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iTx III > Gout > Flashcards

Gout Flashcards

1
Q

What is gout?

A

inflammatory arthritis caused by deposition of monosodium urate crystal s in synovial fluid (most common form of inflammatory arthritis)

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2
Q

Hyperuricemia is defined by…

A

serum urate level >7 mg/dL (males)
serum urate level >6 mg/dL (females)

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3
Q

gout is more prominent in men than women with the exceptions of…

A

post-menopausal women

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4
Q

Which enzyme do humans lack?

A

uricase

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5
Q

Acute gouty arthritis

A
  • monoarticular
  • typically effect first MTP joint –> podagra
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6
Q

gouty nephropathy

A
  • nephrolithiasis (kidney stones)
  • acute on chronic renal impairment
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7
Q

Tophi (or Tophaceous gout)

A

MSu crystal deposits within the synovial fluid

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8
Q

Predisposing Factors

A
  • dietary
  • medications
  • medical conditions
  • other
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9
Q

Dietary Factors

A
  • meat and seafood (increase purine)
  • fatty foods
  • dietary overindulgence
  • alcohol
  • sugar-sweetened soft drinks
  • high-fructose foods
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10
Q

Medication Factors

A
  • aspirin (ASA)/salicylates
  • Calcineurin inhibitors (cyclosporine, tacrolimus)
  • Cytotoxic chemotherapy (i.e. paclitaxel)
  • Diuretics (loops, thiazides)
  • Nicotine acid (niacin)
  • Pyrazinamide
  • Teripatide
  • Testosterone
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11
Q

medical conditions

A

obesity; renal transplant; metabolic syndrome
diabetes; hypertension; dyslipidemia; CHF; renal insufficiency; early menopause; psoriasis; hypothyroidism; sarcoidosis; hyper/hypo-parathyroidism; myeloproliferative disorders; anemias

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12
Q

Other conditions

A
  • starvation
  • dehydration
  • lead toxicity
  • acute or episodic alcoholism
  • enzyme deficiencies (HGPRT & PRPP)
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13
Q

Gout classifications:
MILD

A

one joint, stable disease

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14
Q

Gout classifications:
MODERATE

A

2 or 4 joints, stable disease

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15
Q

Gout classifications:
SEVERE

A
  • 4 or more joints, stable disease
  • unstable, complicated, severe articular top
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16
Q

non-pharm treatment

A
  • limit purine rich foods, alcohol intake, high-fructose corn syrup & maintain adequate hydration
  • promote weight loss
  • adjuvant ice therapy (avoid heat -may worsen attacks)
17
Q

Pharm treatment goals

A
  • terminate acute attacks
  • prevent recurrent attacks of gouty arthritis
  • prevent complications assoc. w/ disposition of urate crystals in tissues
  • prevent/reverse comorbidities assoc. w/ your (i.e. obesity, hypertension)
18
Q

Acute gout treatment

A

NSAIDs, Corticosteroids, Colchicine

19
Q

NSAIDs

A
  • Indomethacin (indocin), Naproxen (Naprosyn), Sulindac (Clinoril), Celecoxib (Celebrex)
  • Initiate 24-48 hours
  • Consider if GI AE effects limit use of other NSAIDs
  • AVOID: if significant CAD hx
  • Consider PPI therapy for longer NSAID course if risk of GI bleed
20
Q

NSAID contraindications

A
  • active PUD
  • decompensated heart failure
  • severe renal impairment (CrCl less than or equal to 30 mL/min
  • hypersensitivity to ASA/NSAIDs
21
Q

Corticosteroids

A
  • Prednisone
  • Methylprednisolone (Solumedrol, Medal)
  • Triamcinolone (Kenalog)
  • Adrenocorticotropin Hormone (ACTH)
22
Q

Corticosteroids time of initiation

A

24-48 hours

23
Q

Corticosteroids AE

A

metabolic SE
—- HTN
—- Hyperglycemia

24
Q

Corticosteroids CI

A
  • avoid IA injection if septic arthritis can’t be r/o
  • severe/uncontrolled hyperglycemia
  • active systemic infections
25
Q

Colchicine initial dosing:

A

Day 1: 1.2mg PO once
Day 2: after 12 hours

26
Q

Colchicine time of initiation

A

12-24h of sx onset
—- if 36hrs or more from onset, consider alternative therapies

27
Q

If CrCl less than or equal to 30 ml/min…

A

may use during acute flare; DO NOT REPEAT dose in 14 days

28
Q

Colchicine AE

A
  • diarrhea (>20%)
  • nausea/vomiting
29
Q

Cochicine CI

A
  • severe renal disease
    — CrCl < ml/min
30
Q

When would you initiate ULT?

A
  • 1 or more SQ top
  • evidence of radiographic damage from gout
  • 2 or more gout flares per year
31
Q

ULT is recommended for pts who have previously experienced…

A

> 1 flare but have infrequent flares (<2/yr)

32
Q

ULT is recommended for patients with…

A
  • mod-severe CKD (stage 3 or greater)
  • serum Urate concentration >9.0 mg/dL
  • Urolithiasis
33
Q

T/F
ULT can be used with patients experiencing their first gout flare

A

false

34
Q

Gout overlapping agents

A
  • NSAIDs
  • Colchicine
35
Q
A

iTx III (3 decks)

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