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PHM702 > Gout > Flashcards

Gout Flashcards

1
Q

Diseases That Promote Hyperuricemia

A

insulin resistance
obesity
hyperlipidemia
hypertension
CHF
CKD
organ transplanation

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2
Q

Hyperuricemic Foods

A

meat
seafood
beer
soft drinks
fructose

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3
Q

Uricosuric Foods

A

coffee
dairy
vitamin C

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4
Q

Hyperuricemic Drugs

A

thiazide & loop diuretics
nicotinic acid
cyclosporine & tacrolimus
levodopa
aspirin

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5
Q

Uricosuric Drugs

A

losartan
fenofibrate

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6
Q

Gout Flare - Precipitation Factors

A

alcohol ingestion
high purine ingestion
stress
drugs

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7
Q

Classic Acute Gout - Presentation

A

monoarticular arthritis
usually joint of lower extremity

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8
Q

Interval Gout - Presentation

A

asymptomatic period between attacks

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9
Q

Tophaceous Gout - Presentation

A

deposits of crystals in soft tissues
associated with nerve compression syndromes

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10
Q

Atypical Gout - Presentation

A

polyarthritis affecting any joint
may be confused with RA or OA

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11
Q

Gouty Nephropathy - Presentation

A

nephrolithiasis

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12
Q

Acute Gout - Goal of Therapy

A

reduce pain and duration of attack

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13
Q

Acute Gout - NSAID Mechanism

A

COX inhibition

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14
Q

Acute Gout - NSAID Options

A

indomethacin
naproxen
sulindac

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15
Q

NSAIDs - Conditions to Avoid Them In

A

renal insufficiency
CHF
bleeding disorders
peptic ulcer disease
age 75 or over

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16
Q

Acute Gout - Colchicine Mechanism

A

inhibition of beta-tubulin polymerization into microtubules

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17
Q

Acute Gout - Colchicine Dose

A

1.2 mg PO once, then 0.6 mg PO one hour later

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18
Q

Colchicine - Adverse Reactions

A

GI symptoms
hematologic abnormalities
rhabdomyolysis

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19
Q

Colchicine - DDIs

A

CYP3A4 inhibitors
P-gp inhibitors

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20
Q

Strong CYP3A4 Inhibitors

A

darunavir / ritonavir
itraconazole
clarithromycin
ketoconazole

21
Q

Colchicine - Dose Adjustment with Strong CYP3A4 Inhibitors

A

acute: 0.6 mg, then 0.3 mg one hour later
prophylactic: 0.3 mg QOD-QD

22
Q

Moderate CYP3A4 Inhibitors

A

diltiazem
erythromycin
fluconazole
verapamil

23
Q

Colchicine - Dose Adjustment with Moderate CYP3A4 Inhibitors

A

acute: single 1.2 mg dose
prophylactic: 0.3-0.6 mg QD

24
Q

P-gp Inhibitors

A

cyclosporine
amiodarone
ranolazine

25
Q

Colchicine - Dose Adjustment with P-gp Inhibitors

A

acute: since 0.6 mg dose
prophylactic: 0.3 mg QOD-QD

26
Q

Colchicine - CIs

A

concurrent use with P-gp or strong CYP3A4 inhibitors in renal and/or hepatic impairment

27
Q

Acute Gout - Corticosteroid Mechanism

A

reduce polymorphonuclear leukocyte migration & suppress the lymph system

28
Q

Acute Gout - Systemic Corticosteroid Options with Doses

A

prednisolone 30-35 mg PO QD x 5 days
prednisone 30-60 mg PO QD x 2 days, then taper over 10 days
methylprednisolone dose pack

29
Q

Acute Gout - Intra-articular Corticosteroid with Doses

A

triamcinolone
large joint: 40 mg
medium joint: 30 mg
small joint: 10 mg

30
Q

Acute Gout - Corticosteroid Relative CIs

A

DM
CHF
severe GERD
severe PUD

31
Q

Chronic Gout - Goal of Therapy

A

prevent future attacks
maintain serum uric acid < 6

32
Q

Chronic Gout - Xanthine Inhibitors

A

allopurinol
febuxostat

33
Q

Allopurinol - Adverse Reactions

A

rash - best to d/c the drug
DRESS - immediately d/c

34
Q

Allopurinol & Febuxostat - DDIs

A

warfarin (allopurinol only)
6-MP
azathioprine
theophylline

35
Q

Allopurinol - Dosing

A

initial 100 mg PO QD with normal renal function, then increase by 100 mg increments every 2-5 weeks to target < 6 mg/dL
initial 50 mg in CKD 4 or worse

36
Q

Febuxostat - Dosing

A

40 mg PO QD
increase to 80 mg PO QD if SUA < 6 not achieved after 2 weeks

37
Q

Febuxostat - Adverse Reactions

A

headache
arthralgias
GI symptoms
abnormal LFTs
flushing
BBW: CV events and death

38
Q

Chronic Gout - Uricosurics

A

probenecid

39
Q

Probenecid - Mechanism

A

competitive inhibition of uric acid at the proximal convoluted tubule, promoting its excretion

40
Q

Probenecid - Dosing

A

250 mg BID for 1 week, may increase by 500 mg increments every 4 weeks up to 2 grams per day

41
Q

Probenecid - Relative CIs

A

avoid with CrCl < 50
avoid with history of nephrolithiasis
avoid with methotrexate, penicillin, carbapenems, salicylates

42
Q

Uricase Agents

A

pegloticase

43
Q

Pegloticase - Dosing

A

1.8 mg IV every 2 weeks over 2 hrs

44
Q

Pegloticase - Adverse Reactions

A

BBW: infusion-related reactions
anaphylaxis (pre-medicate with steroids and antihistamines)

45
Q

Chronic Gout Therapy Indications

A

1 or more SQ tophi and evidence of damage attributable to gout, OR
2 or more flares per year

46
Q

Chronic Gout Therapy - May Be Considered…

A

1 attack per year, OR
first flare and CKD 3 or more, UA > 9, urolithiasis

47
Q

Gout - First-Line Agent

A

allopurinol

48
Q

Gout - Monitoring

A

UA levels every 2-5 weeks

49
Q

Chronic Gout Therapy - Pegloticase Switch

A

if all other interventions failed to achieve the goal UA level, and patients have 2 or more flares per year, OR
non-resolving tophi

PHM702 (20 decks)

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