Gout and Hyperuricemia Flashcards
what is the primary cause of gout?
uric acid builds up due to overproduction or underexcretion
what drugs decrease renal uric acid clearance which increases risk of gout?
diuretics, nicotinic acid, salicylates, ethanol, pyrazinamide, levodopa, ethambutol, cyclosporine, and cytotoxic drugs
how can acute uric acid nephropathy occur?
blocks urine flow due to uric acid crystals
what does a gout flare-up look like? where does it commonly occur? what time of day do they typically start? How long does it normally last?
rapid onset of excruciating pain, swelling, and inflammation. most commonly affects the ball of the foot, can also occur in ankles, heels, knees, wrists, fingers, and elbows. They usually begin at night. Fever is common. Untreated lasts 3-14 days before spontaneous recovery
what are common reasons a gout attack can occur?
stress, trauma, alcohol, infection, and surgery
how is gout diagnosed?
examination of synovial fluid, or based on presence of characteristic signs and symptoms as well as response to treatment
best non-pharm tx for gout?
best pharm tx?
ice
NSAIDs, corticosteroids, or colchicine
which NSAIDs are FDA approved for gout?
indomethacin, naproxen, and sulindac
Counseling points for colchicine/colcrys:
can cause N/V/diarrhea. use with caution in pts w/ impaired kidney or hepatic function
nonpharm therapy for hyperuricemia in gout
-promote weight loss
-alcohol restriction
-limiting high-fructose corn syrup
describe the MoA of Xanthine Oxidase Inhibitors such as Allopurinol
reduce uric acid by preventing conversion of hypoxanthine to xanthine and xanthine to uric acid to prevent long-term recurrent gout attacks
what is the starting/dosing guidelines for allopurinol?
100mg qd titrated every 2-5 wks up to max of 800mg qd
what are the counseling points for allopurinol?
maybe some GI upset, takes several months for full efficacy
what is the starting/dosing guidelines for febuxostat?
40mg qd. up to 80mg qd after 2 wks of therapy.
what are the SEs of febuxostat?
nausea, arthralgias, increased CV mortality compared to allopurinol (second-line to allopurinol)
