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PHRM 864 > 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
what drugs have increased risk GI bleed and ulcer
corticosteroids
26
if pt has infection what dosage form to avoid
intra-articular
27
when is colchicine given
within 24 hours of acute attack
28
brand of colchicine
Colcrys
29
dosing of colchicine
day 1: 1.2 mg once then 0.6 mg 1 hr later day 2+: 0.6 mg BID until resolved
30
colchicine adverse effects
N/V/D neutropenia axonal neuromyopathy
31
colchicine renal adjustments
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
hepatic dosage adjustment colchicine
mild to moderate: none mod to severe: none, dont take more than once in two weeks
33
what if pt has inadequate response to initial adequate treatment
<50% improvement in pain in 24h switch agents add 2nd agent but avoid NSAIDs w PO corticosteroids
34
what is pill in pocket
used if pt gets sx of acute flare NSAID or colchicine
35
non pharm therapy for chronic gout
weight loss avoid sat fats and sweetened beverages/foods alcohol restriction limit purine rich foods
36
who is a candidate for ULT chronic
2+ flares per year 1+ tophus radiographic evidence of gout 1+ prior flare first flare + CKD, uric >9, urolithiasis
37
who is not a candidate for ULT
asymptomatic hyperuricemia with no prior flares or tophi first attack with no risk factors
38
monitoring for ULT
serum uric acid target < 6
39
treatment classes for chronic gout
1st line xanthine oxidase inhibs 2nd line uricosurics 3rd line uricase agents
40
xanthine oxidase inhibitor drugs
allopurinol febuxostat
41
xanthine oxidase inhibitors MOA
reduce uric acid by impairing ability of xanthine oxidase to convert hypoxanthine to xanthine (which is then converted to uric acid)
42
allopurinol dose
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
febuxostat dose
40 mg PO daily CrCl < 30: 20 mg daily titrate to 80 mg if uric acid > 6 after 2 weeks
44
allopurinol drug interactions
loop and thiazide warfarin azathioprine, 6MP, flurouracil
45
adverse reactions allopurinol
rash headache uticaria hypersensitivty: steven johnson
46
what is the biggest risk factor for allopurinol hypersensitivity steven johnson syndrome
HLA-B*5801 allele + south asian descent
47
monitoring for allopurinol
uric acid q2-5 weeks while titrating every 6 month when stable
48
febuxostat black box warning
increased CV mortality
49
urosicase drugs MOA
increase clearance of uric acid by inhibiting reabsorption in proximal tubule
50
urosicase drug
probenecid
51
probenecid dosing
250 BID x1-2 weeks titrate in 500 mg incremements every 1-2 weeks till benefit
52
probenecid adverse reactions
urolithiasis - contraindicated
53
probenecid renal considerations
not reccommended if eGFR < 60
54
pegloticase MOA
converts uric acid to allantoin
55
when is pegloticase used
SEVERE gout failed xanthine and urosicase > 3 gout flares in 18 month 1+ tophi joint damage
56
pegloticase dosage form
IV infusion over 2 hours every 2 weeks
57
what do we do with pegloticase
pre-medicate
58
black box warning pegloticase
infusion related reactions G6P deficiency may cause hemolysis
59
other option for uric acid lowering
fenofibrate - increase clearance losartan - inhibit reabsorption
60
preferred agent in pts with HTN and gout when able
losartan
61
when initiating ULT how should we prophylax and how long?
first 3-6 months of ULT NSAIDs - low dose steroids - pred < 10 mg/day colchicine
62
colchicine prophylaxis dosing
0.6 mg daily or BID CrCl < 30: consider alt, or 0.3 mg daily dialysis: 0.3 mg twice weekly
63
what should we not give if mental health disorder
steroids
64
what should we not give if HTN
steroids NSAIDs

PHRM 864 (28 decks)

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