Gout Flashcards
What is the normal value of uric acid?
3-7
What is the goal for a gout pt?
6
Do human have enzyme to break down uric acid?
No
Gout affects men and women equally. T or F
False, it affects men more
Gout is a common form of inflammatory ______ in adults.
arthritis
Does prevalence of gout inc with age?
Yes
When do men and women separate in terms of how many of the respective populations have high uric acid?
in the 10-14 y.o. range
High serum uric acid levels above ___ will parcipitate out in the _____ more because of the lower pH
6.8, joints
After crystals start to form in the joint two things start to happen, what are they?
activation of the innate immune system via IL-1 production resulting in acute gout arthritis flares AND continued deposition of urate cyrstals leading to formation of tophi and bone erosion both of these lead to symptoms of gouty arthritis
What are the most common sxs of gouty arthritis?
warm sensation, redness, pain, swelling
does acute gouty arthritis usually affect more than one joint?
No
does serum uric acid levels confirm or exclude gout?
nope; you can have hyperuricemia and not have gout or you can and gout but have normal uric levels
What are some other conditions that should be ruled out before you assume its gout?
pseudogout, septic arthritis, cellulitis, arthritis (RA, OA, PA), lyme disease
What is a strong risk factor for gout?
higher adiposity and wt gain
Is weight loss protective for gout?
yes
What are 5 comorbidities associated with gout?
HTN, obesity, hyperlididemia, CKD, CVD
What does lipid lowering agents do to gout?
inc serum uric acid over time
What anti-HTN meds are assocaited with inc uric acid and gout?
Diuretics, beta blockers, ACE, Non-losartan ARBs
What anti-HTN meds dec uric acid?
CCB and losartan
Does alcohol intake inc risk of gout?
yes
Which type of alcohol inc risk of gout the most and least?
Beer is most, wine is least
if someone is going to take alcohol can you inc the dose of allopurinol?
yes, only real toxicity is hypersensitivity
What drugs lead to inc uric acid reabsorption?
diuretics
what drug inc serum urate and dec uric acid clearance?
low-dose apsirin
what three drugs have higher incidence of gout?
pyrazinamide, ethambutol, niacin
What is Tophaceous gout?
deposits of uric acid crystals that occur in cartilage (ears, joints, epiphyseal joints, tendon, bursa, heart, etc)
What can cause the Tophi?
long duration of gyperuricemia, high uric acid levels, untreated gout (11 yrs or under-tx), or have more than 4 or more attacks per year
Is tophaceous gout treatable with drugs? which ones?
Yes: probenecid, allopurino, febuxostat, pegloticase
What are the two types of classifications of gout?
metabolic and renal (90%)
What is characteristic of metabolic gout?
overproducers from either molectular defects, enzymatic defects, onset at young age, high incidence of uric acid stones or high turn over in nucleic acids
what are the three reasons for renal gout?
reduced filtration, enhanced reabsorption, decreased secretion
What are drugs that cause renal gout?
diuretics, ASA, pyrazinaminde, niacin, ethambutol, ethanol
Can starvation ketosis, diabetic ketoacidosis, and lactic acidosis cause renal gout?
yes
What are the normal uric acid levels for males and females?
M: 3-7
F 3-6
tx in serum lvl even tho they dont have gouty arthritis?
yes
Which one of the following drugs is not effective in tx acute gout attacks?
Acetaminophen (no inflammatory properties)
What are some tx for acute gout therapy?
indomethacin (indocin), Naproxen (Naprosyn), Sulindac (Clinoril), Colchicine (colcrys), interlukin 1b inhibitors (Canakinuma, Rilonacept, anakinra)
what are the goals of gout therapy?
terminate acute attack rapidly, prevent future acute gouty attacks, lower uric acid levels to prevent deposits, prevent formation of uric acid calculi, tx accompanying disorders (obesity, excess alcohol ingestion, etc)
Do not take more than 3 tablets of ________
colchincine
can you get gi effects from colchicine?
yes
What drug inc toxic effect of colchicine?
clarithromycin
What do you do for colchicine if they are on weak 3A4 inhibitors?
just take 2 tablets (0.6mg each)
What do you do for colchicine if they are on strong 3A4 inhibitors?
just take 1 tablet (0.6mg) then half a tablet (0.3mg) an hour later if needed
How fast does indomethacin for for acute gout attacks? Do you need high or low doses of indomethacin? What population do you have to be care with NSAIDs?
