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GI/Rheumatology Module > Gout Treatment > Flashcards

Gout Treatment Flashcards

1
Q

What are the goals of Gout Treatment?

A
  1. Relieve Pain
  2. Relieve Inflammation
  3. NOT decrease uric acid
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2
Q

How do you spell the brand name of Colchicine?

A

Colcrys

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3
Q

What is the MOA of Colcrys?

A

Inhibits neutrophil function and inflammatory response to urate crystals

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4
Q

What is the main side effect of Colcrys?

A

GI Effects >80% at full high dose

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5
Q

What are the Colcrys Cautiions of the 2020 ACR Guidelines?

A
  1. Only use colchicine if within 36 hrs of attack onset
  2. No further colchicine for >14 days if CrCl <30 or severe hepatic impairment
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6
Q

What are the Colcrys interactions?

A
  1. Macrolides
  2. Cyclosporine
  3. Grapefruit Juice
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7
Q

What are other side effects of Colcrys?

A
  1. Myopathy
  2. Bone Marrow Depression
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8
Q

What are the cautions for NSAID use for Gout?

A
  1. Renal failure
  2. Ulcer disease
  3. HTN
  4. CHF
  5. Liver disease
  6. With anticoagulants
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9
Q

What are the FDA Approved NSAIDs for Gout (effective)?

A
  1. Indomethacin
  2. Naproxen
  3. Sulindac
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10
Q

Are salicylate and COX-2 inhibitors recommended for gout treatment?

A

NO, not effective

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11
Q

When are corticosteroids used for Gout treatment?

A

Effective but reserved for:
1. Resistant cases
2. Other drugs contraindicated

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12
Q

What is the concern with Corticosteroids?

A

Exacerbate tophaceous disease

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13
Q

Corticosteroids can be given with Colcrys but not with what?

A

NSAIDs

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14
Q

What are the corticosteroid options that can be used in Gout?

A
  1. Oral Prednisone tapered
  2. ACTH tapered
  3. Intra-articular injections
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15
Q

What are the alternative therapy options for gout? Interleukin-1B?

A
  1. Anakinra
  2. Canakinumab
  3. Rilonacept
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16
Q

How do you spell the brand name of Allopurinol?

A

Zyloprim

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17
Q

What is the MOA of Allopurinol?

A

Xanthine Oxidase Inhibitors XOI

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18
Q

What are the side effects to be aware of for Allopurinol?

A

Skin Rash

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19
Q

What increases the risk of hypersensitivity with Allopurinol?

A
  1. Higher initial dose
  2. Chronic kidney disease
  3. Concomitant thiazides
  4. HLA-B*5801
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20
Q

What is the drug interaction for Allopurinol?

A

Inhibits breakdown of azathioprine and mercaptopurine, cut dose 25% if used with allopurinol

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21
Q

Allopurinol should be avoided when used with what?

A
  1. Didanosine
  2. Theophylline
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22
Q

How to spell Febuxostat brand name?

A

Uloric

23
Q

What is the MOA for Uloric?

A

Selective Xanthine Oxidase Inhibitor

24
Q

When should you avoid the use of Uloric?

A
  1. Azathioprine
  2. Mercaptopurine
  3. Didanosine
  4. Theophylline
25
Q

What is the primary use of Uloric?

A
  1. Allopurinol hypersensitivity, intolerance, or failure
  2. Uricosurics not indicated or failed
  3. Renal dysfunction
26
Q

Uricosurics are preferred for what?

A

Underexcretion

27
Q

When should uricosurics be avoided?

A

Nephrolithiasis

28
Q

What is a uricosuric drug that inhibits the reabsorption of urate and low dose ASA inhibits its effects?

A

Probenecid

29
Q

What is the MOA of Urate Oxidases?

A

Convert uric acid to allantoin

30
Q

What are the possible effects of Urate Oxidases?

A
  1. Gout flare
  2. Potential antigenicity
  3. Declining efficacy
  4. Anaphylaxis
31
Q

What is the CI for Urate Oxidases?

A

G6PD Deficiency

32
Q

What drug is an Urate Oxidase?

A

Pegloticase

33
Q

How do you spell the brand name of Pegloticase?

A

Krystexxa

34
Q

When should you use Pegloticase?

A

For patients with refractory chronic gout

35
Q

What is the Gout Management ACR 2020 Guideline?

A
  1. Topical Ice
  2. Monotherapy with NSAID or Systemic Steroid or Low Dose Colcry
  3. If NPO, IA Steroid or IV Methylprednisolone
    All of these over ACTH or IL-1 Inhibitor
  4. If ineffective or CI recommend IL-1 Inhibitor
36
Q

If severe pain or polyarticular gout, can consider what?

A
  1. Colcry + NSAID
  2. Steroid + Colcry
  3. IA Steroid + Other Med

NOT NSAID + Steroid = GI Effects

37
Q

What can increase Pseudogout?

A

Bisphosphonate or Loop Diuretic

38
Q

What can be used for prevention of Pseudogout?

A

Magnesium and Probenecid

39
Q

What are the goals of Gout Prophylaxis?

A
  1. Prevent recurrent attacks
  2. Prevent complications or urate deposition
  3. Target uric acid is <6
40
Q

What can you used for Gout Prophylaxis?

A
  1. Non-Drug Treatment
  2. Colcrys
  3. Low dose NSAID
  4. Low dose prednisone
  5. Allopurinol
  6. Uricosurics
41
Q

What should you monitor in Colcrys Prophylaxis?

A

CBC and CK

42
Q

What are the Nondrug Treatment ACR 2020 Guideline recommendations?

A
  1. Limit alcohol, purine intake, high-fructose corn syrup
  2. If overweight/obese, lose weight
  3. Recommend AGAINST adding vitamin C
43
Q

What are dietary recommendations for gout?

A

Avoid high purine foods: meat, seafood, beer

44
Q

What is Rasburicase/Elitek approved for?

A

Hyperuricemia associated with malignancy (tumor lysis syndrome)

45
Q

When should you initiate urate-lowering therapy ULT?

A

If >t tophi: radiographic damage: >2 flares/y

46
Q

What is the choice of initial ULT?

A
  1. Allopurinol, even if CKD stage >3 (or Uloric if CI)
  2. XOI over probenecid if CKD stage >3
47
Q

With initial ULT, start anti-inflammatory prophylaxis

A
  1. Colcrys, NSAID, Prednisone
    choice based on patient factors
    Keep on for 3-6 months
48
Q

Do not use what as 1st line for initial ULT?

A

Pegloticase

49
Q

For all taking ULT, what is the target?

A

<6 mg/dL

50
Q

If you have a history of CVD or new CV event, use alternative medication instead of what?

A

Febuxostat

51
Q

In uricosurics, you do NOT need to do what?

A
  1. Do NOT check urinary A before starting
  2. Do NOT alkalinize urine
52
Q

If not at target and frequent flares or unresolving tophi, switch to what instead of continuing current ULT?

A

Pegloticase

53
Q

If not at target but <2 flares/y and no tophi, do NOT switch to what?

A

Pegloticase

54
Q

What are drugs that induce hyperuricemia?

A
  1. Diuretics
  2. Cyclosporine
  3. Low Dose Salicylate

GI/Rheumatology Module (18 decks)

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