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PHRM 845 > Gout > Flashcards

Gout Flashcards

1
Q

what is gout

A

inflammatory process in response to crystallization in articular and non-articular tissue

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2
Q

what is hyperuricemia classified as

A

uric acid > 6.8 mg/dL AND symptomatic

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3
Q

what is main product in purine degradation

A

uric acid

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4
Q

what is a byproduct of uric acid breakdown

A

allantoin

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5
Q

how is uric acid overproduced

A

increase in dietary purines
chronic alcohol intake
cytotoxic meds
regulatory enzyme variability

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6
Q

how is uric acid underexcreted

A

dehydration
medications
acute alcohol intake
insulin resistance

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7
Q

medications that cause hyperuricemia

A

diuretics
salicylates (<2 g/day)
cytotoxic drugs

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8
Q

risk factors for gout

A

male
post menopausal women
elderly
obesity
diet
alcohol intake
sedentary lifestyle
renal impairment

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9
Q

presentation of acute gout

A

acute inflammatory monoarthritis
podagra
uric acid deposit in fingers, cartilage, kidneys

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10
Q

symptoms of acute gout

A

fever
intense pain
erythema, warmth, edema, inflammation of joints

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11
Q

lab tests to confirm acute gout

A

uric acid > 6.8 mg/dL
WBC > 11,000

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12
Q

what is podagra

A

big toe joint inflamed and big

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13
Q

what is tophi

A

deposits of monosodium erate
bumps in fingers and feed

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14
Q

what is gouty nephropathy

A

acute and chronic kidney disease

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15
Q

how do we get a true diagnosis of gout

A

synovial fluid aspiration to see pins and needles

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16
Q

non-pharm therapy for acute gouty arthritis

A

ice
risk factor modification

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17
Q

drug class options for acute gouty arthritis

A

NSAIDs
corticosteroids
colchicine

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18
Q

NSAID options for acute gouty arthritis

A

indomethacin
naproxen
ibuprofen
sulindac

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19
Q

adverse effects NSAIDs

A

GI effects
kidney injury
CV effects
CNS effects (headache,dizzy)
bleeding risk

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20
Q

if pt has an ASA allergy should we do NSAID

A

no, choose something else

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21
Q

when do we initiate treatment for acute gouty arthritis

A

ASAP

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22
Q

corticosteroid options for acute

A

PO medrol dose pack
PO prednisone tapered
IM triamcinolone or methylpred
intra-articular triamcinolone

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23
Q

corticosteroid adverse effects

A

hyperglycemia
increased BP
GI upset
anxiety/restlessness
insomnia
fluid retention

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24
Q

what corticosteroids should be tapered?

A

PO

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25
Q

what drugs have increased risk GI bleed and ulcer

A

corticosteroids

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26
Q

if pt has infection what dosage form to avoid

A

intra-articular

27
Q

when is colchicine given

A

within 24 hours of acute attack

28
Q

brand of colchicine

A

Colcrys

29
Q

dosing of colchicine

A

day 1: 1.2 mg once then 0.6 mg 1 hr later
day 2+: 0.6 mg BID until resolved

30
Q

colchicine adverse effects

A

N/V/D
neutropenia
axonal neuromyopathy

31
Q

colchicine renal adjustments

A

CrCl >30 no adjust
CrCl < 30 1.2 at onset then 0.6 1 hr later, not repeated more than once every 2 weeks
dialysis: one 0.6 mg dose, not repeated more than once every 2 weeks

32
Q

hepatic dosage adjustment colchicine

A

mild to moderate: none
mod to severe: none, dont take more than once in two weeks

33
Q

what if pt has inadequate response to initial adequate treatment

A

<50% improvement in pain in 24h
switch agents
add 2nd agent but avoid NSAIDs w PO corticosteroids

34
Q

what is pill in pocket

A

used if pt gets sx of acute flare
NSAID or colchicine

35
Q

non pharm therapy for chronic gout

A

weight loss
avoid sat fats and sweetened beverages/foods
alcohol restriction
limit purine rich foods

36
Q

who is a candidate for ULT chronic

A

2+ flares per year
1+ tophus
radiographic evidence of gout
1+ prior flare
first flare + CKD, uric >9, urolithiasis

37
Q

who is not a candidate for ULT

A

asymptomatic hyperuricemia with no prior flares or tophi
first attack with no risk factors

38
Q

monitoring for ULT

A

serum uric acid
target < 6

39
Q

treatment classes for chronic gout

A

1st line xanthine oxidase inhibs
2nd line uricosurics
3rd line uricase agents

40
Q

xanthine oxidase inhibitor drugs

A

allopurinol
febuxostat

41
Q

xanthine oxidase inhibitors MOA

A

reduce uric acid by impairing ability of xanthine oxidase to convert hypoxanthine to xanthine (which is then converted to uric acid)

42
Q

allopurinol dose

A

100 mg PO daily
CrCl < 30: 50 daily, titrate slowly
max 800 mg
titrate by < 100 mg every 2-4 weeks to achieve uric acid < 6

43
Q

febuxostat dose

A

40 mg PO daily
CrCl < 30: 20 mg daily
titrate to 80 mg if uric acid > 6 after 2 weeks

44
Q

allopurinol drug interactions

A

loop and thiazide
warfarin
azathioprine, 6MP, flurouracil

45
Q

adverse reactions allopurinol

A

rash
headache
uticaria
hypersensitivty: steven johnson

46
Q

what is the biggest risk factor for allopurinol hypersensitivity steven johnson syndrome

A

HLA-B*5801 allele +
south asian descent

47
Q

monitoring for allopurinol

A

uric acid q2-5 weeks while titrating
every 6 month when stable

48
Q

febuxostat black box warning

A

increased CV mortality

49
Q

urosicase drugs MOA

A

increase clearance of uric acid by inhibiting reabsorption in proximal tubule

50
Q

urosicase drug

A

probenecid

51
Q

probenecid dosing

A

250 BID x1-2 weeks
titrate in 500 mg incremements every 1-2 weeks till benefit

52
Q

probenecid adverse reactions

A

urolithiasis - contraindicated

53
Q

probenecid renal considerations

A

not reccommended if eGFR < 60

54
Q

pegloticase MOA

A

converts uric acid to allantoin

55
Q

when is pegloticase used

A

SEVERE gout
failed xanthine and urosicase
> 3 gout flares in 18 month
1+ tophi
joint damage

56
Q

pegloticase dosage form

A

IV infusion over 2 hours every 2 weeks

57
Q

what do we do with pegloticase

A

pre-medicate

58
Q

black box warning pegloticase

A

infusion related reactions
G6P deficiency may cause hemolysis

59
Q

other option for uric acid lowering

A

fenofibrate - increase clearance
losartan - inhibit reabsorption

60
Q

preferred agent in pts with HTN and gout when able

A

losartan

61
Q

when initiating ULT how should we prophylax and how long?

A

first 3-6 months of ULT
NSAIDs - low dose
steroids - pred < 10 mg/day
colchicine

62
Q

colchicine prophylaxis dosing

A

0.6 mg daily or BID
CrCl < 30: consider alt, or 0.3 mg daily
dialysis: 0.3 mg twice weekly

63
Q

what should we not give if mental health disorder

A

steroids

64
Q

what should we not give if HTN

A

steroids
NSAIDs

PHRM 845 (38 decks)

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