Gout

Question 1

Uric acid is a endproduct of what?

Answer 1

Purine metabolism

Question 2

Uric acid excretion

Answer 2

2/3 renal

1/3 GI tract

Question 3

Normal serum uric acid levels

Answer 3

~2.0 - 7.2 mg/dL

Question 4

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

Answer 4

false

only becomes gout in the uric acid crystallize in the joints

Question 5

Most common site of gout attacks

Answer 5

MTP joint (big toe)

Question 6

Risk factors for gout

Answer 6

Male 
obesity
excessive alcohol (beer)
HTN 
CKD
advanced age

Question 7

Asymptomatic hyperuricemia does not require treatment (t/f)

Answer 7

True

Question 8

Goal uric acid levels for treatment

Answer 8

uric acid < 6 mg/dl

Question 9

Drugs that increase UA

Answer 9

high dose ASA
Diuretics
Niacin
tacrolimus, cyclosporine

Question 10

Treatment options for gout attacks

Answer 10

NSAIDs
Colchicine
Systemic steroids

Question 11

1st line for gout prevention

Answer 11

xanthane oxidase inhibitors

allopurinol or febuxostat

Question 12

Colchicine brand

Answer 12

Colcrys

Mitigare

Question 13

Colchicine dosing

Answer 13

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

repeat dose in 3 days if needed

Question 14

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

Answer 14

true, can cause gout attack

give NSAIDs or colchicine when initiating

Question 15

Colchicine prophylaxis dose

Answer 15

0. 6 mg daily or BID

0. 3 mg if crcl < 30

Question 16

Colchince main side effects

Answer 16

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

Question 17

Indomethacin dose

Answer 17

Indocin

50 mg TID until attack resolves

Question 18

Naproxen dose

Answer 18

750 mg x1, then 250 mg q8h until resolved

Question 19

Sulindac dose

Answer 19

Clinoril

200 mg BID until resolved

Question 20

Celecoxib dose

Answer 20

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

Question 21

Colchicine metabolsim

Answer 21

CYP3A4 and p-gp

do not use with strong CYP3A4 inhibitors (clarithromycin)

Question 22

Max dose of colchicine if used with mod CYP3A4 inhibitor

Answer 22

1.2 mg

Question 23

Allopurinol brands

Answer 23

zyloprim

Aloprim

Question 24

Doses of ___ mg of allopurinol should be dosed BID?

Answer 24

> 300 mg

titrate dose to UA < 6

Question 25

Risk for allopurinol hypersensitivty reaction

Answer 25

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

Question 26

allopurinol renal dosing

Answer 26

crcl: 10-20 = max 200 mg | crcl < 10 = 100 mg

Question 27

allopurionol side effects

Answer 27

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

Question 28

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

Answer 28

3-6 months

Question 29

Febuxostat brand and dosing

Answer 29

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

Question 30

Febuxostat warnings

Answer 30

Hepatoxicity

Question 31

Lesinurad

Answer 31

Zurampic

Question 32

Lesinurad dose

Answer 32

200 mg in the AM w/ xanthine oxidase inhibitor | only used as adjunct therapy

Question 33

Lesinurad warnings

Answer 33

Cant be used of crcl < 30,

Question 34

Lesinurad MOA

Answer 34

inhibits reabsoprtion of UA in the kidneys --> incr excretion

Question 35

Probenecid dose

Answer 35

250 mg BID | Max 2 g/day

Question 36

Probenecid contraindications

Answer 36

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

Question 37

Pegloticase brand

Answer 37

Krystexxa

Question 38

Pegloticase MOA

Answer 38

converts UA to allantoin (inactive)

Question 39

Pegloticase dose

Answer 39

8 mg IV q 2 weeks

Question 40

Pegloticase key notes

Answer 40

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

Question 41

Allopurinol/febuxostat increases the concentration of which drugs?

Answer 41

mercaptopurine azathioprine didanosine

Question 42

Rasburicase brand

Answer 42

Elitek

Question 43

Rasburicase use

Answer 43

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

Question 44

Duzallo

Answer 44

allopurinol/lesinurad