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NAPLEX Content > Gout > Flashcards

Gout Flashcards

1
Q

What xterizes gout?

A

Gout typically occurs in 1 joint, which is most often the metatarsophalangeal joint (MTP, the big toe)

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2
Q

Causes of gout?

A

Uric acid is produced as an end-product of purine metabolism

Once gout crystallizes in joints, results in severe, painful gout attack

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3
Q

When does gout typically strike?

A

After many years of persistent Hyperuricemia

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4
Q

Risk factors of gout?

A

Male sex

Obesity

Excessive alcohol consumption (particularly beer)

HTN

Chronic kidney dx

Lead intoxication

Advanced age

Meds that increase uric acid

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5
Q

What should pt avoid to reduce risk of recurrent gout attacks?

A

Organ meats

High-fructose corn syrup

Alcohol

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6
Q

What should pt be encouraged to reduce risk of recurrent gout attacks?

A

Low-fat dairy products

Vegetables

Hydration

Weight loss

Exercise

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7
Q

Meds with highest known risk to increase uric acid (there are others with possible risk or case reports)?

A

Diuretics (thiazides, loops)

Niacin

Aspirin, higher doses

Pyrazinamide

Cyclosporine

Tacrolimus

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8
Q

What increases purine

A

Diet

Alcohol

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9
Q

Purine leads to?

A

Xanthine

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10
Q

What enzyme converts Xanthine to Urate?

A

Xanthine oxidase

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11
Q

What inhibits Xanthine oxidase?

A

Allopurinol

Febuxostat

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12
Q

What enzyme converts Urate to Allantoin and Uric acid crystals?

A

Urate oxidase

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13
Q

What’s normal serum uric acid level?

A

2.0 - 7.2

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14
Q

Is asymptomatic Hyperuricemia treated?

A

No!

T/4 if given a case with elevated uric acid, don’t choose tx unless gout attack has occurred

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15
Q

What’s the goal of tx?

A

Treat acute attacks, prevent future flare-ups and reduce UA levels

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16
Q

T/F? Drugs used to treat an acute attack (colchine, NSAIDs, steroids) are diff than drugs used to prevent attacks?

A

T

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17
Q

First line tx for acute gout tx?

A

Colchine

NSAID

Systemic corticosteroids

Or combo of these agents

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18
Q

What can the first line tx be supplemented with?

A

Topical ice therapy

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19
Q

If a pt is already on (Allopurinol, Febuxostat) should they be interrupted during a gout attack?

A

No!

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20
Q

When should chronic prophylactic therapy be started?

A

In pts with >= 2 acute attacks/yr

In pts who have tophi

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21
Q

What’s first line agents for chronic gout prophylactic therapy?

A

Xanthine-oxidase (XO) inhibitors (Allopurinol or Fubuxostat)

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22
Q

How are Xanthine-oxidase (XO) inhibitors (Allopurinol or Fubuxostat) titrated? Why?

A

Slowly

To lower uric acid to < 5-6 mg/dL

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23
Q

List agents used in acute gout attack tx

A

Colchine

NSAIDs

Steroids

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24
Q

What’s the brand name of Colchine? (Acute gout attacks)

A

Colcrys

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25
Q

How to use Colchine (Colcrys)? (Acute gout attacks)

A

1.2mg orally (this is two 0.6mg tablets) followed by 0.6mg in 1hr (don’t exceed a total of 1.8mg)

Until the acute attack resolves

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26
Q

SEs of Colchicine (Colcrys)? (Acute gout attacks)

A

Nausea

Vomiting

Diarrhea

27
Q

When is colchicine (Colcrys) recommended? (Acute gout attacks)

A

Only when tx is started within 36hrs of onset of sx

28
Q

List NSAIDs agents used in acute gout attacks

A

Indomethacin (Indocin)

Naproxen (Naprosyn, others)

Sulindac (Clinoril)

Celecoxib (Celebrex) - off-label

29
Q

What’s brand name of Indomethacin used in tx of Acute gout attacks?

30
Q

What’s brand name of Naproxen used in tx of Acute gout attacks?

31
Q

What’s brand name of Celecoxib used in tx of Acute gout attacks?

32
Q

Which NSAIDs is used off-label in tx of Acute gout attacks?

A

Celecoxib (Celebrex)

33
Q

In what grp of pts is NSAIDs CI wrt to acute gout attack tx?

