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Autoimmune > gout > Flashcards

gout Flashcards

1
Q

where does Gout typically occur and what causes it?

A

Typically occurs in the metatarsophalangeal joint (MTP, big toe) and is due to many years of persistent hyperuricemia.

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2
Q

Risk Factors for gout

A

-Male sex, Overweight, Excessive alcohol intake (beer), Hypertension, Renal insufficiency, Advanced age, Medication (Diuretics, niacin, aspirin, and pyrazinamide

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3
Q

Treatment Goals for gout

A

Treat acute attacks, Prevent future flare-ups, Reduce UA levels

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4
Q

What are the first line agents for Acute Gout Attack Treatments

A

-Colchicine (Colcrys); NSAIDS: Indomethacin (Indocin), Naproxen (Naprosyn), Sulindac (Clinoril),Celecoxib (Celebrex); Steroids:Prednisone, Methylprednisolone, Triamcinolone

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5
Q

Colchicine (Colcrys) moa

A

Inhibits beta-tubulin polymerization

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6
Q

Administration directions for Colcrys initiation

A

-At first sign of attack take 2 tablets (1.2mg) followed by 1 more tablet (0.6mg) in one hour (max = 1.8 mg/day);

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7
Q

NSAIDs used in Gout & when should they be avoided?

A

-Indomethacin (Indocin), Naproxen (Naprosyn), Sulindac (Clinoril), Celecoxib (Celebrex); Avoid use in severe renal disease

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8
Q

What are the side effects of indomethacin

A

psychiatric: confusion, depression, psychosis

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9
Q

What dose of Naproxen is used in gout & for how long

A

750mg once, then 250mg q8h until attack resolves

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10
Q

What is the dose of Indocin for gout

A

50mg, TID till attack resolves

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11
Q

For gout, what are the routs of administration of steroids?

A

PO, IM, IV, intra-articular or ACTH( adrenocorticotropic hormones)

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12
Q

what are the acute side effects of steroids

A

Side effects: increased blood glucose, elevated blood pressure, nervousness, insomnia, increased appetite, and edema

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13
Q

which steroids are used intra-articularly for gout

A

Methylprednisolone and triamcinolone is given intra-articularly based on joint size

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14
Q

Which medications can be used for Prophylactic Treatment (lowering of uric acid production)

A

Allopurinol (Zyloprim), Febuxostat (Uloric), Probenecid, Pegloticase (Krystexxa)

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15
Q

Prior to initiation of UA-lowring therapy what should the patient do?

A

take colchicum 0.6mge daily or BID or NSAIDs for at least 6 months to reduce acute flares

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16
Q

What are Xanthine oxidase inhibitors and how doe they work

A

Allopurinol(Zyloprim) & Febuxostat(Uloric); MOA: block UA prodution

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17
Q

Side effects of Allopurinol (Zyloprim) & renal adjustment

A

Side effects: precipitation of gout attacks, increase LFTs, and skin rash; Dose adjust if CrCl <20

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18
Q

What are the warning for Zyloprim (allopurinol

A

Hypersensitivity: test HLAB*5801 prior to start, hepatotoxicity

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19
Q

What is the initial dose of allopurinol

A

50-100mg/day; slowly titrate to UA target; doses >300mg needed in pts w/ CKD

20
Q

Couseling for Allopurinol

A

take once daily with a meal to Reduce stomach upset, May take up to several weeks for medicine to be effective, If you get a rash, notify your doctor

21
Q

Febuxostat (Uloric) is ideal for whom and why?

A

For resistant cases b/c it is very expensive, and possibly in renal disease as no dose adjustment needs to be made

22
Q

What are the contraindications to Uloric use

A

concurrent use with azathiopurine or mercaptopurine

23
Q

What are the side effects & warnings of Uloric

A

-Side effects: liver enzyme elevation, rash; Warning: Hepatotoxicity(eps in liver impairment) increased thrombocytopenic events

24
Q

Probenecid MOA & indication

A

-Uricosuric: Inhibits the reabsorption of uric acid; indicated when XO inhibitors are CI, not tolerated or added if UA level not at goal w/ max dose of XO-inhibitor

25
Q

What interactions does probenecid have

A

may decrease renal clearance of (aspirin, methotrexate, theophylline, penicillins)

26
Q

What are the contraindications to probenecid?

A

Concomitant use of aspirin; uric acid kidney stones; blood dyscrasias, starting during an acute attack, CrCl <30ml/min

27
Q

What are the side effects & warnings of Probenecid?

A

Side effect: hypersensitivity rtxn, hemolytic anemia; Warning: increased risk hemolytic anemia in G6PD deficient pts

28
Q

pts on uricosurics must have what?

A

good renal function. if pt’s CrCl <50, this can not be used mono therapy

29
Q

Pegloticase (Krystexxa) class and MOA

A

recombinant Uricase enzyme: converts uric acid to an inactive water-soluble metabolite that can be easily excreted.

30
Q

In what cases is pegloticase (Krystexxa) indicated for use?

A

Used in resistant cases only

31
Q

What are the side effects of pegloticase (Krystexxa)

A

Antibody formation, gout flare, infusion rxtn, urticaria, erythema, pruritus, bruising

32
Q

Pegloticase (Krystexxa) is never to be used in combination with which gout agent?

A

allopurinol

33
Q

Pegloticase BBW, how is it managed & who is at risk

A

Anaphylactic rxtn: during infusion; premeditate with antihistamines & steroids; highest risk if UA level >6mg/dl (D/C) therapy

34
Q

Krystexxa (pegloticase) is contraindicated in which condition

A

G6PD deficiency

35
Q

do not use X for acute treatment

A

ASPIRIN (bufferin included in this)

36
Q

food to avoid

A

organ meats, high fructose corn syrup & alcohol, fruit juice, table sugar, sweetened drinks, salt, beef, seafood )high in purine sward fish, shellfish)

37
Q

what is the normal serum uric acid level

A

-Normal serum uric acid levels: 2.0 - 7.2

38
Q

How is uric acid produced

A

Uric acid is produced as an end-product of purine metabolism

39
Q

What are the side effects & warnings of Colchicine (Colcrys)

A

Side effects: nausea, vomiting, abdominal pain, diarrhea; Warning: decreased clearance in renal & hepatic impairment

40
Q

What interactions does Colcrys have & how are they managed?

A

interacts with 3A4 inhibitors (clarithromycin) and P-gp inhibitors (cyclosporine); a max dose of 1.2mg (2 tablets) can be used acutely if using these agents

41
Q

how many days should a patient wait before starting another course of therapy

A

Wait at least 3 days before initiating another course of therapy

42
Q

When is the second dose of colchicine not given

A

-You should not take the 2nd dose if you have upset stomach, nausea, and diarrhea

43
Q

What is the prophylactic dose of colchicine

A

0.6mg BID starting 12 hours after acute dosing & continued till attack resolves

44
Q

Colchicine is contraindicate if

A

pt is taking P-gp or strong CYP 3A4 inhibitor & they have renal or liver impairment

45
Q

When is the ideal colcrys initiation time?

A

within 36 hours of onset & only if pt has not used it prophylacticly & used acute regimen in the last 14 days

46
Q

Medications known to increase Uric acid

A

Diuretics( thiazides & loops), niacin, aspirin (higher doses), pyrazinamide, cyclosproin, tacrolimus

47
Q

What is the target Uric acid level for chronic therapy with XO-inhibitors

A

<5-6mg/dl

Autoimmune (4 decks)

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