Gout

Question 1

What level indicates risk of gout?

What is the goal?

Answer 1

Serum urate >8mg/dL

Goal <6

Question 2

If gout attack, do we start urate-lowering agents? what if they are already on one?

Answer 2

Don’t start one

Don’t D/C it

Question 3

What are the three meds for gout attack?

Answer 3

Steroids, NSAIDs, Colchicine

Question 4

What are 4 long-term prevention of gout

Answer 4

Colchicine
Uricosuric drugs
XO inhibitors
PEGylated uric acid

Question 5

When do you start NSAIDs during gout attack?

Answer 5

within 12-48 hours

Question 6

Indomethacin concerns

Answer 6

Renal, GI, CVD, hyperK+, elderlyC

Question 7

Cochicine

MOA
Dose
PGx
ADE

Answer 7

Inhibits celldivision

Acute - 0.6mg BID then 1 tab 1 hour later
Prophylaxis - 0.6mg QD

3A4 substrate so don’t use inhibitors

BMS, GI upset, renal/hepatic impairment, decreased B12 absorption

Question 8

When would you use corticosteroids for acute gout attack over NSAID and colchicine

Answer 8

If renal impairment

Question 9

Steroid ADE

PREDNISONE

Answer 9

PUD
Rash
Eye - glucoma
DM
Neurologic
Immunosuppression
Swelling
OSteoporosis
Nausea
Electrolyte changes (increase Na+ and decreased K+)

Question 10

Probenacid

Brand
MOA
Indications
Dose
Avoid in..

Answer 10

Benemid

Increases urinary excretions of urate

Hyperuricemia and prolonged penicillin serum levels

250mg BID x 1 week then 500mg BID

CrCl <50 , renal stones, >800mg/day of uric acid production, methotrexate use

Question 11

When do you start a XO inhibitor after a gout attack

Answer 11

start them 1-2 weeks after the flare resolvesAl

Question 12

Allopurinol

Brand
Dose
ADE
Testing

Answer 12

Alorim, zyloprim

Gout - CrCl >60 : 100mg/day and work to 800mg/d after meals
CrCl 10-20 - 200mg/day
CrCL <10 - max 100mg/d

Rash

Must test for HLAB 5801 prior to use

Question 13

six drug interactions with allopurinol

Answer 13

Azathoprine
6MP
Warfarin (increased warfarin effect)
Thiazide/ACEi
Alkylating agents (BMS)
Vitamin C (increases kidney stone)

Question 14

Febuxostat

Brand
MOA
Dose
ADE

Answer 14

Uloric

XO Inhibitor

40mg/d to 80mg/d

Increased LFT, RASH, CV death

Question 15

Pegloticase

Brand
MOA
Indication
Dose / premed
Contraindication
ADE

Answer 15

Krystexxa

Enzyme that breaks down urate

Refractory chronic gout

8mg IV every 2 weeks and premedicate with antihistamine, tylenol, and IV hydrocortisone

G6PD deficiency

Anaphylaxis
Infusion reactions
Gout flares
CHF