Gout

Question 1

What is the enzyme related to the rate-limiting step of uric acid formation?

Answer 1

Xanthine oxidase

Question 2

What are the main reasons for primary gouty attacks?

Answer 2

Defect in uric acid excretion, Or uric acid overproduction

Question 3

where is uric acid made?

Answer 3

produced as an end product of purine metabolism (DNA)

Question 4

How is uric acid excreted?

Answer 4

2/3Renally and 1/3 GI

Question 5

What drugs may cause hyperuricemia

Answer 5

ASA, Diuretics (EXCEPT spironolactone), Pyrazinamide, Niacin

Question 6

what are risk factors for getting gout?

Answer 6

male
overweight
drinks too much beer or etoh
high blood pressure
problems with kidney
older or meds that increase uric acid

Question 7

when do you start treatment with meds for gout?

Answer 7

only if the patient has an elevated uric acid level AND HAS A GOUT ATTACK

Question 8

Colcrys

Answer 8

colchicine

Question 9

What are the three treatments available for acute gouty attacks?

Answer 9

Colchicine, NSAIDS (indomethacin), Corticosteroids

Question 10

typical colchicine regimen for gout attack?

Answer 10

two 0.6 tabs then one hour later another tablet

Question 11

Indocin

Answer 11

indomethacin

Question 12

When should a pt stop taking Colchicine

Answer 12

Abdominal cramping or diarrhea

Question 13

Colchicine dosing limit

Answer 13

Three tablets within the first hour

Question 14

Colchicine ADEs

Answer 14

Common: n/v/abdomian pain, Diarrhea (GI), Rare w/ high doses: Bone marrow suppression and neuromyopathy

Question 15

When should you avoid NSAIDS with patients w/ gout?

Answer 15

if the patient has severe renal insufficiency

Question 16

what is the DOC NSAID for Gout? What is the dose?

Answer 16

indomethacin 50mg TID until pain is tolerable and then taper down to avoid rebound

Question 17

Is the IV form of colchicine available?

Answer 17

No - taken off the market for bad reactions

Question 18

what four NSAIDS are tyicall used for gout?

Answer 18

indomethacin, naproxen , sulindac or celecoxib

Question 19

Who should not take colchicine?

Answer 19

Pts with PUD

Question 20

What is the max dose of colchicine?

Answer 20

1.8 mg

Question 21

When is colchicine most effective?

Answer 21

12-36 hours after the attack

Question 22

Indomethacin (Indocin) gout information. When is it effective?

Answer 22

Most studied NSAID. Effective at any point of a gouty attack.

Question 23

with colchicine, when can you take a second course of therapy for a gout attach again?

Answer 23

3 days after the initial first course of therapy

Question 24

Corticosteroid treatment for acute gout

Answer 24

Prednisone intra-articularly, IV, IM or orally, or via ACTH. Use limited to colchicine and NSAID failures.

Question 25

Zyloprim

Answer 25

Allopurinol

Question 26

When is gout prophylaxis given?

Answer 26

After an actual gouty arthritis attack

Question 27

Pegloticase (Krystexxa) MoA / place in therapy

Answer 27

IV tx for chronic gout in pts refractory to conventional therapy.

Question 28

Probenecid (Benemid) MoA

Answer 28

Uricosuric agent that promotes the excretion of uric acid by blocking it reuptake at the proximal convoluted tubule

Question 29

What should pts do when on probenecid or sulfinpyrazone?

Answer 29

Drink at least 2 liters of water per day to decrease the risk of uric acid stone formation. Take w/food if GI intolerance occurs

Question 30

Probenecid drug interactions

Answer 30

Interacts with renally excreted weak acids, Penicillins, Cephalosporins, Nitrofurantoin (Reduction in efficacy), Rifampin
Do not use Benemid and ASA together!
Increases effects of furosemide and HCTZ
Sulfonylureas –> hypoglycemia

Question 31

When should Benemid or Anturane not be started?

Answer 31

At the beginning of an acute attack! Can make it worse!

Question 32

Allopurinol (Zyloprim) MoA

Answer 32

Allopurinol and its metabolite (oxypurinol) inhibit xanthine oxidase formation –> allows uric acid water soluble precusors to be cleared

Question 33

Zyloprim ADE

Answer 33

Rash - may occur at any time in therapy (maculopapular to SJS), percipitation of acute attacks, AHS

Question 34

how should patients take allopurinol?

Answer 34

patient take it once daily awith a meal to reduce sotmch upcet. Cant take several weeks for it to work. Report rash :)

Question 35

Average dose of allopurinol

Answer 35

50 - 200mg QD, Dose adjust for renal insufficiency

Question 36

What is the name of the other xanthine oxidase inhibitor?

Answer 36

Febuxostat (Uloric)