A

Avoid use in severe renal dx

CVD risk (most with Celecoxib: Celebrex)

34
Q

What’s the unique SE of indomethacin (Indocin)

A

Psychiatric SE including confusion, depression, psychosis

35
Q

How can steroids used in acute gout attack tx be given?

A

PO, IM, IV, Intra-articular or via ACTH (adrenocorticotropic hormone) which triggers endogenous glucocorticoid secretion

36
Q

List steroids agents used in acute gout attack?

A

Prednisone (PO)

Methylprednisolone (intra-articular; oral; IM)

37
Q

Howz prednisone dosed?

A

0.5mg/kg/day for 5-10 days (no taper)

OR

0.5mg/ kg/day for 2 days, then taper to 5mg each day for 7-10 days

38
Q

What’s xtics of Colchicine may be important to know for drug interactions?

A

Colchicine is a substrate of CYP 3A4 and efflux transporter P-glycoprotein (P-gp)

39
Q

When is fatal toxicity a concern when using colchicine (Colcrys)?

A

When Colchine (3A4 substrate) is used with strong inhibitors e.g Clarithromycin

OR

Strong inhibitor of P-gp, such as cyclosporine

40
Q

What the max dose of Colchine (Colcrys) if used with a moderate 3A4 inhibitor?

A

1.2mg (2 tablets)

41
Q

When should colchicine be used?

A

At first sign of gout attack

Take 2 tabs immediately. U can use 1 more tab in 1 hr

42
Q

When should the 2nd dose of colchicine NOT be taken?

A

If pt has upset stomach, nausea or diarrhea

43
Q

How long after Colchicine should pt wait b4 initiating another tx for acute gout attacks?

A

At least 3 days

44
Q

MOA of Xanthine oxidase (for prophylactic tx of gout)?

A

Block uric acid (UA) production

45
Q

List chronic uric acid (UA) lowering drugs

A

Xanthine oxidase inhibitors (Allopurinol and Febuxostat)

Uricosuric (Probenecid and Colchicine-Probenecid)

Uricase (Pegloticase injection)

46
Q

What should be used in addition to chronic UA therapy, when initiating chronic UA therapy? Why?

A

Colchicine at daily dose of 0.6mg once or twice daily

OR

NSAIDs for at least 6 months

To reduce the risk of acute flares when beginning UA-lowering acid therapy

47
Q

List Xanthine Oxidase Inhibitor agents

A

Allopurinol (Zyloprim)

Febuxostat (Uloric)

48
Q

What’s the brand name of Allopurinol (Xanthine Oxidase Inhibitors - used for chronic UA lowering)?

49
Q

What’s warnings associated with Allopurinol (Zyloprim)?

A

Hypersensitivity rxns including severe rash (SJS/TEN)

50
Q

What’s the max starting dose of allopurinol (Zyloprim) in pts with CKD?

A

50mg daily

51
Q

What’s the warning associated Febuxostat (Uloric) use?

A

Hepatotoxicity

52
Q

List Uricosuric agents (chronic UA-lowering therapy)

A

Probenecid

Colchicine-Probenecid

53
Q

What’s required before Uricosuric agent (Probenecid and Colchicine-Probenecid) is used?

A

Adequate renal fxn

54
Q

What’s the agent under Uricase (chronic UA-lowering therapy)?

A

Pegloticase (Krystexxa)

55
Q

When is Pegloticase (Krystexxa) used?

A

Refractory cases only

56
Q

What’s the black box warning associated with Pegloticase (Krystexxa) use?

A

Anaphylactic rxn

57
Q

What can be done to alleviate the black box warning ass with Pegloticase (Krystexxa) use?

A

Premedicate with antihistamines and corticosteroids

58
Q

When do u d/c Pegloticase (Krystexxa)?

A

UA > 6mg/dL

59
Q

SEs of Pegloticase (Krystexxa)?

A

Antibody formation

Gout flare

Infusion rxns

Nausea

Bruising

Urticaria

Erythema

Pruritus

60
Q

What chronic UA-lowering drugs can’t Pegloticase (Krystexxa) be used with?

A

Allopurinol (Zyloprim)

61
Q

Cockcroft-Gault Eqn?

A

(140-age) x body weight (kg)
Divided by
72 x SCr

62
Q

What SE may a pt on short-course prednisone therapy experience?

A

Insomnia/spaciness

63
Q

What’s gout?

A

A dx that usually presents with recurrent attacks of acute inflammatory arthritis

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