Gout and Hypeurecemia

Question 1

Uric acid has no known physiological purpose?

Answer 1

TRUE

Question 2

Uric acid is the degradation of what nucleic acid type?

Answer 2

purines

Question 3

T/F Humans express uricase which allows metabolism of uric acid into a less harmful substance

Answer 3

False

Question 4

What is the water soluble form of uric acid?

Answer 4

allantoin

Question 5

Drugs active in gout block what process?

Answer 5

stop phagcytosis of uric acid particles

block mediator release/inflammation induced by PMN

Question 6

T/F 90% of people with gout are underexcreters?

Answer 6

TRUE
2/3 eliminated by urine
1/3 eliminated by GI

Question 7

T/F asymptomatic tx for hyperurecemia may not require tx?

Answer 7

TRUE

Question 8

How do you dx gout?

Answer 8

Tap on joint

examine uric acid crystals in lab

Question 9

T/F During an attack uric acid crystal levels fall?

Answer 9

TRUE

Question 10

Differentiate Acute Gout vs Chronic Gout?

Answer 10

Acute:

• 3-10 days
• attack of inflammation
• most common to occur at LE joint for 1st episode
• affects first MTP -podagra aka foot pain

Chronic:

• rheumatoid like
• Tophaceous gout

Question 11

What should you initiate before starting urate lowring medication and why??

Answer 11

Anti-inflammatory: NSAID, colchicine, because if you don’t you can cause an acute attack

Question 12

Which drugs are used to treat acute gout?

Answer 12

Corticosteroids : triamcinolone (IM), methylprednisone (Iv), prednisone (oral)
Colchicine 
NSAIDS
Indomethicin 
Naproxen 
Ibuprofen 
Celecoxib

Question 13

What is prophylactic tx for gout?

Answer 13

NSAID

colchicine

Question 14

What is tx for chronic gout?

Answer 14

allopurinol
febuxostat
probenecid
pegloticase

Question 15

What is the target level or uric acid with chronic tx?

Answer 15

uric acid <6 mg/dL

Question 16

How long should you tx acute gout after an attack?

Answer 16

Continue tx for 5-8 days after initial onset

Question 17

What is MOA of colchicine?

Answer 17

blocks B4 leukotriene-decreasing inflammation

decreases macrophage migration and phagocytosis

Question 18

What is Clinical application of colchicine?

Answer 18

treats gout attack if attack within 36 hrs

prophylaxis

Question 19

What is the unique dosage associated with colchicine prophylaxis?

Answer 19

1.2 mg for initial dose, followed by 0.6mg 1 hr later and begin 0.6 mg of colchicine BID on day 2 for thenext 4-7 days

Question 20

Who should use oral glucocorticoids for acute gout?

Answer 20

people on anti-coagulants who cannot take NSAIDS

DONT TAKE IF DM, recent or current infection,

Question 21

Who should not use NSAIDS?

Answer 21

elderly, people who have GI bleed risk, NSAID allergy, low eGFR

Question 22

Who should avoid corticosteroid injection?

Answer 22

suspected joint infection

2 or more joints affected

Question 23

What are ADE of colchicine?

Answer 23

GI, diarrhea, nausea, vomiting

Question 24

What are drug interactions with colchicine?

Answer 24

CYP3A4 and P-glycoprotein inhibitors

Question 25

What corticosteroids can be given for acute gout?

Answer 25

methylprednisolone pack triamcinolone IM-must be given followed with oral prednisolone intra-articular (TAC-kenalog): must be used in combo with NSAID, colchicine, or oral steroid

Question 26

What are ADE of steroids?

Answer 26

- adrenal suppression - muscle wasting - mood changes - growth inhibition

Question 27

What is MOA of XOI?

Answer 27

blocks xanthine oxidase to stop the conversion of hypoxanthine or xanthine into uric acid

Question 28

What is the clinical use of XOI?

Answer 28

``` when >2 gout attacks per year presence of multiple tophus CKD hx of urolithiasis used in both underexcretes or over producers of uric acid ```

Question 29

What is 1st line XOI?

Answer 29

Allopurinol

Question 30

Mechanism of allopurinols?

Answer 30

irreversibly inhibits xanthine oxidase

Question 31

What is clinical use of allopurinol?

Answer 31

chronic gout

Question 32

What are ADE of allopurinol?

Answer 32

AHS/Acute Hypersensitivity syndrome: like DRESS syndrome | -consider genetic testing in Asian or Koreans with CKD, or Thai or HAN chinese

Question 33

T/F Febuxostat is reversible in binding xanthine oxidase

Answer 33

TRUE

Question 34

What is ADE of Febuxostat?

Answer 34

elevated liver enzymes

Question 35

T/F No dose adjustment necessary in those with mild to moderate renal impairment?

Answer 35

TRUE

Question 36

what is MOA of probenecid?

Answer 36

helps excrete uric acid | take with alot of water

Question 37

When do you not use probenecid?

Answer 37

with hx of urolithiasis or CC< 50

Question 38

T/F XOI and fenofibrate or losartan help with increased uric acid excretion

Answer 38

TRUE

Question 39

What is MOA of pegloticase?

Answer 39

recombinant porcine like uricase that converts uric acid into allantoin

Question 40

What is clinical use of pegloticase?

Answer 40

refractory gout

Question 41

What is MOA of Lesinurad?

Answer 41

blocks 1-URAT-1 to stop the reabsorption of uric acid in the kidneys

Question 42

T/F Lesinurad must be taken with XOI due to risk of kidney injury with monotherapy

Answer 42

TRUE

Question 43

What is clinical use of Lesinurad?

Answer 43

refractory hyperurecemia in gout

Question 44

What is alternative therapy for gout?

Answer 44

Drugs targeting IL-1 | Anakinra, Canakinumab

Question 45

What is clinical use of IL-1 inhibitor therapy

Answer 45

off-label tx for refractory acute gout

Question 46

Which drugs can icrease uric aicd?

Answer 46

``` Diuretics-HCTZ Nicotinic acid salicylates ethanol pyrazinamide ethambutol cytotoxic drugs cyclosporine Levydopa ```