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PHAR 255 > Gout > Flashcards

Gout Flashcards

1
Q

hyperuricemia conc.?

A

> 420umol/L

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1
Q

What compound percipitates out resulting in gout?

A

Monosodium urate

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2
Q

Causes of overproduction of uric acid?

A

diet: rich purine (proteins)
Diseases: obesity and hypertriglyceridemia
Drugs: diuretics, cytotoxic drugs

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3
Q

causes of underexcretion of uric acid?

A

diseases: CKD, HTN, dehydration
Drugs: Alcohol, ACEi/ARB, ASA, cyclosporine, diuretics, levodopa, tacrolimus

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4
Q

Numbers of uric acid in urine for overproducers?

A

on purine free diet q3-5d = >600mg/24h
Regular diet = 1000mg/24h

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5
Q

Gout more common in Male or Female?

A

Male

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6
Q

Clinical phases of gout?

A

ASymptomatic hyperuricemia
acute gouty arthritis
intercritcal gout
chronic tophaceous gout

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7
Q

Treatment for pts in asymptomatic hyperuricemia?

A

Majority not required

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8
Q

Potential concequences of hyperuricemia?

A

Gout
CKD
urate nephropathy
kidney stones

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9
Q

When does acute gouty arthritis usually resolve?

A

self resolving in 7-14d

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10
Q

Characteristics of acute gouty arthritis?

A

Quick and sudden onset of:
pain
erythema
swelling in joint
limited range of motion

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11
Q

triggers of acute gout arthritis?

A

tauma/surgery
starvation
fatty food binge
dehydration
drugs

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12
Q

What happens to intercrtical gout as disease progresses?

A

becomes shorter (less time asymptomatic period between flares)

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13
Q

What are tophi?

A

uric acid deposits, not common in most

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13
Q

Consequences of tophi?

A

joint deformity
surrounding tissue damage
joint destruction and pain
compresses nerves
kidney stones
urate nephropahy

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14
Q

Most common first-line choice for acute gout flare?

A

NSAIDs any can be used

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15
Q

Naproxen and Ibu dosing for acute gout flare?

A

Intial: 500mg, then 250-500mg BID MD
Intial 600-800 TID then 400-600mg TID

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16
Q

Steroid used for flare and dose?

A

25-50mg prednisone OD x 3-5d

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17
Q

Limitation of intra-articular steroid injection?

A

one joint 4x/yr

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18
Q

Colchicine onset of effect?

A

significant improvement in 24h
should be intiated within 24h of flare

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19
Q

Colchicine dosing for acute flare?

A

1.2mg then 0.6mg 1 hour after
then 0.6mg OD or BID until resolved
or
0.6mg BID x1-3d then 0.6mg OD until resolved

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20
Q

More worried about use in renal or heptatic impairment?

A

Renal!!! any renal impairment consider different options

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21
Q

2 factors affecting colchicine?

A

moderate/strong 3A4 inhibtors
P-GP inbitors

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22
Q

Colchicine common SEs?

A

GI
NVD
Fatigue

23
Q

Serious SE of colchicine?

A

mypathy
rhabdomyolysis

24
Q

When is combo therapy used for acute? options?

A

in severe flares/ monotherapy unresponsive
Colchicine + NSAID
Colchicine + Steroids
intra-articular steroid + any other option

25
Q

Canidates for gout prophylaxis?

A

history of kidney stones/ renal insuffeciecny
>800umol/L uric acid
radiographic damage
tophi
> 1 severe acute attack
>= 2 attacks/yr

26
Q

goal of serum urate in prophylaxis?

A

<300-360umol/L

27
Q

Prophylaxis gout options?

A

Colchicine or NSAIDs
Uricosuric agents
xanthine oxidase inhibtors
uricase enzyme

28
Q

Prophylaxis dosing for NSAIDs?

A

Indomethacin 25mg BID
Naproxen 250mg BID

29
Q

Colchicine prophylaxis dosing?

A

0.6mg 3x week up to 0.6mg BID

30
Q

Duration of NSAID and colchicine prophylaxis?

A

3-6 months

31
Q

What is required when using uricosuric agents?

A

good kindey function
Must be adequately hydrated

32
Q

Uricosuric agents?

A

Probenecid
Sulfinpyrazone

33
Q

common SEs of uricosuric agents?

A

rash
GI
headache
gout flares

34
Q

Serious SEs of uricosuric agents?

A

kidney stones
sulf: bleeds

35
Q

CI of uricosuric agents?

A

pts on ASA
CrCl <60mL/min
history of kidney stones
can’t intiate during flare

36
Q

DIs of uricosuric agents?

A

NSAIDs
loop
beta-lactam antibiotics
quinolones
methotrexate
theophyline
Sulfas
Sulf: antiplatlet/coag, phenytoin

37
Q

When are uricosuric agents used for prophylaxis?

A

when other agents failed/ not tolerated

38
Q

Xanthine oxidase inhibitor drugs?

A

allupurinol
Febuxostat

39
Q

when does xanthine oxidase inhibitor max effect occur

A

in 2 weeks

40
Q

Dosing for allupurinol?

A

100mg OD up to 800mg/d, average 300mg/d

41
Q

How is allopurinol titrated?

A

slowly; +100mg q4w

42
Q

Febuxostat dosing?

A

40-80mg up to 120mg/d

43
Q

Common SE w/ allopurinol

A

rash
pruitis
diarrhea
gout flare

44
Q

common SE febuxostat?

A

Nausea
arthalgia
rash
gout flare

45
Q

Serious SE w/ allopurinol?

A

hypersensitivity syndrome;
large rash

46
Q

Percaution w/ allopurinol?

A

HLA-B 5801 gene

47
Q

CI of allopurinol and febuxostat?

A

A: none
F: use w/ azathioprine or mercaptopurine

48
Q

DI of allopurinol?

A

ACE
AMox
Loops
Thiazide
warfarin
azathioprine mercaptopurine

49
Q

Which xanthine oxidase inhibitor is more efficace and less SEs?

A

febuxostat

50
Q

Which xanthine oxidase inhibitor is more associated with gout flares?

A

febuxostat

51
Q

Uricase enzyme?

A

rasburicase

52
Q

Rasburicase MOA?

A

converts uric acid into allantoin

53
Q

rasburicase place in therapy?

A

other therapies CI
need rapid improvement
numerous flares or tophi

54
Q

Limitations of rasburicase?

A

antibody development common
infusion reactions
chest pain
severe cosntipation/nausea/vomitting
gout flares

55
Q

Main choice in pregnancy for prophylaxis?

A

allopurinol

56
Q

option used in pregnancy for acute flare?

A

colchicine and short course prednisone likely safe

57
Q
A

PHAR 255 (14 decks)

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