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PHRM 864 therapeutics > Gout Therapeutics > Flashcards

Gout Therapeutics Flashcards

1
Q

what are the main causes of gout

A

over production of uric acid or underexcretion of uric acid

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2
Q

what can cause overproduction of uric acid

A

Enzyme variability
Cytotoxic medications
Increase dietary intake of purines
chronic alcohol intake

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3
Q

what can cause under excretion of uric acid

A

dehydration
insulin resistance
acute alcohol intake
medications

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4
Q

what are the 3 main meds that lead to gout

A

Diuretics
Cytotoxic drugs
Salicylates

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5
Q

Presentation of acute gout

A

-podagra
-UA deposits elsewhere
-fever
-intense pain
-swelling at joints

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6
Q

what UA level is elevated

A

above 6.8

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7
Q

what are complications of acute gout

A

-Tophi
-Nephrolithiasis
-Nephropathy

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8
Q

What is the general treatment approach for treating gout

A

-treat pain
-use ULT to prevent recurrence
-anti-inflammatory prophylaxis

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9
Q

Non pharm gout treatment

A

modify risk factors
applying ice
no supplements

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10
Q

What are the NSAIDs for gout

A

Indomethacin
Naproxen
Ibuprofen
Sulindac

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11
Q

Tapering for prednisone

A

7-10 days

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12
Q

What is the MOA of colchicine

A

disrupts cytoskeletal functions by inhibiting tubules

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13
Q

when to administer colchicine for acute attack

A

within 24 hours

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14
Q

what is the colchicine dosing

A

Day 1: 1.2mg PO once then 1 hour later
Day 2+: 0.6mg BID until attack resolves

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15
Q

Colchicine AEs

A

Neutropenia
Axonal neuromyopathy

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16
Q

Do you renally adjust colchicine

A

yes

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17
Q

Colchicine dose with CrCl less than 30

A

1.2mg onset, 0.6mg 1 hour later (once)
tx should be repeated no more than once every 2 weeks

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18
Q

Colchicine dose with dialysis

A

single 0.6mg dose
tx should not be repeated more than once every 2 weeks

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19
Q

When should you switch from colchicine

A

less than 50% improvement in pain in 24hrs

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20
Q

What to do with inadequate colchicine response

A

switch agents
add 2nd agent

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21
Q

What is the pill-in-pocket method

A

using abortive agent when gout onset comes on

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22
Q

Diet changes for gout

A

DASH diet
avoid foods with saturated fats and sweetened bevs/food
alcohol restriction
limit high fructose corn syrup and organ meats

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23
Q

when to start ULT

A

more than 2 gout flares/year
tophus
first flare w/ either CKD, uric acid above 9, urolithiasis

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24
Q

who is not a candidate for ULT

A

asymptomatic hyperuricemia
first gout attack w/o risk factors

25
Q

what are risk factors for gout

A

male
post-menopausal
elderly
obesity
diet & alc intake
sedentary
renal impairments

26
Q

when to initiate ULT

A

wait 2 weeks after acute attack

27
Q

how long should ULT last

A

life long

28
Q

what UA level should you target for ULT

A

less than 6

29
Q

what is first line for ULT

A

Allopurinol and Febuxostat

30
Q

what is the initial dose of allopurinol

A

100mg PO daily

31
Q

how to titrate allopurinol

A

every 2-4 weeks in 100 mg increments

32
Q

what is the max dose of allopurinol

A

800mg/day

33
Q

what is the initial dose of Febuxostat

A

40mg daily

34
Q

how to titrate febuxostat

A

titrate to 80mg daily

35
Q

max dose of febuxostat

A

max dose 120mg/day

36
Q

should you renally adjust allopurinol

A

yes

37
Q

allopurinol dose eGFR less than 60

A

initial dose 5mg
titrate slowly

38
Q

what are the DDIs with allopurinol

A

loop and thiazide diuretics
warfarin

39
Q

what is the severe reaction to allopurinol

A

SJS and TEN

40
Q

what gene should be tested for allopurinol

A

HLA-B*5801

41
Q

main counseling for allopurinol

A

take this med even when you do not have gout symptoms

42
Q

what is second line ULT

A

Probenecid

43
Q

Probenecid initial dose

A

250mg PO BID x1-2 weeks up to 500mg BID

44
Q

Probenecid titration

A

Titrate by 500mg increments every 1-2 weeks

45
Q

Probenecid max dose

A

2g/day

46
Q

Probenecid ADR

A

Urolithiasis

47
Q

what should you consider before probenecid

A

G6PD deficiency
not recommended in eGFR less than 60

48
Q

what DDIs are there for probenecid

A

antibiotics

49
Q

what is 3rd line for ULT

A

Pegloticase

50
Q

when to use Pegloticase

A

used in severe gout and hyperuricemia
patients not responsive to subcutaneous tophi

51
Q

what formulation is pegloticase

A

IV infusion

52
Q

what is the dose of pegloticase

A

8mg IV every 2 weeks

53
Q

Pegloticase pearls

A

patients may develop antibodies

54
Q

When to start gout prophylaxis

A

initiating ULT

55
Q

what is the duration of gout attack prophylaxis

A

first 3-6 months of ULT initiation

56
Q

what agents can be used for gout prophylaxis

A

NSAIDs
Prednisone
Colchicine

57
Q

Colchicine prophylactic dose

A

0.6mg once or twice daily

58
Q

prophylactic colchicine dose with CrCl less than 30

A

0.3mg daily

59
Q

prophylactic colchicine dose on dialysis

A

0.3mg twice weekly

PHRM 864 therapeutics (16 decks)

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