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NAPLEX - OUR cards > Gout > Flashcards

Gout Flashcards

1
Q

Uric acid is a endproduct of what?

A

Purine metabolism

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2
Q

Uric acid excretion

A

2/3 renal

1/3 GI tract

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3
Q

Normal serum uric acid levels

A

~2.0 - 7.2 mg/dL

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4
Q

All patients with high uric acid levels (hyperuricemia) will develop gout (t/f)

A

false

only becomes gout in the uric acid crystallize in the joints

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5
Q

Most common site of gout attacks

A

MTP joint (big toe)

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6
Q

Risk factors for gout

A 
Male 
obesity
excessive alcohol (beer)
HTN 
CKD
advanced age
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7
Q

Asymptomatic hyperuricemia does not require treatment (t/f)

A

True

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8
Q

Goal uric acid levels for treatment

A

uric acid < 6 mg/dl

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9
Q

Drugs that increase UA

A

high dose ASA
Diuretics
Niacin
tacrolimus, cyclosporine

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10
Q

Treatment options for gout attacks

A

NSAIDs
Colchicine
Systemic steroids

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11
Q

1st line for gout prevention

A

xanthane oxidase inhibitors

allopurinol or febuxostat

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12
Q

Colchicine brand

A

Colcrys

Mitigare

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13
Q

Colchicine dosing

A

1.2 mg (2 tabs) x1, then 0.6 mg 1 hour later

repeat dose in 3 days if needed

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14
Q

When starting a xanthine oxidase inhibitor you need prophylaxis for gout (t/f)

A

true, can cause gout attack

give NSAIDs or colchicine when initiating

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15
Q

Colchicine prophylaxis dose

A
  1. 6 mg daily or BID

0. 3 mg if crcl < 30

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16
Q

Colchince main side effects

A

GI side effects, myelosuppression, myopathy (incr risk with statins, CYP3A4 inhibitors), neuropathy

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17
Q

Indomethacin dose

A

Indocin

50 mg TID until attack resolves

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18
Q

Naproxen dose

A

750 mg x1, then 250 mg q8h until resolved

19
Q

Sulindac dose

A

Clinoril

200 mg BID until resolved

20
Q

Celecoxib dose

A

800 mg x1,
then 400 mg x1 (one day later),
then 400 mg BID x 1 week

21
Q

Colchicine metabolsim

A

CYP3A4 and p-gp

do not use with strong CYP3A4 inhibitors (clarithromycin)

22
Q

Max dose of colchicine if used with mod CYP3A4 inhibitor

A

1.2 mg

23
Q

Allopurinol brands

A

zyloprim

Aloprim

24
Q

Doses of ___ mg of allopurinol should be dosed BID?

A

> 300 mg

titrate dose to UA < 6

25
Q

Risk for allopurinol hypersensitivty reaction

A

HLA-B*5801 allele
people of Asian descent
severe rask (SJS/TEN)

26
Q

allopurinol renal dosing

A

crcl: 10-20 = max 200 mg

crcl < 10 = 100 mg

27
Q

allopurionol side effects

A

N/D (take with food)
rash
gout attacks
incr LFTs

28
Q

How long do you need prophylaxis when starting xanthine oxidase inhibitor?

A

3-6 months

29
Q

Febuxostat brand and dosing

A

Uloric
40 mg daily
incr to 80 mg daily if UA > 6 @ 6 weeks

30
Q

Febuxostat warnings

A

Hepatoxicity

31
Q

Lesinurad

A

Zurampic

32
Q

Lesinurad dose

A

200 mg in the AM w/ xanthine oxidase inhibitor

only used as adjunct therapy

33
Q

Lesinurad warnings

A

Cant be used of crcl < 30,

34
Q

Lesinurad MOA

A

inhibits reabsoprtion of UA in the kidneys –> incr excretion

35
Q

Probenecid dose

A

250 mg BID

Max 2 g/day

36
Q

Probenecid contraindications

A

do not use with ASA
kidney stones
decr effectiveness if Crcl < 30-50

37
Q

Pegloticase brand

A

Krystexxa

38
Q

Pegloticase MOA

A

converts UA to allantoin (inactive)

39
Q

Pegloticase dose

A

8 mg IV q 2 weeks

40
Q

Pegloticase key notes

A

anaphylatic reactions - medicate with antihistamines and steroids
do not use with allopurinol or febuxostat

41
Q

Allopurinol/febuxostat increases the concentration of which drugs?

A

mercaptopurine
azathioprine
didanosine

42
Q

Rasburicase brand

A

Elitek

43
Q

Rasburicase use

A

tumor lysis syndrome
dose: 0.2 mg/kg daily
max of 5 days

44
Q

Duzallo

A

allopurinol/lesinurad

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