gout

Question 1

what lab values indicate gout?

Answer 1

Men: >7 mg/dL
Women: > 6 mg/dL

have to have

Question 2

which is more common? under or overproduction?

Answer 2

underexcretion – relative decrease in the renal excretion of uric acid for an unknown reason (primary idiopathic hyperuricemia)

Question 3

drugs capable of inducing hyperuricemia and gout?

Answer 3

Diuretics
Nicotinic acid
Salicylates (<2g/day)
Ethanol
Pyrazinamide
Ethambutol
Cytotoxic drugs
Cyclosporine
Levodopa

Question 4

where does gout most commonly affect?

Answer 4

1st MTP - Podagra “foot pain”

Question 5

drug therapy for acute gout?

Answer 5

NSAIDs and corticosteroids

- etodolac, ibuprofen, indomethacin, ketoprofen, naproxen, celecoxib

Question 6

drug therapy for chronic treatments for gout?

Answer 6

Colchicine
Probenicid (uricosuric)
Allopurinol, febuxostat (xanthine oxidase inhibitors-XOI)

Biologic-pegloticase

Question 7

what med is used to help reduce pain quickly?

Answer 7

Indomethacin (NSAID)

Question 8

MOA for colchicine in acute attacks?

Answer 8

Inhibition of microtubule assembly decreases macrophage migration and phagocytosis

Inhibits leukotriene B4 decreasing inflammation

Question 9

clinical applications for colchicine?

Answer 9

Acute attacks of gout-resolution of pain - if started w/in 36hrs of attack onset

prophylaxis for gout attacks

Question 10

colchicine dosing for terminated acute attack?

Answer 10

1.2mg followed by 0.6mg in 1 hour

Question 11

ADE’s for colchicine in acute attacks?

Answer 11

Dose-dependent GI adverse effects (diarrhea, nausea, vomiting)

Question 12

interactions for colchicine

Answer 12

Dose adjustment recommended when used with selected CYP3A4 and P-glycoprotein inhibitors

Question 13

when is intraarticular (TAC_kenalog) corticosteroids be used?

Answer 13

is acceptable when only one to two joints involved and should be used in combination with NSAIDs, colchicine, or oral corticosteroids

Question 14

ADE’s for corticosteroids

Answer 14

Adrenal suppression
Growth inhibition
Muscle wasting
Osteoporosis
Salt retention
Glucose intolerance
Behavioral changes

Question 15

how long after achieving target serum uric acid should you continue anti-inflammatory regimens?

Answer 15

at least 6 mo’s during initiation or 3-6 mo’s after achieving target

Question 16

ULT: xanthine oxidase inhibitors is efficacious for…

Answer 16

prophylaxis of recurrent gout attacks in both underexcreters and overproducers of uric acid

Question 17

reasons for initiating allopurinol or febouxostate therapy?

Answer 17

for urate lowering therapy:
two or more gout attacks per year
presence of one or more tophus
chronic kidney disease (stage 2 or worse)
history of urolithiasis