Gout

Question 1

What causes gout

Answer 1

Buildup of uric acid due to purine break down

Question 2

What is a tophi

Answer 2

UA crystals in joints

Question 3

Most common joint affected by uric acid

Answer 3

MTP joint

Question 4

RF of gout

Answer 4

Male, obesity, excessive alcohol

Question 5

Drugs that ↑ UA

Answer 5

Aspirin
Cyclosporine
Diuretics
Niacin
Pyrazinamide

Question 6

What foods to avoid with gout

Answer 6

Orang meats
High-frutise
Alcohol
Rich foods

Question 7

When is prophylaxis initiated

Answer 7

UA level of <6

Question 8

Treatment of acute gout flares

Answer 8

Colchicine
Steroids
NSAIDs
IL1 antagonist (refractory or intolerance to other meds)

Question 9

Treatment of chronic gout

Answer 9

Xanthine oxidase inhibitors

Question 10

If XOI didn’t work well enough and UA is >6?

Answer 10

Add probenecid
or Replace with IV pegloticase

Question 11

Cochicine

Answer 11

Colcrys

Question 12

Dosing of colchicine

Answer 12

2 0.6 mg tab followed by 0.6 mg in 1 hr (do not exceed 1.8 mg in 1 hr or 2.4 mg/d)

Start within 36 hrs of sx onset
Wait 12 hr after tx before resuming prophylaxis dosing

Question 13

CI of Colcrys

Answer 13

Pgp or CYP3A4 inhibitors

Question 14

ADR of Colcrys

Answer 14

Myelosuppression and myopathy risk
Diarrhea, nausea, myopathy, neuropathy

Question 15

NSAIDs indicated for gout flares

Answer 15

Indomethacin
Celecoxib
Naproxen

Question 16

When do you avoid NSAID use

Answer 16

Severe renal disease and CVD risk

Question 17

Indomethacin

Answer 17

Indocin

Question 18

Celecoxib

Answer 18

Celebrex

Question 19

Naproxen

Answer 19

Aleve

Question 20

Dosing of methylprednisone

Answer 20

IA: if 1-2 joints are involved

Question 21

ADR of steroids

Answer 21

↑ BG, BP, insomnia, and appetite

Question 22

IL-1 antagonist

Answer 22

Canakinumab (Ilaris)

Question 23

XOI

Answer 23

Allopurinol
Febuxostat

Question 24

Allopurinol

Answer 24

Zyloprim, Aloprim

Question 25

Febuxostat

Answer 25

Uloric

Question 26

Counseling for allopurinol? ADR?

Answer 26

Hypersensitivity reactions, HLA-B*5801 prior to use

Hepatotoxicity, rash, gout flare, nausea

Question 27

How to prevent gout flares when on ULT

Answer 27

Use with colchicine (0.6 mg QD or BID) or NSAID first 3-6 months

Question 28

BBW of Febuxostat

Answer 28

Increased CV risk but should be used if CI with allopurinol

Question 29

ADR of Febuxostat

Answer 29

Hepatotoxicity, serious skin reactions, increased LFTs

Question 30

Mechanism of probenacid

Answer 30

Uricouric: Inhibit reabsorption of UA in the kidneys which ↑ UA excretion

Question 31

MOA of pegloticase

Answer 31

Recombinat urinase: converts UA to allantoin → excreted

Question 32

BBW of pegloticase

Answer 32

Anaphylaxis → premedicate with antihistamine and steroids

Question 33

CI of pegloticase

Answer 33

G6D deficiency
Combo with ULT or probenecid → anaphylaxis

Question 34

Pegloticase

Answer 34

Krystexxa

Question 35

What agent can be used to ↑ beta-lactam levels

Answer 35

Probenacid