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Therapeutics 1 > Gout > Flashcards

Gout Flashcards

1
Q

What causes Gout?

A

monosodium urate crystal (MSUC) deposition in tissue leading to arthritis (most common cause of inflammatory arthritis), soft tissue masses, nephrolithiasis, urate nephropathy

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2
Q

What are the common symptoms of Gout?

A

pain, swelling, redness, fever, podagra

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3
Q

What are the risk factors for Gout?

A

-genetics
-age
-sex (men»>women)
-diet (alcohol, red meat, seafood, high-fructose foods or drink)
-overweight or obesity
-hypertension
-medications (diuretics, cyclosporin, aspirin)
-poor kidney function

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4
Q

What foods/beverages should be avoided in a patient with Gout?

A

-organ meats high in purine (liver, kidney, sweetbreads)
-high fructose corn syrup
-alcohol overuse especially during flare-ups

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5
Q

What foods/beverages should be limited in a patient with Gout?

A

-serving sizes of beef, lamb, pork, and seafood high in purine
-naturally sweet fruit juices
-table sugar and sweetened beverages and desserts
-alcohol (particularly beer)

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6
Q

What foods/beverages should be encouraged in patients with Gout?

A

low-fat or nonfat dairy products and vegetables

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7
Q

What are the goals of therapy for Goat treatment?

A

-end the acute attack
-prevent recurrent attacks
-prevent complications associated with chronic deposition of urate crystals in tissues

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8
Q

What is the role of NSAIDs in Gout treatment?

A

pain relief through reducing inflammation for acute treatment and for prophylaxis at lower doses

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9
Q

What NSAIDs are approved by the FDA for treatment of Gout?

A

naproxen, indomethacin, sulindac

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10
Q

What are the adverse effects of NSAIDs?

A

-GI (upset or bleed)
-cardiovascular effects
-renal effects (contraindicated in CrCl < 30 mL/min)

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11
Q

What is the role of corticosteroids in Gout?

A

reduce inflammation for acute attacks

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12
Q

What is the dosing of corticosteroids for Gout?

A

-0.5mg/kg prednisone equivalent daily for 5-10 days then discontinuation or tapered therapy
-IM bolus followed by oral therapy for rapid effect
-intraarticular corticosteroids can be used if large joints are involved

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13
Q

MOA: Colchicine

A

disrupts cytoskeletal functions by inhibiting beta-tubulin polymerization into microtubules, preventing activation, degranulation, and migration of neutrophils

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14
Q

When should Colchicine be used in Gout treatment?

A

onset of symptoms <36h prior to treatment initiation

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15
Q

Dosing: Colchicine

A

1.2mg initially, followed by 0.6mg 1 hour later, then 0.6 mg daily

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16
Q

Precautions: Colchicine

A

blood dsycrasis or hepatic/renal impairment

17
Q

Drug Interactions: Colchicine

A

CYP3A4 inhibitors (must reduce dose), -statins

18
Q

What is the indication for urate lowering therapy?

A

-one or more of the following: 1 or more subcutaneous tophi, radiographic damage, 2 or more flares
-conditionally if <2 flares a year

19
Q

What is target serum urate?

A

<6 mg/dL

20
Q

What other drugs are needed when initiating urate lowing therapy?

A

colchicine or NSAID, treat for at least 3-6 months and serum urate level <6 for at least 3 months

21
Q

What is first line therapy for chronic gout management?

A

allopurinol or febuxostat (xanthine oxidase inhibitor)

22
Q

MOA: Allopurinol

A

inhibit the terminal enzymatic step in uric acid production, effective for underexcreters or overproducers

23
Q

Dosing: Allopurinol

A

start at 100 mg, may gradually titrate every 2-5 weeks up to 800mg until target serum urate level is met- doses over 300mg must be given in divided doses

24
Q

What genetic testing may be considered for Allopurinol?

A

HLA testing in high risk patients (chinese, koreans, thai, african american)

25
Q

Monitoring parameters: Allopurinol

A

LFTs and CBC

26
Q

Drug Interactions: Allopurinol

A

ACE inhibitors, warfarin, amoxicillin

27
Q

Dosing: Febuxostat

A

40-80mg/daily

28
Q

Precautions: Febuxostat

A

potential risk of hepatic failure or CV death (BLOCK BOX WARNING)

29
Q

MOA: Probenecid

A

competitively inhibits the reabsorption of uric acid in the proximal convoluted tubule

30
Q

Precautions: Probenecid

A

-avoid in CrCl < 50mL/min
-may interact with salicylates
-can inhibit the tubular secretion of other organic acids- increased plasma concentrations of penicillins, cephalosporins, sulfonamides, and indomethacin

31
Q

MOA: Pegloticase

A

pegylated recombinant uricase that reduces serum uric acid by converting uric acid to allantoin

32
Q

MOA: Losartan

A

inhibit urate reabsorption and lowering the plasma urate concentration

33
Q

MOA: Fenofibrate

A

increase the clearance of hypoxanthine and xanthine

34
Q
A

Therapeutics 1 (16 decks)

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