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Nurs 5229 Clinical Pharmacotherapeutics > Gout > Flashcards

Gout Flashcards

1
Q

Gout characterized by

A

Characterized biochemically by extracellular fluid urate saturation
Hyperuricemia – serum > 6.8 mg/DL

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2
Q

Gout is not just a

A

Not just a bone and joint issue

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3
Q

gout can cause

A 
Increased hypertension (HTN) and cardiovascular (CV) risks associated with higher uric acid level
Dietary Approaches to Stop Hypertension (DASH) diet not only helps in heart disease but also gout
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4
Q

old gout diets ar

A

Old gout diets not supported by evidence

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5
Q

gout what is key

A

Fluid intake is key

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6
Q

Gout managment

A

Acute management of gout flare-ups
Systemic and intra-articualar glucocorticoids, NSAIDs, and colchicine
Prevention of re-current gout flares and damage to joints and other tissues
Urate-lower drugs

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7
Q

Gout - drug examples

A

Colchicine and Probenecid, pegloticase, and lesinurad impact uric acid excretion (probenecid) or change it into inert substances

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8
Q

Colchicine does not

A

Does not impact purine metabolism

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9
Q

Colchicine major issue

A

Major issue of impacting granulocytes, but this does reduce deposits of uric formation

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10
Q

Colchicine is

A

Is pain med, but not an analgesic

Is anti-inflammatory

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11
Q

Colchicine mostly used

A

used as prophylactic or during acute attack

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12
Q

Probenecid, pegloticase, and lesinurad impact uric acid excretion (probenecid) or change it into inert substances
Deposits are

A

reduced and deposition retarded

NOT monotherapy drugs

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13
Q

Xanthine Oxidase - Uses on

A

Uses on patients with gout
To inhibit inflammation
Prevent synthesis of uric acid
Must not disrupt the biosynthesis of vital purines

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14
Q

Xanthine Oxidase do not need

A

for inflammatory agents (indocin) and steroids (in advanced renal disease)

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15
Q

Gout meds not used

A

in pregnancy except for probenecid

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16
Q

Gout Meds not used in childern except

A

children except for uricemia of malignancy

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17
Q

Uric acid crystals when

A

crystals when mobilized can precipitate renal stones

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18
Q

Gastrointestinal (GI) disturbances

A

Gastrointestinal (GI) disturbances abound, and peptic ulcers can occur

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19
Q

Probenecid is

A

Probenecid is sulfa based

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20
Q

Allopurinol causes

A

causes hypersensitivity rash (higher in blacks and Hispanics)

21
Q

Colchicine results in

A

Colchicine results in myopathy, weakness, neuropathy and malabsorption of B12

22
Q

Uric acid more toxic

A

Uric acid more toxic in older adults
Probenecid is drug of choice
Allopurinal can be used for renal impairment
More likely toxic when combined with thiazides

23
Q

Off-label use of chochicine in

A

pericarditis and sclerodema (seek consultation)

24
Q

Bone loss occurs when there is imbalance

A

between osteoblast and osteoclast activities.

25
Q

Osteoporosis is diagnosed when bone density is

A

2.5 standard deviations below average.

26
Q

Bone is histologically and biochemically

A

normal

27
Q

Osteoporosis risk for

A

fractures, especially at areas of stress, increases.

28
Q

Osteoporosis Risk Factors

A 
Family history, 
Age greater than 70 years 
Slight build 
Fair complexion 
Low calcium and/or vitamin D diet 
Minimal sun exposure 
Weight less than 70 kg 
Sedentary lifestyle
29
Q

osteoprosis risk factors continueed

A

Glucocorticoid use greater than 5 mg/day for longer than 3 months
Anticonvulsants (phenobarbitol, phenytoin, carbamazepine)
Long-term proton pump inhibitor
Heavy tobacco or alcohol use
Aromatase inhibitors
Young African American women have higher bone density, but risk increases with age.
Traditionally have lower calcium intake
Asian women are at high risk.
Traditionally consume inadequate calcium
Hispanic women have similar risk as white women

30
Q

Pharmacodynamics - Estrogen prevents

A

bone resorption action of PTH.

31
Q

bone resorption action of PTH.

A

Have estrogenic effects on bone

Raloxifene (Evista)

32
Q

Bisphosphonates reduce bone

A

resorption by inhibiting osteoclast activity.

33
Q

Calcium and vitamin D together

A

not individually) prevent and treat osteoporosis.

34
Q

Osteoperosis what is the best treatment

A

Prevention is the best treatment.
Adequate calcium intake with vitamin D
Low-impact bone-strengthening exercise (not swimming)

35
Q

osteoprosis no evidence of

A

optimal time of duration
Some molecules have 10-year half-life!
Starting medications in osteopenia status no longer considered good practice for most patients
This may vary with oncology patients on aromatase inhibitors

36
Q

Estrogen - low

A

Low-dose therapy maintains bone mineral density (BMD)

37
Q

calcium combination of

A

Combination of diet and calcium supplement to meet daily requirement
Vitamin D required to enhance absorption

38
Q

bisphonates no

A

longer used for preventative therapy!

First-line therapy for postmenopausal women with osteoporosis
First-line therapy for men older than age 70 years with osteoporosis

39
Q

Selective estrogen receptor modulators (SERMs):

A

Reloxifene (Evista) is prototype, newer agents available

Also protective against breast cancer

40
Q

Teriparatide (human PTH)

A

Reserved for highest-risk patients who cannot take bisphosphonates or do not respond to them
Questionable cancer risk

41
Q

Denosumab: expensive

A

All the risks of other biologicals

42
Q

Before treatment, rule out other disorders that may cause further low bone density. such as

A

Hyperparathyroidsim
Vitamin D deficiency
Hyperthyroidism
Renal disease

43
Q

Measure BMD

loss and gold standard

A

Measure BMD

44
Q

DEXA Screening sholuld be used for

A

Women who are long-term estrogen deficient

Women and men with vertebral abnormalities

Monitoring treatment of osteoporosis

No firm guideline for how often to do so

Patients on long-term glucocorticoid or thyroid therapy

Patients with diseases that have the risk of osteoporosis development

Women older than age 40 years who have a fracture

45
Q

dexa screening all women older than

A

65 for baseline evaluation

46
Q

Additional considerations

for Dexa

A

Body weight less than 127 lb or body mass index (BMI) of 20 or less
Current smoker
Surgical menopause at age less than 40 years
Amenorrhea for more than a year in premenopausal female
Immobility for over 1 year

47
Q

Osteopenia begins

A

Osteopenia 2 to 5 years after menopause if no HRT/estrogen therapy
No evidence for how fast or IF patient will progress to osteoporosis

48
Q

Consider referral for

A

complex cases or those who do not respond to therapy

Nurs 5229 Clinical Pharmacotherapeutics (78 decks)

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