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Pharm II MHM - FINAL > Gout > Flashcards

Gout Flashcards

1
Q

What is the goal serum uric acid level for treatment of gout?

A

Less than 6 mg/dL

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2
Q

What meds can increase risk of hyperuricemia?

A

Niacin
Thiazide and loop diuretics
Immunosuppressants

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3
Q

How is gout categorized by severity?

A

0-10 pain scale

  • Mild is 4 or less
  • Moderate is 5-6
  • Severe is 7 or higher
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4
Q

How is gout categorized by onset?

A

Early - less than 12 hrs onset
Well established - 12 to 36 hrs after attack
Late - over 36 hrs since attack

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5
Q

How is the extent of gout categorized by joints?

A
  • One or a few small joints
  • 1 or 2 large joints (ankle, knee, wrist, elbow, hip shoulder)
  • Polyarticular w/more than 1 region (4 or more joints)
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6
Q

Acute gout attack treatment

A
  • NSAIDs
  • Colchicine
  • Corticosteroids
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7
Q

When should treatment be started with an acute gout attack?

A

Within 24 hrs if possible

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8
Q

NSAID use in gout

A
  • No specific preferred (MC are indomethacin and naproxen)
  • Full dose until attack is resolved (3-5 days)
  • COX2 inhibitor can be used (high doses needed)
  • ADEs are GI, HTN, dizzy, CV events, tinnitus
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9
Q

MOA colchicine in gout

A

Decreases microtubule assembly and inhibits activation of inflammatory response

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10
Q

1st line treatment of mild to moderate gout?

A

Monotherapy of either:

  1. NSAID (or COX2 inhibitor)
  2. Systemic steroids
  3. Colchicine
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11
Q

ADEs of colchicine

A
  • Abdominal pain, cramping, vomiting, diarrhea
  • Monitor in renal and hepatic impairment
  • Narrow therapeutic range before toxicity
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12
Q

How should colchicine be taken?

A

With plenty of water

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13
Q

What can increase levels of colchicine?

A

Grapefruit juice

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14
Q

Drug interactions with colchicine

A
  • Clarithromycin
  • Statins
  • Digoxin
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15
Q

How do corticosteroids work in gout?

A

Suppresses migration of PMN leukocytes and decreases immune repsonse

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16
Q

ADEs of corticosteroids

A
  • Hyperglycemia
  • Dyspepsia, nausea
  • Mood changes
  • HTN
17
Q

How should corticosteroids be taken in gout?

A
  • With food
  • Can be given intra-articular
  • Use for 5-10 days then discontinue (oral)
18
Q

Nonpharm prevention of gout

A
  • Diet (decrease purines, HFCS, sugar and salt)
  • Reduce weight
  • Exercise
  • Reduce ETOH
  • Increase fluids, rest and ice
19
Q

What are the urate-lowering treatment criteria?

A
  • Pts w/tophi
  • 2 or more attacks per year
  • Stage 2 to 5 CKD
  • History of uric acid kidney stones
20
Q

Xanthine oxidase inhibitors

A

Allopurinol and febuxostat

21
Q

What is the 1st line treatment for gout prevention?

A

Xanthine oxidase inhibitors (allopurinol, febuxostat)

22
Q

Should xanthine oxidase inhibitors be stopped during acute gout attacks?

A

NO - add colchicine or NSAID

23
Q

Allopurinol ADEs

A
  • Hypersensitivity in pts taking ACEI and diuretics

- Rash MC w/concurrent amoxicillin/ampicillin

24
Q

Who is at high risk for allopurinol hypersensitivity?

A

HLA-B 5801 (Koreans, Han Chinese, Thai)

25
Q

How should allopurinol be taken?

A

After meals w/fluids

26
Q

What is febuxostat and how is it used?

A
  • Potent selective xanthine oxidase inhibitor

- Used for gout (both overproduction AND underexcretion of uric acid)

27
Q

ADEs of febuxostat

A
  • Diarrhea, HA, liver function, CV risks

- Use w/caution in severe renal disease

28
Q

What is an alternative 1st line treatment for gout prevention?

A

Probenecid (uricosuric agents) in those with contraindications or intolerance to xanthine oxidase inhibitors

29
Q

What is probenecid?

A
  • Uricosuric agent
  • Alternative 1st line agent for gout prevention
  • Can be combined with XO inhibitor
  • Takes time to reduce plasma concentration of uric acid
30
Q

Probenecid MOA

A

Inhibits reabsorption of uric acid at proximal tubule

31
Q

Which gout med increases risk of kidney stones?

A

Probenecid

32
Q

When should probenecid be started?

A

2-3 weeks after an acute attack

33
Q

What are uricosuric agents?

A
  • Used for gout prevention
  • Probenecid
  • Fenofibrate (unlabeled use)
  • Losartan (unlabeled use)
34
Q

How is fenofibrate used in gout?

A
  • Uricosuric agent for gout prevention
  • Unlabeled use
  • Avoid in hepatic impairment
  • Dosing changes in renal impairment
35
Q

How is losartan used in gout?

A
  • Uricosuric agent for gout prevention
  • Unlabeled use
  • Increases urinary flow rate and increases excretion of uric acid, Mg, Ca
36
Q

What is Pegloticase and what is it used for?

A
  • Pegylated recombinant form of uricase (enzyme normally absent in humans)
  • Converts uric acid to allantoin (inactive and water soluble metabolite)
  • Severe refractory chronic gout
  • IV infusion
37
Q

In gout, which med requires discontinuing urate-lowering and uricosuric agents?

A

Pegloticase

Pharm II MHM - FINAL (17 decks)

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