Gout

Question 1

What is the key to gout treatment?

Answer 1

NEVER start urate lowering therapy during an acute attack (can continue if already taking htem)

Question 2

What is uric acid?

Answer 2

End product of purine metabolism, usually excreted via GI and renal mechanisms

Question 3

What can cause under secretion of uric acid?

Answer 3

Loop or thiazide diuretic use (increase net urate reabsorption)
Caution, ACEi / ARB may also

Question 4

What can bring on an acute attack?

Answer 4

• Alcohol
• Purine diet
• Kidney disease

Question 5

How do you treat an acute attack?

Answer 5

Indomethacin
Colchicine

They decrease movement of granulocytes into joints

Question 6

Aspirin for acute attacks?

Answer 6

No, competes with uric acid excretion in the proximal tubule

Question 7

How do you treat chronic gout?

Answer 7

Urate lowering medications with NSAIDS or colchicine

Question 8

What are the uricosuric drugs?

Answer 8

Probenecid and lesinurad

Question 9

Who should not use uricosuric drugs?

Answer 9

Patients with impaired renal function

Question 10

Drug interactions of probenecid?

Answer 10

Increases drug levels of : Penicillin, naproxen, ketoprofen, indomethacin, methotrexate

Question 11

What drug has decreased effectiveness with probenecid?

Answer 11

Salicylates

Question 12

Contraindication of probenecid?

Answer 12

Nephrolithiasis

Question 13

Adverse reaction of probenecid?

Answer 13

Rash

Question 14

Use of colchicine?

Answer 14

Initial flare and prevention of gout attacks

Question 15

Therapeutic effect of colchicine?

Answer 15

Decreased migration of granulocytes & decreased inflammation

Question 16

Side effects of Colchicine?

Answer 16

GI disturbances, agranulocytosis, aplastic anemia, alopecia

Question 17

When do you adjust colchicine?

Answer 17

Renal function, contraindicated if CrCl

Question 18

Risk with allopurinol?

Answer 18

Allergy rash, leukopenia, thrombocytopenia, stevens Johnson

Question 19

50% dose reduction with what?

Answer 19

Azothiapine and febuxostat

Question 20

Who should get febuxostat?

Answer 20

If you can not tolerate allopurinol

Question 21

What is allopurinol used for?

Answer 21

Prevention of gouty attacks

Question 22

When should you use corticosteroids?

Answer 22

Bottom line agent for patients who can not take NSAIDS or colchicine

Question 23

What is another therapy option?

Answer 23

Pegloticase, an exogenous uricase

Question 24

Febuxostate contraindicated with what drug?

Answer 24

Azathioprine