Gout, Osteo, RA

Question 1

Gout

Answer 1

Recurrent inflammatory disorder
- seen mainly in men

Hyperuricemia
- greater than 7 men
Greater than 6 women

Joint pain ( large toe)

Question 2

Gout- drug therapy - overview

Answer 2

Short term, attack, ( fewer than 3/ times a year)

• NSAIDS
• glucocorticoid

Long term
- uricosuric drugs

Question 3

Gout- risk factors

Answer 3

HTN, obesity, alcoholism, high purine diet, ASA, TD

Question 4

Gout can lead to diseases…

Answer 4

Metabolic syndrome, insulin resist, HTN, Kidney stones, CVA

Question 5

Acute Gouty arthritis

Answer 5

NSAIDs

If at risk for GI bleed Cox-2

Corticosteroids

Colchicine

Question 6

NSAID - gout

Answer 6

Relief starts within 24 hours

Indocin, Naprosyn, Voltaren

Question 7

Colchicine

Answer 7

Anti-inflammatory agent ( not first line)

Reserved for pt who are unresponsive or intolerant to other agents

Uses:
Treats acute gouty attack
Reduces incidences of attack
Aborts an impending attack

Black box warning : high renal toxicity

Question 8

Gout attack prevention

Answer 8

Start with non-pharmacological management

Preventative meds not initiated during acute phase

Question 9

Drug therapy for hyperuricemia ( goals)

Answer 9

Promote dissolution of irate crystals
Prevent new crystal formation
Prevent disease progression
Reduce freq of attacks 
Improve QOL 

These drugs are not useful for acute gouty attacks

Question 10

Drugs for therapy for hyperuricemia

Answer 10

Allopurinol, Febuxostat, Probenecid, Pegloticase

Question 11

Allopurinol

Answer 11

Keys: start low and go slow - can trigger attack when first introduced

Check kidney function and LFT’s before and during therapy

Question 12

Febuxostat (Uloric)

Answer 12

Reduces blood levels of úrico acid

Question 13

Pegloticase ( Krystexxa)

Answer 13

Last effort

IV therapy of chronic gout

Question 14

Bisphosphonates ( foamax)

Answer 14

Inhibit the activity of osteoclasts and indirectly increases bone mineral density

Long term use = jaw necrosis, spontaneous long one fracture

Only good for 5 years

Admin: take 30-60 min before eating or drinking, take med with 8 ounces of plain water, do not lie down for 30 min after taking med

Question 15

SERM

Answer 15

Raloxifene ( Evista)

Reduces reabsorption of bone , reduces breast cancer risk, LDL reduction

Question 16

Drug goals for RA

Answer 16

Relieve symptoms, maintain joint function, minimize systemic involvement , delay progression of disease

Question 17

NSAIDs for RA

Answer 17

COX-1 and COX-2

Question 18

Glucocorticoid - RA

Answer 18

Generalized symptoms - oral glucocorticoids

One or two joints - intra-articular injections

Question 19

DMARD’s I : Major nonbiologic DMARDs

Answer 19

Methotrexate - rapid acting ( 3-6 weeks) watch out for active infection

Question 20

DMARDs II: major biologic DMARDs

Answer 20

Tumor necrosis factor ( TNF) inhibitors
- suppress immune function

Ex. Humira, remicade, Simponi,

Question 21

Non pharm for RA

Answer 21

PT, OT, articular rest, excerise, weight loss, heat and cold packs

Do not over heat a hot joint

Question 22

Pharm therapy RA ( list)

Answer 22

Conventional DMARD = 1 st line
Acetaminophen - mild pain
COX - 2 = moderate to severe pain
Low dose oral - supplementation with calcium and Vit D
Biological DMARD treatment ; watch out for adverse effects