Gout Flashcards
True or False
Gout is a type of arthritis
True
What is uric acid an end-product?
Purine emtabolism
What is normal UA level?
2-6.5 - females
3.5-7.2 - males
Risk factors for gout
Male Obesity Excessive alcohol consumption (esp beer) HTN CKD Lead intoxication Advanced age Use of medications that increase UA
What foods should be avoided in gout?
Organ meats
High-fructose corn syrup
Alcohol
How to treat asymptomatic hyperuricemia?
Changes in diet
NOT medication
What medications are used for acute gout attacks?
Colchicine
NSAIDs
Steroids
What is the UA goal after a gout attack to prevent future attacks?
<6
What drugs increase UA?
ASA Calcineurin inhibitors (tacrolimus and cyclosporine) Diuretics (loops and thiazide) Niacin Pyrazinamide Select chemo (tumor lysis syndrome) Select pancreatic enzyme products
What medications are used prophylactically to prevent gout attacks?
Xanthine oxidase inhibitors (Febuxostat, allopurinol)
Uricosuric (Probenecid, lesinurad)
Recombinant uricase (Pegloticase)
Colchicine CI, warnings, SE, and notes
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
What NSAIDs are used for gout?
Indomethacin (Indocin)
Naproxen (Aleve)
Celecoxib (Celebrex)
What steroids are used for gout?
Prednisone/prednisolone
Methylprednisolone
What to do if xanthine oxidase inhibitor doesn’t work and UA remains > 6
Add on probenecid or lesinurad to daily XOI OR
Replace XOI with IV pegloticase (Krystexxa)
When should chronic prophylactic gout treatment be initiated?
after gout attack, in patients who have intermittent symptoms, or have tophi
What genetic mutations puts patients at a high risk of allopurinol hypersensitivity reaction
HLA-B*5801 allele
Probenecid MOA
inhibits reabsorption of UA in proximal tubule, increasing UA excretion
Pegloticase MOA
converts UA to an inactive metabolite that can be easily excreted
When to use febuxostat for gout?
in patients who do not tolerate allopurinol or if allopurinol is not effective
Allopurinol and febuxostat MOA
decreases uric acid production
Allopurinol warnings, SE, notes
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
Febuxostat BBW, warnings, notes
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
Pegloticase BBW, CI, and notes
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)
What medications should not be used with allopurinol
Mercaptopurine, azathioprine, and didanosine - Increased concentration with allopurinol or febuxostat use
Antacids decrease allopurinol absorption
