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Phar 508 > Gout > Flashcards

Gout Flashcards

1
Q

What is gout

A

A type of arthritis caused by monosodium urate (MSU) crystals

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2
Q

Why is there not a build up of uric acid in other mammals

A

Other mammals have an enzyme called uricase that metabolizes uric acid to allantoin that is readily eliminated (humans have no uricase)

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3
Q

What factors increase the risk of gout

A

Age, Increased Scr, Increased BUN, Male gender, high blood pressure, high body weight, alcohol intake, serum uric acid greater than 7 mg/dL, family history

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4
Q

What are the two ways that normal uric acid is eliminated

A

GI excretion after enzymatic degradation by colonic bacteria (1/3) , Urine excretion (2/3)

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5
Q

What are the two main causes of UNDEREXCRETION of uric acid

A

CKD and Diabetes

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6
Q

What are 3 purine sources that are used to make nucleic acid or uric acid leading to OVERPRODUCTION

A

Conversion of tissue nucleic acid to purine nucleotides, De novo synthesis, dietary purine

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7
Q

T/F: High dietary purine intake alone will increase serum uric acid

A

False: Vast majority of overproduction is increased breakdown of tissue nucleic acids due to increased cell turnover

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8
Q

What medications are associated with getting gout

A

Salicylates, diuretics, cytotoxic drugs

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9
Q

What causes the pain from GOUT

A

inflammatory attack due to uric acid deposition mediated by leukocytes

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10
Q

T/F: The most common clinical presentation is in the big toe BUT can be present in other joints such as the feet, knees, hands, or elbows

A

True

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11
Q

What joint in the big toe is most often affected by gout

A

Metatarso-phalangeal joint (MTP)

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12
Q

What would be found if aspiration form the synovial fluid was possible for the patient

A

Urate crystals inside synovial fluid leukocytes, large numbers of polymorphonuclear leukocytes

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13
Q

What are the 11 criteria (need 6) that needs to be met to be diagnosed with gout

A 
More than 1 acute attack of arthritis
Exquisite pain involving joint
Joint inflammation maximal with one day
Oligoarthritis
Erythema over involved joints
Tophi
Podagra (unilateral)
Hyperuricemia
MSU crystals in joint fluid during attack
Joint fluid negative for organisms
Asymmetric selling in a join and/or subcortical cysts
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14
Q

What non pharmacological treatment can aid initially for a Gout attack

A

Ice and joint rest

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15
Q

What is the MOA desired for drugs treating gout acutely, what are the meds, when should they be initiated

A

Reducing the inflammation/ NSAIDs, corticosteroids, cholchicine/ 24 hours

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16
Q

`T/F: Though indomethacin is the most favored NSAID there is NO evidence that any given NSAID is superior to the others

A

True

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17
Q

`What cautions/contrainidicatons for using NSAIDs to treat a patient

A

CHF, CKD, history of GI bleed, asthma, anticoagulation

18
Q

What is the most potent anti-inflammatory drugs used for resistant cases but could also be used first line

A

Corticosteriods

19
Q

What are the corticosteriods that can be given for gout

A

Prednisone (0.5 mg/kg/day for 2-5 dyas then taper for 7-10 days to prevent rebound attack), Methylprednisolone pack, Triamcinolone acetonide 20-40 mg (intra-articular administration)

20
Q

What are the adverse effects of corticosteroids

A

fluid retention and HTN, mood swings, hyperglycemia, infection, GI

21
Q

What are cautions/contraindications of using corticosteroids

A

Infection (latent or active), HTN, cirrhosis, CHF

22
Q

What is the drug that was FDA approved for gout in 2015, what is the FDA approved dose

A

Colchicine: 1.2 mg (two 0.6 mg tablets) once, then 0.6 mg one hour later

23
Q

What are tips for colchicine administration

A

Wait 12 hours to resume prophylactic dose, DON’T take another course within 3 days, CrCl less than 30 do not give another coure for 14 days

24
Q

What CYP3A4 inhibitors should be monitored when co-administered with colchicine

A

protease inhibitors, Macrolides (clarithromycin and erythromycin), antifungals (irtraconazole, ketoconazole, flucanozole), non-DHP CCBs (dilitazem and verapmil), grapefruit juice

25
Q

What p-gp inhibitors should be cautioned when using cochicine

A

Cyclosporine and Ranolazine

26
Q

Adverse effects of colchicine

A

nausea/vomiting, diarrhea. bone marrow toxicity, neurologic loss of reflexes, myopathy, renal dysfunction

27
Q

What are nonpharmacologic treatment options for long term long term management of gout

A

Weight loss, exercise, smoking cessation, comorbid conditinos that promote hyperuricemia, increase fluid intake and decrease salt intake

28
Q

When should maintenance medication be considered for gout

A

Greater than 2 attacks a year, presence of tophi,CKD stage 2 or worse, urolithiasis (stone formation in the urinary system)

29
Q

What are the first line medications, HINT: xanthine oxidase inhibitors

A

Allopurinol and Febuxostat

30
Q

What are the uricosuric agents (increases uric acid excretion)

A

Probenecid (first line), Lesinurad, losartan and fenofibrate (off-label)

31
Q

What is the goal serum uric acid

A

less than 6 mg/dL (less than 5 mg/dL if trophi)

32
Q

T/F: Allopurinol is preferred over probenecid if the patient has a CrCl is greater than 50 ml/min and can be used in overproduction and underexcretion

A

True

33
Q

What is the dose of allopurinol for osteoarthritis, what if the patient has CKD, drug interactions

A

100 mg by mouth every day, titrate up by 100 mg per day every 2-5 weeks up to 600-800 mg/day/ start with 50 mg by mouth per day then titrate up by 50 mg per day for a max of 300 mg/day/ azathioprine

34
Q

What Adverese effect should be monitored if a patient is taking allopurinol

A

Rash/hypersensitivity

35
Q

What is the common dose of Febuxostat, what are the risk of using the medication

A

40 mg daily that can increased to 80 mg per day after two weeks if uric acid is high not/ Not recommended in CrCl less than 30 ml/min, higher risk of CV deaths

36
Q

What is the dose of probenecid, when should it be used

A

250 mg BID for 1-2 weeks then 500 mg BID for 2 weeks (increases by 500 mg is advised until max dose of 2 grams is reached)

37
Q

T/F: Probenecid should not be taken if CrCl is less than 50 ml/min and if someone has had renal stones since

A

True

38
Q

What is the MOA of lesinurad, dose, what is BBW

A

inhibits renal tubular reabsorption of uric acid (URAT transporter), 200 mg/day given at the same time as a XOI (monotherapy could have lower renal function), Avoid in patients with CrCl less than 45ml/min

39
Q

What recombinant uricase reserved for severe case and is given IV

A

Pegloticase, 8 mg every every 2 weeks over 2 hours

40
Q

What medications should be given as prophylaxis when initiating XOI

A

`Colchine: 0.6 mg BID (every other day if CrCl less than 30)
Naproxen 250 mg BID (others may be used)
Prednisone: Less than 10 mg/day

41
Q

T/F: Lesinurad can be taken alone

A

False: Lesinurad must be taken with a XOI

42
Q

What is the amount of water that should be taken when taking medications

A

At least 2 hours

Phar 508 (21 decks)

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