Gout

Question 1

What is the component that causes gout?

Answer 1

monosodium urate

Question 2

Where does urate usually deposit?

Answer 2

joints, tissues, kidneys

Question 3

How is uric acid produced?

Answer 3

purine metabolism from food

Question 4

What enzyme degardes uric acid?

Answer 4

uricase

Question 5

What is considered too high of uric acid?

Answer 5

> 420

Question 6

What can alter deposition of uric acid?

Answer 6

Cold temp, or trigger

Question 7

What drugs typically cause hyperurcemia?

Answer 7

diuretics alcohol, ACE, ASA- competes for elim

Question 8

Why is uric acid excreted so slow?

Answer 8

too high concentration is toxic

Question 9

How can we see if they are an overproduced of uric acid?

Answer 9

> 1000mg in 24 hours excretion
600 if on purine free diet

Question 10

Which gender gets gout?

Answer 10

male older

Question 11

What are the four steps of gout?

Answer 11

Asymptomatic
Acute- precipitation, sx of pain red in 1 hour
Intercritical - between flares, can be multiple years
Chronic tophaceous-get tophi= late complication

Question 12

What percentage get gout in asymptomatic stage?

Answer 12

25%

Question 13

Do you need treatment in asymptomatic hyperuricemia?

Answer 13

NO

Question 14

How many joints does gout affect?

Answer 14

usually one

Question 15

Which joints usually get gout?

Answer 15

Toes> ankle>knee>wrist

Question 16

As gout progresses how long does the not flare point change?

Answer 16

gets shorter

Question 17

WHat can happen if gout is not treated?

Answer 17

Joint deforms, kidney stones, urate nephropathy,

Question 18

Using the questionaire for helping diagnose, what score indicates gout?

Answer 18

> 6

Question 19

How long till gout goes away?

Answer 19

1-2 weeks

Question 20

Is compression useful for gout?

Answer 20

NO

Question 21

Non-pharm for gout?

Answer 21

stop meat, lose weight, exercise, DRINK

Question 22

What is enough water?

Answer 22

2 L/day

Question 23

What is good for acute flare of gout?

Answer 23

NSAIDs
CS
Colchincine

Question 24

What CS is used for gout? How much?

Answer 24

25-50 prednisone for 3-5 days

Question 25

Which route of CS is best and how much can this be done?

Answer 25

faster and better for IA, one jopint 4x a year

Question 26

Of the three options for acute flare which is most tolerable which is most efficacious?

Answer 26

E= ALL GOOD T=CS

Question 27

What is mechanism of action of colchicine?

Answer 27

stop WBC motility= lower inflammatory

Question 28

When is colchicine added?

Answer 28

within 24 hours of flare

Question 29

What is dosing of colchicine?

Answer 29

1.2mg then 0.6 in one hour then 0.6 BID or 0.6 BID for 3 days and 0.6 OD

Question 30

What inducers effect colchicine?

Answer 30

3A4 and P-GP

Question 31

Side effcts of colchicine?

Answer 31

GI fatugue,myopathy, hematologic issues

Question 32

What are common 3a4 inducers?

Answer 32

Grapefruit, azoles, clarithriomycin

Question 33

Which people should you have caution with steroids?

Answer 33

Gi issues and diabetics

Question 34

WHo is indicated for prophylaxis?

Answer 34

>2 attacks, > 1 severe, >800 uric acid, tophi, history of kidney stones/renal issues

Question 35

What is goal for gout?

Answer 35

<300-360

Question 36

What should every prophylactic agent also have?

Answer 36

NSAID or colchicine to prevent flare up complication

Question 37

Prophylactic doses for NSAIDs and colchicine

Answer 37

0.6 BID-colch 250 BID- Naproxen

Question 38

What are the uricosuric agents?

Answer 38

Probenecid, sulfinpyrazone

Question 39

WHat is needed for the uricosuric agents?

Answer 39

NEED good kidneys to work

Question 40

S/e of uricosuric agents?

Answer 40

rash, gi, flares, kidney stones, bleeds

Question 41

WHo cant get uricosuric agents?

Answer 41

if on ASA, kidney, flares

Question 42

When should uricosuric agents be used?

Answer 42

only when others have failed

Question 43

What are the Xanthine Ox inhibitors (XOI)?

Answer 43

allopurinol, febuxostat

Question 44

Dose of allopurinol?

Answer 44

300mg/day

Question 45

MOA of XOI?

Answer 45

stops synthesis of uric acid

Question 46

Onset of all prophylactic agents?

Answer 46

US- immediate XOI- 2 weeks

Question 47

S/E of XOI?

Answer 47

rash, itch, flare, pain

Question 48

What is potentially bad s/e of allopurinol?

Answer 48

Hypersensitivity syndrome- Derm/hepatic/renal tox

Question 49

Who has a higher chance of Allopurinol hypersensitivity?

Answer 49

HLA_5801 gene

Question 50

WHo has that gene more?

Answer 50

ASIAN

Question 51

DI of allopurinol?

Answer 51

diuretics and ACE

Question 52

WHich is more tolerable/ more effective Febuxostat, allopurinol?

Answer 52

febuxostat

Question 53

What are the uricase enzymes drugs?

Answer 53

rasburicase

Question 54

MOA of rasburicase?

Answer 54

converts uric acid into allantoin

Question 55

Effectiveness of rasburicase?

Answer 55

REALLY POTENT

Question 56

Bad S/E of rasburicase?

Answer 56

antibody development

Question 57

What is first line prophylactic agent?

Answer 57

allopurinol

Question 58

Who can enter taper off prophylaxis?

Answer 58

Attack free for looong, risks gone, tophi gone, low uric acid levels

Question 59

What agent in pregnancy for gout?

Answer 59

P-allopurinol Flare- colchicine