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Pharmacy 255 > Gout > Flashcards

Gout Flashcards

1
Q

What is the component that causes gout?

A

monosodium urate

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2
Q

Where does urate usually deposit?

A

joints, tissues, kidneys

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3
Q

How is uric acid produced?

A

purine metabolism from food

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4
Q

What enzyme degardes uric acid?

A

uricase

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5
Q

What is considered too high of uric acid?

A

> 420

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6
Q

What can alter deposition of uric acid?

A

Cold temp, or trigger

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7
Q

What drugs typically cause hyperurcemia?

A

diuretics alcohol, ACE, ASA- competes for elim

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8
Q

Why is uric acid excreted so slow?

A

too high concentration is toxic

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9
Q

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

A

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

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10
Q

Which gender gets gout?

A

male older

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11
Q

What are the four steps of gout?

A

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

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12
Q

What percentage get gout in asymptomatic stage?

A

25%

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13
Q

Do you need treatment in asymptomatic hyperuricemia?

A

NO

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14
Q

How many joints does gout affect?

A

usually one

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15
Q

Which joints usually get gout?

A

Toes> ankle>knee>wrist

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16
Q

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

A

gets shorter

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17
Q

WHat can happen if gout is not treated?

A

Joint deforms, kidney stones, urate nephropathy,

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18
Q

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

A

> 6

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19
Q

How long till gout goes away?

A

1-2 weeks

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20
Q

Is compression useful for gout?

A

NO

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21
Q

Non-pharm for gout?

A

stop meat, lose weight, exercise, DRINK

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22
Q

What is enough water?

A

2 L/day

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23
Q

What is good for acute flare of gout?

A

NSAIDs
CS
Colchincine

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24
Q

What CS is used for gout? How much?

A

25-50 prednisone for 3-5 days

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25
Q

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

A

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

26
Q

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

A

E= ALL GOOD
T=CS

27
Q

What is mechanism of action of colchicine?

A

stop WBC motility= lower inflammatory

28
Q

When is colchicine added?

A

within 24 hours of flare

29
Q

What is dosing of colchicine?

A

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

30
Q

What inducers effect colchicine?

A

3A4 and P-GP

31
Q

Side effcts of colchicine?

A

GI fatugue,myopathy, hematologic issues

32
Q

What are common 3a4 inducers?

A

Grapefruit, azoles, clarithriomycin

33
Q

Which people should you have caution with steroids?

A

Gi issues and diabetics

34
Q

WHo is indicated for prophylaxis?

A

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

35
Q

What is goal for gout?

A

<300-360

36
Q

What should every prophylactic agent also have?

A

NSAID or colchicine to prevent flare up complication

37
Q

Prophylactic doses for NSAIDs and colchicine

A

0.6 BID-colch
250 BID- Naproxen

38
Q

What are the uricosuric agents?

A

Probenecid, sulfinpyrazone

39
Q

WHat is needed for the uricosuric agents?

A

NEED good kidneys to work

40
Q

S/e of uricosuric agents?

A

rash, gi, flares, kidney stones, bleeds

41
Q

WHo cant get uricosuric agents?

A

if on ASA, kidney, flares

42
Q

When should uricosuric agents be used?

A

only when others have failed

43
Q

What are the Xanthine Ox inhibitors (XOI)?

A

allopurinol, febuxostat

44
Q

Dose of allopurinol?

A

300mg/day

45
Q

MOA of XOI?

A

stops synthesis of uric acid

46
Q

Onset of all prophylactic agents?

A

US- immediate
XOI- 2 weeks

47
Q

S/E of XOI?

A

rash, itch, flare, pain

48
Q

What is potentially bad s/e of allopurinol?

A

Hypersensitivity syndrome- Derm/hepatic/renal tox

49
Q

Who has a higher chance of Allopurinol hypersensitivity?

A

HLA_5801 gene

50
Q

WHo has that gene more?

A

ASIAN

51
Q

DI of allopurinol?

A

diuretics and ACE

52
Q

WHich is more tolerable/ more effective Febuxostat, allopurinol?

A

febuxostat

53
Q

What are the uricase enzymes drugs?

A

rasburicase

54
Q

MOA of rasburicase?

A

converts uric acid into allantoin

55
Q

Effectiveness of rasburicase?

A

REALLY POTENT

56
Q

Bad S/E of rasburicase?

A

antibody development

57
Q

What is first line prophylactic agent?

A

allopurinol

58
Q

Who can enter taper off prophylaxis?

A

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

59
Q

What agent in pregnancy for gout?

A

P-allopurinol
Flare- colchicine

60
Q
A

Pharmacy 255 (16 decks)

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