2-4hrs; high; elderly from bleeding risk
What are some corticosteropids for acute gout attacks?
methylprednisolone (5-10mg for small joints) (20-60mg for large joints)
Prednison 30-50 mg daily tapering in a 7-10 day period
ACTH or triamcinolone acetonide
prophylaxis for acute gout is what?
Colchicine 0.6 mg one to two times daily (NSAIDs may be added)
What are the three TYPES of urate-lowering strategies?
Uricosuric agents, uricostatic agents and uricolytic agents
What drug is a uricosuric agent?
Probenecid
What drug is a uriostatic agent?
allopurinol, febuxostat
What drug is a uricolytic agent?
pegloticase
When would you not use Probenecid?
when you have poor renal function of CrCl <30 because its not going to push out the uric acid
Can Uric Lowering therapy (ULT) cause an acute gout flare-up? All of them? What do you do to prevent it?
Yes; Yes; give flare prophylaxis like colchicine
What is the starting dose of allopurinol?
100mg/day
inc by how much of allopurinol per week?
100mg/day
what is the average daily dose of allopurinol?
300mg/day
What is the max daily dose of allopurinol?
600mg/day
What are some indications for allopurinol?
overproducers, secretions greater than 1000mg/day, pts with renal failure, hx or renal calculi, Tophaceous gout, allergies to uricosurics, prior to using cytotoxic agents
What is the brand name of Uloric?
Febuxostat
What is the MoA of uloric?
non-purine selective xanthine oxidase inhibitor
What is the starting dose?
40mg/day
How much do you inc Uloric dose?
40mg up to a total of 80mg/day if not at goal
Is there another of side effects from febuxostat?
Nope, well tolerated
Do you have to renal adjust or discontinue cuz its toxic or doesnt work in renal imparied?
No, no need to consider renal impairment
What is the official approval for febuxostat?
chronic tx of hyperuricemia in pts with gout
are there skin reactions with Uloric?
yes
What is pegloticase and how does it work?
It is an enzyme that performs like uricase
what is the dose of pegloticase?
8mg IV over 2 hrs q2wks
How long does pegloticase take to work?
6 hours
What are some side effects of pegloticase?
chest pain, chills, nausea and HA
Is pegloticase recommeneded for asymptomatic hyperuricemia?
nO
do pts develop antibodies?What does that do to tx?
yes, it dec efficacy
What pts usually receive pegloticase?
cancer pts
What is the brand name of Rasburicase?
Elitek
What is the indication for Elitek?
management of plasma uric acid levles in pt with leukemia, lymphoma, and solid tumor malignancies who are receiving anticancer therapy resulting in tumor lysis syndrome and release of uric acid
Whats the dose of rasburicase?
once daily for 5 days as a single course tx only.
Is resburicase indicated for gout?
No
What pt population is rasburicase used for?
cancer
What 3 guidelines are effective for reducing frequency and/or severity of acute flares in patients iwth gout?
maintianing target UA <6mg/dl
the use of ULT continuously instead of intermittently
using colchicine for flare prophylaxis when initiation ULT and continuing past ULT initiation
What drug shows evidence for acute flare up prophylaxis?
colchicine
Does NSAIDs show benefit for acute flare ups or prophylaxis?
flare ups yes, prophylaxis no
Will gout require life time therapy?
Yes
How much water should gout pts drink?
2 liters or more
what do you do if you have GI upset when taking
take with food
What two things should you avoid because of acid risk?
aspirin and vit C
Should you avoid purine rich foods?
Yes
