Gout

Question 1

hyperuricemia conc.?

Answer 1

> 420umol/L

Question 1

What compound percipitates out resulting in gout?

Answer 1

Monosodium urate

Question 2

Causes of overproduction of uric acid?

Answer 2

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

Question 3

causes of underexcretion of uric acid?

Answer 3

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

Question 4

Numbers of uric acid in urine for overproducers?

Answer 4

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

Question 5

Gout more common in Male or Female?

Answer 5

Male

Question 6

Clinical phases of gout?

Answer 6

ASymptomatic hyperuricemia
acute gouty arthritis
intercritcal gout
chronic tophaceous gout

Question 7

Treatment for pts in asymptomatic hyperuricemia?

Answer 7

Majority not required

Question 8

Potential concequences of hyperuricemia?

Answer 8

Gout
CKD
urate nephropathy
kidney stones

Question 9

When does acute gouty arthritis usually resolve?

Answer 9

self resolving in 7-14d

Question 10

Characteristics of acute gouty arthritis?

Answer 10

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

Question 11

triggers of acute gout arthritis?

Answer 11

tauma/surgery
starvation
fatty food binge
dehydration
drugs

Question 12

What happens to intercrtical gout as disease progresses?

Answer 12

becomes shorter (less time asymptomatic period between flares)

Question 13

What are tophi?

Answer 13

uric acid deposits, not common in most

Question 13

Consequences of tophi?

Answer 13

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

Question 14

Most common first-line choice for acute gout flare?

Answer 14

NSAIDs any can be used

Question 15

Naproxen and Ibu dosing for acute gout flare?

Answer 15

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

Question 16

Steroid used for flare and dose?

Answer 16

25-50mg prednisone OD x 3-5d

Question 17

Limitation of intra-articular steroid injection?

Answer 17

one joint 4x/yr

Question 18

Colchicine onset of effect?

Answer 18

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

Question 19

Colchicine dosing for acute flare?

Answer 19

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

Question 20

More worried about use in renal or heptatic impairment?

Answer 20

Renal!!! any renal impairment consider different options

Question 21

2 factors affecting colchicine?

Answer 21

moderate/strong 3A4 inhibtors
P-GP inbitors

Question 22

Colchicine common SEs?

Answer 22

GI
NVD
Fatigue

Question 23

Serious SE of colchicine?

Answer 23

mypathy rhabdomyolysis

Question 24

When is combo therapy used for acute? options?

Answer 24

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

Question 25

Canidates for gout prophylaxis?

Answer 25

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

Question 26

goal of serum urate in prophylaxis?

Answer 26

<300-360umol/L

Question 27

Prophylaxis gout options?

Answer 27

Colchicine or NSAIDs Uricosuric agents xanthine oxidase inhibtors uricase enzyme

Question 28

Prophylaxis dosing for NSAIDs?

Answer 28

Indomethacin 25mg BID Naproxen 250mg BID

Question 29

Colchicine prophylaxis dosing?

Answer 29

0.6mg 3x week up to 0.6mg BID

Question 30

Duration of NSAID and colchicine prophylaxis?

Answer 30

3-6 months

Question 31

What is required when using uricosuric agents?

Answer 31

good kindey function Must be adequately hydrated

Question 32

Uricosuric agents?

Answer 32

Probenecid Sulfinpyrazone

Question 33

common SEs of uricosuric agents?

Answer 33

rash GI headache gout flares

Question 34

Serious SEs of uricosuric agents?

Answer 34

kidney stones sulf: bleeds

Question 35

CI of uricosuric agents?

Answer 35

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

Question 36

DIs of uricosuric agents?

Answer 36

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

Question 37

When are uricosuric agents used for prophylaxis?

Answer 37

when other agents failed/ not tolerated

Question 38

Xanthine oxidase inhibitor drugs?

Answer 38

allupurinol Febuxostat

Question 39

when does xanthine oxidase inhibitor max effect occur

Answer 39

in 2 weeks

Question 40

Dosing for allupurinol?

Answer 40

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

Question 41

How is allopurinol titrated?

Answer 41

slowly; +100mg q4w

Question 42

Febuxostat dosing?

Answer 42

40-80mg up to 120mg/d

Question 43

Common SE w/ allopurinol

Answer 43

rash pruitis diarrhea gout flare

Question 44

common SE febuxostat?

Answer 44

Nausea arthalgia rash gout flare

Question 45

Serious SE w/ allopurinol?

Answer 45

hypersensitivity syndrome; large rash

Question 46

Percaution w/ allopurinol?

Answer 46

HLA-B 5801 gene

Question 47

CI of allopurinol and febuxostat?

Answer 47

A: none F: use w/ azathioprine or mercaptopurine

Question 48

DI of allopurinol?

Answer 48

ACE AMox Loops Thiazide warfarin azathioprine mercaptopurine

Question 49

Which xanthine oxidase inhibitor is more efficace and less SEs?

Answer 49

febuxostat

Question 50

Which xanthine oxidase inhibitor is more associated with gout flares?

Answer 50

febuxostat

Question 51

Uricase enzyme?

Answer 51

rasburicase

Question 52

Rasburicase MOA?

Answer 52

converts uric acid into allantoin

Question 53

rasburicase place in therapy?

Answer 53

other therapies CI need rapid improvement numerous flares or tophi

Question 54

Limitations of rasburicase?

Answer 54

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

Question 55

Main choice in pregnancy for prophylaxis?

Answer 55

allopurinol

Question 56

option used in pregnancy for acute flare?

Answer 56

colchicine and short course prednisone likely safe