Gout Flashcards
normal UA levels
female 2-6.5
male 3.5-7.2
what drugs increase UA levels
ASA
chemo drugs with TLS
CN-i (tacrolimus, CYA)
diuretics (loop, thiazide)
pancreatic enzyme products
what foods should be avoided in gout
seafood (sardines, shellfish)
salt
organ meats, beef, lamb, pork
desserts
sweetened beverages/juices/sugar
alcohol
high fructose corn syrup
acute treatment options for gout
colchicine
NSAIDs
steroids (PO, IA)
colchicine dosing and counseling for acute gout tx
within 36 hours of sx onset…
1.2mg (2 x 0.6mg tab) po x1
then 1 hour later take 0.6mg po x1
wait to take ppx dose until 12+ hours after last acute dose
ADE colchcine
myopathy
myelosuppression
colchicine counseling points
do not take with p-gp or 3A4 inhibitors, non-DHPs or statins
intake adequate fluids
NSAID options for gout acute tx
dose and freq
indomethacin 50mg PO TID until attack resolves
naproxen 500mg PO BID until attack resolves
celecoxib 200mg PO BID until 2-3 days after attack resolves
steroid options and dosing for acute gout attack
30-40mg/day QD or DIV BID until sx resolve then taper down by 5mg a day for 7-10 days
MEPN intra-articular if 2+ large joints involved
chronic gout tx options
allopurinol = #1
febuxostat
probenecid
allopurinol dosing for chronic gout management
pearls, warnings
100mg po qd, gradually increase up to 300mg
*if CrCl <30, start at 50mg and gradually increase to 300mg
must have colchicine or NSAID on board for first 3-6 months to prevent attacks as crystals mobilize
SE/warnings: SJS/TEN, DRESS, hepatotox, HLA-B*5801 (+) CI
febuxostat
why not preferred
BBW CV death
only use if allopurinol not tolerated or CI
colchicine chronic dosing
0.6 mg QD-BID
0.3mg/day if CrCL <30
colchicine MDD
2.4mg
allopurinol DDI
allopurinol increases [ ] of
- mercaptopurine
- azathioprine
- didanosine
antacids dec allopurinol absorption
