Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

825 > Gout > Flashcards

Gout Flashcards

1
Q

Gout

A
  • Disease spectrum including hyperuricemia and recurrent attacks of acute painful inflammatory arthritis
  • Affects approximately 4% of adults
  • “Disease of kings”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Gout Risk Factors

A
  • High purine diet (red meals, shellfish)
  • Alcohol consumption
  • Male
  • Obesity
  • Genetics
  • Renal impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Uric Acid Metabolism

A
  • Byproduct of purine metabolism
  • Waste product with no biological purpose
  • Exclusively occurs in humans/primates which have a nonfunctional urate oxidase (uricase enzyme)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Uricemia

A
  • Overproduction (~10%) and underexcretion (~90%)
  • Normal levels vary by gender
  • Male: 3.4-7.0 mg/dL
  • Female: 2.4-6.0 mg/dL
  • Hyperuricemia: Uric acid >7 mg/dL (supersaturated)
  • Higher uric acid levels = higher risk of gout
  • May be an asymptomatic condition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Clinical Presentation

A
  • Rapid onset
  • Excruciating pain
  • Erythema
  • Swelling
  • Monoarticular vs polyarticular
  • Tophus - deposits of urate crystals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Joints Affected by Gout

A
  • Generally 1st metatarsophalangeal joint is most affected (MTP) - big toe joint
  • Typically affects small joints like insteps, ankles, wrists, fingers, elbows
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Diagnosis Considerations

A
  • Symptoms
  • History and risk factors
  • Hyperuricemia
  • Imaging and arthrocentesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Non-pharm Therapy

A
  • Education: attacks are spontaneous and resolve in 3-10 days
  • Lifestyle changes
  • Joint rest: 1-2 days
  • Topical therapy: apply ice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Gout Lifestyle Changes

A
  • Reduce purine rich food intake
  • Reduce alcohol intake
  • Increase water intake
  • Weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pharmacological Therapy - Treatment

A
  • Terminate acute attack

- Initiate within 24 hours of symptoms onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pharmacological Therapy - Prophylaxis

A
  • Prevent recurrent attacks

- Should not be initiated during an acute attack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment Basics

A
  • Monotherapy: mild to moderate pain on one major joint or a few small joints
  • Dual Therapy: Severe pain with polyarticular or multiple large joints
  • Concurrent prophylatic therapy should NOT be interrupted
  • Educate about recurrent attacks and to self-initiate treatment based on symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Gout Treatment Agents

A
  • NSAIDs
  • Corticosteroids
  • Colchicine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

NSAIDs

A
  • Acceptable first line therapy
  • Little evidence to support one agent over another
  • Indomethacin is the most studied for gout - drug-of-choice for termination of acute attacks
  • High-doses as early as possible for as short a duration as possible
  • CAUTION: renal impairment, high-risk for GI bleed/ulceration, severe heart failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Common NSAID Regimens

A
  • Indomethacin (Indocin) - 50 mg PO TID
  • Naproxen (Naprosyn/Aleve) - 500 mg PO BID
  • Sulindac - 200 mg PO BID

Initiate within 24-48 hours of symptoms onset and discontinue 2-3 days after resolution (usually 5-7 days total)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Corticosteroids

A
  • Acceptable first line therapy
  • Similar efficacy to NSAIDs
  • By mouth and intra-articular options
17
Q

Oral Corticosteroids Options

A
  • Prednisone
  • 0.5 mg/kgday PO for 5-10 days
  • 30-60 mg/day PO until symptom improvement then taper over 7-10 days
  • Methylprednisone dose oack is also an option
18
Q

Intra-articular Corticosteroid Options

A
  • Methylprednisolone (Solu-Medrol) or Triamcinolone (Kenalog-10 or -40)
  • DO NOT use if suspicion for infection/septic joints
  • Usually limited to 1-2 joints, use IV/IM if multiple joints involved
19
Q

Colchicine

A
  • Colcrys
  • MoA: neutrophil inhibition resulting in reduced inflammation
  • Acceptable first line if started within 36 hours of attack onset
  • Can be used as a prophylatic at low doses (abortive at high doses)
  • Many patients respond favorably bu
  • Falling out of favor due to adverse reactions/toxicities
20
Q

Colchicine Dosing/Toxicities

A
  • Traditional: 1.2 mg followed by 0.6 mg q2h until symptoms subside or GI distress occurs (Max of 4-6 mg/day)
  • Colcrys dosing: 1.2 mg followed by 0.6 mg 1 hour later, then 0.6 mg TID until symptoms resolve
  • Colcrys dosing has significantly less adverse GI effects
  • Toxicities: nausea, vomiting, diarrhea, bone marrow suppression, hepatotoxicity
  • Avoid in severe renal/hepatic impaired patients or those with blood dyscrasias
21
Q

