • Pearls: 2C9
37
Q

W

What is the MOA of Uricase Agents in Chronic Gout?

A
  • MOA: Helps make Uricase, which converts uric acid to the more soluble form Allantoin
38
Q

What is the Uricase Agent that is used in Chronic Gout?

A
  • Pegloticase 8 mg IV every 2w [2h long]
39
Q

What is important to know about Pegloticase in Chronic Gout?

BLACK BOX? ADRs?

A
  • BLACK BOX: Anaphylaxis & G6PD Deficiency
  • ADR: GI issues, Chest Pain, Flu-Like symptoms
40
Q

When should Pegloticase be used in Chronic Gout?

A
  • When they are already on ULT + having Gout symptoms = ADD Pegloticase
41
Q

What are some of the other ULT Medications that are used in Chornic Gout?

A
  • Fenofibrate: Helps clear Uric Acid; For Gout + Increased Cholesterol
  • Losartan: Inhibits reabsorption of uric acid; For Gout + HTN
42
Q

How long should Gout Prophylaxis last?

A
  • 3-6 months
43
Q

What are some of the Prohylaxis options for Gout?

A
  • NSAIDS
  • Prednisone <10 mg/day
  • Colchicine
44
Q

For Gout Prophylaxis, what is important to understand about Colchicine dosing?

A
  • Renal: CrCl > 30 = 0.6mg qd or BID; CrCl < 30 =0.3 mg daily
  • Interactions 3A4 & PgP = 0.3 mg every other day to daily

PHRM 864: Therapeutics IV (28 decks)

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