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PHM 702 pulm, tox & rheumatoid > gout > Flashcards

gout Flashcards

1
Q

Epidemiology of gout

A
  • inc age = inc risk
  • inc in postmenopausal women due to estrogen loss
  • link w/ co-morbid conditions, diet, med use, genetics
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2
Q

what conct is purine soluble and what is our goal UA level with therapy

A

soluble at <=6.7
goal w/ therapy 6.0 mg/dl

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3
Q

what causes overproduction of urate

A
  1. diet high in urate : red meat, seafood, beer, soft drinks, fructose
  2. disease states: DM, hyperlipidemia, obesity, CKD, HTN, Organ transplant, CHF
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4
Q

what diet is recommended for gout patients

A

coffee, diary vit c

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5
Q

What medications can be harmful to gout patients

A
  • Thiazide diuretics
  • Loop Diuretics
  • Nicotinic Acid
  • Aspirin <1g/day
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6
Q

Helpful Meds

A

Losartan (1st line), Fenofibrate

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7
Q

clinical presentation of gout flare

A

rapid onset (w/in 24 hours) of severe pain, erthyema & swelling in single or multiple joints
*ankle, fingers, wrist, elbows

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8
Q

What can cause a gout flare

A

alcohol ingestion
high purine ingestion
stress (emotional & physical)
Meds

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9
Q

3 ways to diagnosis gout and which is most common

A
  • most common: gout flare
  • crystals in synovial fluid
  • Serum UA > 6.7
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10
Q

What agents can be used in acute gout flare

A
  • Anti-inflammatory: NSAIDs, Colchicine
  • Corticosteroids: Prednisone + Intra-articular triamcinolone
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11
Q

which NSAID has FDA approval for goat

A

Indomethicin, Sulindac, Naproxen

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12
Q

NSAID clinical pearls, avoid

A
  • 1st line
  • 7 day therapy
  • Avoid in: renal impairment, bleeding disorders/anti coag, peptic ulcer disease, CHF, older adults>/= 75 age
    *ppi for prophylaxis
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13
Q

Colchicine dosing acute vs prophylaxis

A

acute : 1.2 mg po x1 then .6mg 1 hr later
prophylaxis: 0.6 mg QDor BID

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14
Q

Strong CYP3A4 inhs and dose of colchicine (DICK)

A

Clarithromycin
Darunavir/Ritonavir
Itrazonazole
Ketoconazole
- acute: 0.6 mg x1 then .3mg 1 hr later
- prophylaxis: 0.3 mg every other day

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15
Q

Moderate CYP3A4 Inhibitors and dose of colchicine (VFED)

A

Dilitazem
Erythromycin
Fluconazole
Verapamil
- Acute: 1.2 mg x1
- prophylaxis: 0.3-0.6 mg QD

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16
Q

PGP inh and dose of colchicine (CAR)

A

Cyclosporine
Amiodarone
Ranolazine
- Acute: 0.6mg x1
- prophylaxis: 0.3mg every other day to 0.3mg once daily

17
Q

Colchicine AE

A

Diarrhea
hematologic abnormalities
rnhabdomylosis (Risk w/ renal insuff elderly)

18
Q

Intra-articular triamcinolone dosing and ae

A
  • depends on joint size 40,30, 10
  • ae: leukocytosis, inc appetite, mood changes, inc blood glucose
19
Q

What agents can be used in chronic gout therapy

A
  • Xanthine Oxidase: Allopurinol, Febuxostate
  • Uricosurics: Probenicid
  • Pegloticase
20
Q

What is 1st line gout therapy

A

Allopurinol

21
Q

Allopurinol dose SE and DDI

A
  • 50-100 mg/day, dec in CKD <30
  • se: rash
  • DDI: Amoxicillin, Ampicillin, Thiazide, ACE-I cause cause inc rash
  • DDI warfarin (dec allo dose)
  • CI: 6-MP, Azathiopurine, Theophylline (D/C ALLO)
22
Q

Febuxostate dose, ae, ci, avoid

A
  • 40 mg QD inc to 80 mg until at target (inc q2 week)
  • avoid w/ cardiac issues & crcl <30
  • AE: HA, arthralgia, abdominal pain, n, LFTs, flushing
  • CI: 6-MP, Azathiopurine, Theophylline
23
Q

Probenicid dose, Avoid, DDI

A
  • 250 mg BIDx 1 week, inc to 500 bid, maz 2g/day
  • avoid in crcl <50 ml/min and nephrolithiasis
  • DDI: Penicillin, Methotreaxate, Carbapenems, Salicylates
24
Q

Pegloticase who gets it

A

LAST LINE
- Other therapies fail to achieve goal,
- pts w/ flares >/= 2yrs
- non-resolving tophi

25
Q

Pegloticase BBW

A

Infusion related rxns & anaphylaxis

26
Q

what do you premedicate Pegloticase with?

A

Anithistamines and corticosterioids

27
Q

Who gets chronic therapy

A
  • 1 or more tophi
  • radiographic evidence of gout damage or
  • 2 or more gout flares yearly
28
Q

Who should we consider chronic therapy for

A
  • hx of 1 or more attack but less 2 attacks per year
  • ckd stage >/= 3, UA >9 mg/dl, urolithiasis
29
Q

what to monitor in gout patients

A

UA levels monitored q2-5 wks with inc in therapy intensity until goal is reached

PHM 702 pulm, tox & rheumatoid (15 decks)

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