Prophylaxis Basics

A
  • May not be needed if first episode resolves quickly or if uric acid level minimally elevated
  • Recommended if severe attacks occur, uric acid >10 mg/dL, or 2+ attacks per year
  • Target uric acid level <6 mg/dL to lower attack frequency/complications
  • Should monitor levels every few weeks initially during dose modification then every 6 months
  • Initiate 1-2 weeks after acute attack resolution to prevent flare-ups and rebound attacks
22
Q

Prophylatic Agents

A
  • Allopurinol
  • Febuxostat
  • Colchicine
  • Probenecid
  • Pegloticase
  • Lesinurad
23
Q

Allopurinol

A
  • Zyloprim
  • MoA: XOI (Xanthine Oxidase Inhibitor) to reduce the production of uric acid
  • Drug of choice for most patients
  • Bridge with prophylatic colchicine or NSAID for acute attack precipitation
  • Can continue during acute attacks
24
Q

Allopurinol Dosing

A
  • Initial: 100 mg PO QD
  • Titration: 100 mg increments every 204 weeks to achieve desired uric acid level
  • Usual dose: 300 mg PO QD (max of 800 mg/day)
  • Dose reduced in the renally dysfunctioned
25
Q

Allopurinol AE

A
  • Mild: skin rash, N/V/D, headache
  • Severe allergic reactions
  • Highest risk of severe, possibly fatal, SE in the first few months
26
Q

Febuxostat

A
  • Uloric
  • MoA: XOI that reduces production of uric acid
  • Non-inferior to allopurinol
  • Bridge with prophylatic colchicine or NSAID for acute attack precipitation
  • Can continue during acute attacks
  • Viable option in patients with allopurinol allergies, intolerance, or failures
27
Q

Febuxostat Dosing

A
  • Initial: 40 mg PO QD
  • Titration: increase to 80 mg after 2 weeks to achieve desired uric acid level
  • Usual dose: 40-80 mg PO QD (max of 120/day)
  • IF CrCl < 30 mL/min then the max dosing is 40 mg PO QD
28
Q

Febuxostat AE

A
  • Mild: skin rash, N/V/D, LFT elevation

- No allergic reactions

29
Q

Probenecid

A
  • Benemid
  • MoA: uricosuric - inhibits tubular reabsorption of uric acid which increases its renal clearance
  • Alternative to XOI or additional agent in non-responders
  • Bridge with prophylatic colchicine or NSAID for acute attack precipitation
  • Can continue during acute attacks
  • Other indications: prolong PCN serum levels and neurosyphillis in addition to IM PCN (antibacterial action)
30
Q

Probenecid Dosing

A
  • Initial: 250 mg BID x 7 days
  • Titration: increase in 500 mg increments every 4 weeks
  • Usual dose: 500-1000 mg PO BID (max of 2000 mg/day)
  • Avoid use in CrCl < 50 mL/min and history of renal stones
31
Q

Probenecid AE

A

-Mild: skin rash, N/V/D, kidney stones

32
Q

Pegloticase

A
  • Krystexxa
  • MoA: PEGylated urate oxidase
  • Converts uric acid to allantoin
  • IV option used for severe debilitating, refractory gout
  • D/C PO anti-hyperuricemic agents prior to starting
  • Flare prophylaxis is with NSAIDs or colchicine is recommended starting at least 1 week prior to initiation
  • Dose: 8 mg IV q2w (expensive!!!)
33
Q

Pegloticase AE

A
  • Infusion reactions
  • Allergic reactions
  • Gout flares

Premedicate with antihistamines and corticosteroids

34
Q

Lesinurad

A
  • Zurampic
  • DISCONTINUED
  • MoA: selective uric acid reabsorption inhibitor that blocks renal URAT1 transporter
  • Used in combination with XOI when goal uric acid levels not achieved with ZOI alone
  • XOI therapy is interrupted, lesinurad should be held
  • Dose: 200 mg PO QD in combination with XOI (also max dose)
  • CI with CrCl < 30 mL/min
  • AE: GERD, influenza, increased SCr, gout flares
35
Q

Other Gout Agents

A
  • Fenofibrate

- Losartan

36
Q

Fenofibrate

A
  • MoA: increases clearance of xanthine

- Potential add-on to XOI non-responders or patients with hyperlipidemia

37
Q

Losartan

A
  • MoA: promotes renal excretion of uric acid

- Potential add-on to XOI nonresponders or patients with hyperlipidemia

825 (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions