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NAPLEX Review > Gout > Flashcards

Gout Flashcards

1
Q

True or False

Gout is a type of arthritis

A

True

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2
Q

What is uric acid an end-product?

A

Purine emtabolism

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3
Q

What is normal UA level?

A

2-6.5 - females

3.5-7.2 - males

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4
Q

Risk factors for gout

A 
Male
Obesity
Excessive alcohol consumption (esp beer)
HTN
CKD
Lead intoxication
Advanced age
Use of medications that increase UA
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5
Q

What foods should be avoided in gout?

A

Organ meats
High-fructose corn syrup
Alcohol

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6
Q

How to treat asymptomatic hyperuricemia?

A

Changes in diet

NOT medication

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7
Q

What medications are used for acute gout attacks?

A

Colchicine
NSAIDs
Steroids

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8
Q

What is the UA goal after a gout attack to prevent future attacks?

A

<6

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9
Q

What drugs increase UA?

A 
ASA
Calcineurin inhibitors (tacrolimus and cyclosporine)
Diuretics (loops and thiazide)
Niacin
Pyrazinamide
Select chemo (tumor lysis syndrome)
Select pancreatic enzyme products
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10
Q

What medications are used prophylactically to prevent gout attacks?

A

Xanthine oxidase inhibitors (Febuxostat, allopurinol)
Uricosuric (Probenecid, lesinurad)
Recombinant uricase (Pegloticase)

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11
Q

Colchicine CI, warnings, SE, and notes

A

CI: P-gp or strong CYP3A4 inhibitor
Wanings: myelosuppression, GI symptoms, neuromuscular toxicity
SE: Diarrhea, nausea, myelosuppression, myopathy, neuropathy
Notes: start within 36 hours of symptom onset, wait 12 hours after treatment dose before resuming prophylaxis dosing

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12
Q

What NSAIDs are used for gout?

A

Indomethacin (Indocin)
Naproxen (Aleve)
Celecoxib (Celebrex)

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13
Q

What steroids are used for gout?

A

Prednisone/prednisolone

Methylprednisolone

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14
Q

What to do if xanthine oxidase inhibitor doesn’t work and UA remains > 6

A

Add on probenecid or lesinurad to daily XOI OR

Replace XOI with IV pegloticase (Krystexxa)

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15
Q

When should chronic prophylactic gout treatment be initiated?

A

after gout attack, in patients who have intermittent symptoms, or have tophi

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16
Q

What genetic mutations puts patients at a high risk of allopurinol hypersensitivity reaction

A

HLA-B*5801 allele

17
Q

Probenecid MOA

A

inhibits reabsorption of UA in proximal tubule, increasing UA excretion

18
Q

Pegloticase MOA

A

converts UA to an inactive metabolite that can be easily excreted

19
Q

When to use febuxostat for gout?

A

in patients who do not tolerate allopurinol or if allopurinol is not effective

20
Q

Allopurinol and febuxostat MOA

A

decreases uric acid production

21
Q

Allopurinol warnings, SE, notes

A

Warnings: hypersensitivity reactions, including severe rash, HLA-B*5801 testing prior to use and do not use if positive, hepatotoxicity
SE: rash, acute gout attacks, nausea
Note: use with colchicine or NSAID for first 3-6 months d/t high rate of out attacks when begging ULT

22
Q

Febuxostat BBW, warnings, notes

A

BBW: Increased risk of CV death compared to allopurinol, only use in those who cannot tolerate allopurinol
Warnings: hepatotoxicity, increased risk of thromboembolic events, serious skin reactions
Note: use with colchicine or NSAID for first 3-6 months d/t high rate of out attacks when begging ULT

23
Q

Pegloticase BBW, CI, and notes

A

BBW: anaphylaxis (monitor and premedicate with antihistamines and steroids)
CI: G6PD deficiency
Notes: do not use with allopurinol, febuxostat, or probenecid (increased risk of anaphylaxis)

24
Q

What medications should not be used with allopurinol

A

Mercaptopurine, azathioprine, and didanosine - Increased concentration with allopurinol or febuxostat use
Antacids decrease allopurinol absorption

25
Q

What is probenecid used to increase the concentration of when treating patients?

A

Beta lactam abx

26
Q

What urate oxidase enzyme is used to treat tumor lysis syndrome?

A

Rasburicase (Elitek)

27
Q

Colchicine dosing

A

At first sign of attack, take 2 tablets then one more in an hour
Do not exceed 3 tablets in 1 hour or 4 tablets in 48 hours

NAPLEX Review (79 decks)

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