Gout

Question 1

Pathophysiology of Gout?

Answer 1

Caused by a buildup of uric acid crystals in the joint. Uric acid is the end product of purine metabolism which is present in many food and is a building block of DNA

Question 2

What is the normal serum concentration of uric acid?

Answer 2

2 - 6.5 mg/dL in females

3.5 - 7.3 mg/dL in males

Question 3

Where does Gout usually occur?

Answer 3

Typically in 1 joint, most often in big toe (metatarsophalangeal joint)

Question 4

How can you diagnose Gout?

Answer 4

Serum level

A sample of synovial joint fruit to look for uric acid contains

Question 5

What are some foods to avoid in Gout patients?

Answer 5

Organ meats
High-fructose corn syrup
Alcohol

Question 6

At what point is drug treatment appropriate in Gout patients?

Answer 6

Symptomatic

UA level > 6mg/dL

Question 7

What drugs are used in the treatment of acute Gout pain?

Answer 7

Colchicine
NSAID
Steroids

Question 8

What are some drugs which can increase the occurrence of Gout attacks?

Answer 8

• Aspirin
• Diuretics (loop and thiazides)
• Niacin
• Pyrazinamide
• Calcineurin inhibitors (tacrolimus and cycloporine)
• Chemo drugs
• Select pancreatic enzyme products

Question 9

Which NSAIDS can be used in the treatment of Gout?

Answer 9

Indomethacin
Naproxen

Sulindac

Question 10

Colchicine sig

Answer 10

Treatment dose:
1.2mg (two 0.6mg tabs) PO followed by 0.6mg (one tab) in 1 hour

max: 1.8mg in one hour or 2.4mg/day

Prophylaxis dose:
0.6mg once or twice daily

Question 11

Which Steroids can be used in the treatment of Gout?

Answer 11

Prednisone

Methylprednisolone

Question 12

What are prophylactic drugs in the treatment of Gout?

Answer 12

Xanthine oxidase inhibitors (XOIs)

• Allopurinol
• Febuxostat

Question 13

Colchicine ADE

Answer 13

Diarrhea
Nausea
Myelosuppression
Myophathy 
Neuropathy

Question 14

True or False: If patient has experienced 1 episode of Gout pain, prophylactic drugs should be started.

Answer 14

True

Question 15

If Xanthine oxidase inhibitors (XOIs) are not tolerated, what other agent can be used for prophylactic treatment of Gout?

Answer 15

Probenecid

Question 16

What drugs should also be used when starting prophylactic treatment of Gout?

Answer 16

Colchicine or NSAID should be used for the first 3 to 6 months due to high rate of gout attack when beginning prophylactic treatment

Question 17

Xanthine oxidase inhibitors (XOIs) warning, ADE

Answer 17

Hypersensitive reaction (rash like SJS/TEN)
Hepatotoxicity 

Nausea

Question 18

How can Tumor Lysis Syndrome can cause an acute Gout attack?

Answer 18

Tumor Lysis Syndrome is an acute, potentially life threatening complication of some types of chemotherapy.
It causes the breakdown of purines and therefore the increase in uric acid.