Gout Flashcards
What’s gout?
Dz marked by monosodium urate/uric acid deposits in:
- synovial fluids
- tissues
- kidneys
T or F: It’s important to know whether a pt is an underexcreter or overproducer of uric acid.
F
What is uric acid?
end product of purine metabolism
What do Xanthine Oxidase (XO) inhibitors do?
They prevent the synthesis of uric acid from taking place by either blocking purine metabolism or purine metabolites from being converted into uric acid.
Name the XO inhibitors:
- allopurinol
2. febuxostat
4 phases of gout:
- asymptomatic hyperuricemia
- acute gouty arthritis (flare)
- intercritical gout
- chronic tophaceous gout
What’re tophi?
Uric acid deposits in tissues (e.g. joints, kidneys) > pain, damage, destruction can result
During a gout workup, what score would indicate that a pt has gout?
> 7 (90% chance pt has gout)
What uric acid level is considered hyperuricemia?
> 420 µmol/L
Two types of gout drugs:
- acute attack drugs
2. preventative drugs
How long do acute gout flares last?
7-14 days
Most likely joints to be affected by gout flares?
peripheral, smaller joints
1st line drug for gout flares?
NSAIDs (except ASA)
How to use NSAIDs during gout flares?
High initial dosing for 24-72h, followed by lowest effective maintenance dosing (total tx period = 7d)
T or F: NSAIDs are more effective than CS’s and colchicine when it comes to tx’ing acute gout flares.
F
They all have similar efficacies
Why is ASA avoided in tx’ing gout flares?
bc it reduces uric acid excretion in the kidneys
Drugs used to tx gout flares:
- NSAIDs (save for ASA)
- CS’s (oral, intra-articular, or parenteral)
- Colchicine
MOA of colchicine?
Prevents uric acid from getting into joint space
What should colchicine be started?
Within 24h of flare
Least tolerated acute flare tx?
Colchicine (N/V/D, fatigue, myopathy, blood abnormalities)
When should gout flare combo tx be utilized?
Severe flares or if monotx isn’t working.
Acceptable combo tx’s for gout flares?
- Colchicine + NSAID
- Colchicine + CS
- intra-articular CS + NSAID OR oral steroid OR colchicine
(avoid NSAID + oral CS > increases GI AEs and not much benefit)
Serum urate goal for gout prophylaxis?
<360 µmol/L
What is the purpose of colchicine + NSAIDs in gout prophylaxis?
To prevent flares during initiation of other prophylactic drugs.
Drugs used in gout prophylaxis:
- Colchicine + NSAIDs
- Xanthine oxidase inhibitors (allopurinol, febuxostat)
- uricosuric agents (probenecid, sulfinpyrazone)
- uricase enzyme (pegloticase, rasburicase)
Major allopurinol AE?
Allopurinol hypersensitivity syndrome
Allopurinol hypersensitivity syndrome - what should the pt look out for?
A rash
First line for gout prophylaxis?
Allopurinol
What if pt can’t tolerate allopurinol?
Tx with febuxostat
Why should we slowly titrate allopurinol up rather than just start on a higher dose from the start?
To avoid allopurinol hypersensitivity syndrome
What do uricosuric agents do?
Increase renal Cl of uric acid
What kind of patient would benefit from uricosuric agents?
Underexcreters only (only time when knowing whether a pt is an underexcreter or overproducer is useful)
When is uricase enzyme tx used?
When it’s severe gout and other options have failed
Common AE with uricase enzyme tx?
Ab development > decreased efficacy
Safe drugs for ACUTE FLARES during pregnancy?
- colchicine
2. short courses of prednisone
Safe drugs for PROPHYLAXIS during pregnancy?
allopurinol
Safe drugs for PROPHYLAXIS during lactation?
- ibuprofen
- prednisone
- allopurinol
