Gout

Question 1

Pain with gout usually presents in the ______ or at ______

Answer 1

evening or at night

Question 2

What are other systemic symptoms that present with gout?

Answer 2

• fever

- swelling

Question 3

What is the deformity that forms in the joints called with gout?

Answer 3

• tophi

Question 4

Tophi can decrease over time, but need a ___________ in order to do so

Answer 4

decrease in uric acid

Question 5

Do diuretics cause an increase in uric acid?

Answer 5

yes

Question 6

When does HCTZ lose its efficacy?

Answer 6

30 mL/min

Question 7

What is gout typically caused by?

Answer 7

• the inability to eliminate or excrete uric acid

typically not an overproduction thing

Question 8

What starts off the process of pathophys with gout?

Answer 8

• crystal formation within the joints of the synovial fluid is the main thing that starts off the pathophys

Question 9

_____ and ______ go to the synovial fluid to phagocytize the uric acid crystals

Answer 9

neutrophils and phagocytes

Question 10

Neutrophils and phagocytes are ________ when they are aggravated

Answer 10

burst open

Question 11

What do neutrophils and phagocytes do when they burst open?

Answer 11

• release enzymes into the synovial fluid - causes an inflammatory reaction leading to swelling, warmth, etc

Question 12

Rapidly adding a uric acid lowering agent can do what?

Answer 12

• precipitate another gout attack - THIS IS WHY YOU NEED TO ADD A PROPHYLACTIC THERAPY ON

Question 13

What are non-pharms that can be used to manage gout?

Answer 13

• rest, elevation, ice
• avoid/limit seafood, beer, processed foods, limit consumption of alcohol
• limit high fat daily products, increase veggies

Question 14

What is the dosing of colchicine

Answer 14

1.2 mg STAT, 0.6 mg in 1 hour and then 0.3 mg for 5 days

Question 15

What is one of the goals of therapy when initiating gout therapy?

Answer 15

• want to start the therapy right away

Question 16

What is the time interval needed between trials of gout tx?

Answer 16

• need to be a 2 week interval

Question 17

What are the main SE associated with colchicine?

Answer 17

• nausea and diarrhea, weakness

Question 18

What bad things happen when you have too much colchicine?

Answer 18

• neutropenia and neuropathy

Question 19

Colchicine is very effective if started within _______ of pain

Answer 19

36 hours

Question 20

What are the big drug interactions you need to be aware of when giving colchicine?

Answer 20

• PGP inhibitor

- CYP 3A4 inhibitor

Question 21

What is a PGP inhibitor?

Answer 21

amiodarone
clarithromycin
azithromycin

Question 22

What are some of the CYP 3A4 inhibitors?

Answer 22

• clarithromycin
• all of the PIs (antivirals)
• antifungals (ketaconazole, itraconazole)
• diltiazem, verapamil

Question 23

If a person has stage ________ renal dysfunction, we would never give them an NSAID

Answer 23

3 or 4

Question 24

What would the dosing of an NSAID be for gout though?

Answer 24

• high doses for the first 24 to 72 hours, then stop of use lowest dose effective over 1-2 weeks, or while titrating allopurinol

Question 25

What level do we want to decrease uric acid levels below?

Answer 25

360 umol/L

Question 26

What are the main SE associated with allopurinol?

Answer 26

• rash, hypersensitivity reaction

Question 27

What are the main drug interactions associated with allopurinol?

Answer 27

• amipicillin and amoxicillin, and ACE inhibitors - they increase the risk of rash

Question 28

If someone was starting on allopurinol and they were already on an ACE inhibitor, what would we want to do?

Answer 28

• put them on another way to manage bp

Question 29

What is the dose of colchicine when we put someone on allopurinol?

Answer 29

• 0.3 mg daily for 3-6 months

Question 30

What dose of prednisone do we use for people when using prednisone for gout?

Answer 30

• 40 mg OD for 5 days, then taper over 7-10 days

Question 31

What are the main SE associated with prednisone?

Answer 31

• insomnia, stomach pain, sleep disturbances

- other SE we wouldn’t worry about as much for gout due to the short course of treatment

Question 32

What do we want to space out from prednisone by at least 2 hours?

Answer 32

calcium

Question 33

When can we start allopurinol?

Answer 33

can start 3 weeks after, or start at the same time as we put someone on pred/colchicine/or NSAID

Question 34

What are the endpoints of gout?

Answer 34

want to see completely resolution within 1-2 weeks

• decrease in pain in 24 hours
• increase in mobility in a couple of days