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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?

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
What is the primary use of Uloric?
1. Allopurinol hypersensitivity, intolerance, or failure 2. Uricosurics not indicated or failed 3. Renal dysfunction
26
Uricosurics are preferred for what?
Underexcretion
27
When should uricosurics be avoided?
Nephrolithiasis
28
What is a uricosuric drug that inhibits the reabsorption of urate and low dose ASA inhibits its effects?
Probenecid
29
What is the MOA of Urate Oxidases?
Convert uric acid to allantoin
30
What are the possible effects of Urate Oxidases?
1. Gout flare 2. Potential antigenicity 3. Declining efficacy 4. Anaphylaxis
31
What is the CI for Urate Oxidases?
G6PD Deficiency
32
What drug is an Urate Oxidase?
Pegloticase
33
How do you spell the brand name of Pegloticase?
Krystexxa
34
When should you use Pegloticase?
For patients with refractory chronic gout
35
What is the Gout Management ACR 2020 Guideline?
1. Topical Ice 2. Monotherapy with NSAID or Systemic Steroid or Low Dose Colcry 2. If NPO, IA Steroid or IV Methylprednisolone All of these over ACTH or IL-1 Inhibitor 3. If ineffective or CI recommend IL-1 Inhibitor
36
If severe pain or polyarticular gout, can consider what?
1. Colcry + NSAID 2. Steroid + Colcry 3. IA Steroid + Other Med NOT NSAID + Steroid = GI Effects
37
What can increase Pseudogout?
Bisphosphonate or Loop Diuretic
38
What can be used for prevention of Pseudogout?
Magnesium and Probenecid
39
What are the goals of Gout Prophylaxis?
1. Prevent recurrent attacks 2. Prevent complications or urate deposition 3. Target uric acid is <6
40
What can you used for Gout Prophylaxis?
1. Non-Drug Treatment 2. Colcrys 3. Low dose NSAID 4. Low dose prednisone 5. Allopurinol 6. Uricosurics
41
What should you monitor in Colcrys Prophylaxis?
CBC and CK
42
What are the Nondrug Treatment ACR 2020 Guideline recommendations?
1. Limit alcohol, purine intake, high-fructose corn syrup 2. If overweight/obese, lose weight 3. Recommend AGAINST adding vitamin C
43
What are dietary recommendations for gout?
Avoid high purine foods: meat, seafood, beer
44
What is Rasburicase/Elitek approved for?
Hyperuricemia associated with malignancy (tumor lysis syndrome)
45
When should you initiate urate-lowering therapy ULT?
If >t tophi: radiographic damage: >2 flares/y
46
What is the choice of initial ULT?
1. Allopurinol, even if CKD stage >3 (or Uloric if CI) 2. XOI over probenecid if CKD stage >3
47
With initial ULT, start anti-inflammatory prophylaxis
1. Colcrys, NSAID, Prednisone choice based on patient factors Keep on for 3-6 months
48
Do not use what as 1st line for initial ULT?
Pegloticase
49
For all taking ULT, what is the target?
<6 mg/dL
50
If you have a history of CVD or new CV event, use alternative medication instead of what?
Febuxostat
51
In uricosurics, you do NOT need to do what?
1. Do NOT check urinary A before starting 2. Do NOT alkalinize urine
52
If not at target and frequent flares or unresolving tophi, switch to what instead of continuing current ULT?
Pegloticase
53
If not at target but <2 flares/y and no tophi, do NOT switch to what?
Pegloticase
54
What are drugs that induce hyperuricemia?
1. Diuretics 2. Cyclosporine 3. Low Dose Salicylate

GI/Rheumatology Module (18 decks)

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