Gout Flashcards
Pain with gout usually presents in the ______ or at ______
evening or at night
What are other systemic symptoms that present with gout?
- fever
- swelling
What is the deformity that forms in the joints called with gout?
- tophi
Tophi can decrease over time, but need a ___________ in order to do so
decrease in uric acid
Do diuretics cause an increase in uric acid?
yes
When does HCTZ lose its efficacy?
30 mL/min
What is gout typically caused by?
- the inability to eliminate or excrete uric acid
typically not an overproduction thing
What starts off the process of pathophys with gout?
- crystal formation within the joints of the synovial fluid is the main thing that starts off the pathophys
_____ and ______ go to the synovial fluid to phagocytize the uric acid crystals
neutrophils and phagocytes
Neutrophils and phagocytes are ________ when they are aggravated
burst open
What do neutrophils and phagocytes do when they burst open?
- release enzymes into the synovial fluid - causes an inflammatory reaction leading to swelling, warmth, etc
Rapidly adding a uric acid lowering agent can do what?
- precipitate another gout attack - THIS IS WHY YOU NEED TO ADD A PROPHYLACTIC THERAPY ON
What are non-pharms that can be used to manage gout?
- rest, elevation, ice
- avoid/limit seafood, beer, processed foods, limit consumption of alcohol
- limit high fat daily products, increase veggies
What is the dosing of colchicine
1.2 mg STAT, 0.6 mg in 1 hour and then 0.3 mg for 5 days
What is one of the goals of therapy when initiating gout therapy?
- want to start the therapy right away
What is the time interval needed between trials of gout tx?
- need to be a 2 week interval
What are the main SE associated with colchicine?
- nausea and diarrhea, weakness
What bad things happen when you have too much colchicine?
- neutropenia and neuropathy
Colchicine is very effective if started within _______ of pain
36 hours
What are the big drug interactions you need to be aware of when giving colchicine?
- PGP inhibitor
- CYP 3A4 inhibitor
What is a PGP inhibitor?
amiodarone
clarithromycin
azithromycin
What are some of the CYP 3A4 inhibitors?
- clarithromycin
- all of the PIs (antivirals)
- antifungals (ketaconazole, itraconazole)
- diltiazem, verapamil
If a person has stage ________ renal dysfunction, we would never give them an NSAID
3 or 4
What would the dosing of an NSAID be for gout though?
- high doses for the first 24 to 72 hours, then stop of use lowest dose effective over 1-2 weeks, or while titrating allopurinol
What level do we want to decrease uric acid levels below?
360 umol/L
What are the main SE associated with allopurinol?
- rash, hypersensitivity reaction
What are the main drug interactions associated with allopurinol?
- amipicillin and amoxicillin, and ACE inhibitors - they increase the risk of rash
If someone was starting on allopurinol and they were already on an ACE inhibitor, what would we want to do?
- put them on another way to manage bp
What is the dose of colchicine when we put someone on allopurinol?
- 0.3 mg daily for 3-6 months
What dose of prednisone do we use for people when using prednisone for gout?
- 40 mg OD for 5 days, then taper over 7-10 days
What are the main SE associated with prednisone?
- insomnia, stomach pain, sleep disturbances
- other SE we wouldn’t worry about as much for gout due to the short course of treatment
What do we want to space out from prednisone by at least 2 hours?
calcium
When can we start allopurinol?
can start 3 weeks after, or start at the same time as we put someone on pred/colchicine/or NSAID
What are the endpoints of gout?
want to see completely resolution within 1-2 weeks
- decrease in pain in 24 hours
- increase in mobility in a couple of days
