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cdm 2 exam 2 > Lecture 7.1 - Gout 2 > Flashcards

Lecture 7.1 - Gout 2 Flashcards

1
Q

Allopurinol Hypersensitivity Syndrome Manifestation

A

Rash, chills, fever, leukopenia, leukocytosis, eosinophilia, and pruritus

Maybe severe and fatal ( hepatotoxicity, vasculitis, SJS and TEN)

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2
Q

AHS prevention

A

HLA-B*5801 screening

only in high risk, and those who are positive we won’t use allopurinol

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3
Q

AHS management

A

Discontinue allopurinol at 1st sign of rash

Supportive care

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4
Q

AHS mortality rate

A

~ 25%

Rare tho

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5
Q

Allopurinol CI

A

Allopurinol sensitivity

concurrent didanosine use

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6
Q

Allopurinol DI

A

Didanosine

Azathioprine + 6-mercaptourine (MUST reduce dose of both when used in combo with Allopurinol)

Theophylline
Pegloticase
Loop/thiazide diuretics

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7
Q

Allopurinol monitoring

A

Efficacy: SUA every few weeks till goal
Safety: HLA-B*5801 test prior to start in high risk pops

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8
Q

High risk pops for HLA-B*5801

A

Han chinese
Korean
Thai
AA

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9
Q

Allopurinol patient education

A

Signs and symptoms of allergic reaction
HLA testing
How to use

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10
Q

Febuxostat (Uric) MOA

A

non-purine inhib of XAI leading to reduced production of uric acid

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11
Q

Febuxostat ADR

A

Hepatic: abnormal LFTs
GI: nausea
Rheumatologic: Gout flares
Rash, Arthralgia

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12
Q

Febuxostat CI

A

concomitant use of Azathioprine or 6-mercaptopurine

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13
Q

Febuxostat Precuations

A

Acute gout flare
CVD events
Hepatoxicity
Serious skin reactions

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14
Q

Febuxostat DI

A

Azathioprine or 6-mercaptourine
Theophylline
pegloticase
didanosine

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15
Q

Febuxostat Monitoring

A

Efficacy: SUA after 2 weeks of treatment + periodically

Safety: LFTs at BL and if signs of hepatic injury

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16
Q

Febuxostat Pt education

A

use
ADR
dont use with azathioprine or 6-MP

17
Q

Study that chose Allopurinol > Febuxostat in CV patients?

A

CARES Trial

Febuxastat as Black Box warning due to study

18
Q

Uricosurics

A

Probenecid
Sulfinpyrzone
Benzbromerone
Losartan

19
Q

Probenecid MOA (Benamid)

A

Competitively inhibits the postsecretory renal proximal tubular reabsorption of uric acid

20
Q

When to avoid Probenecid?

A

CrCl < 50

21
Q

Probenecid SE

A

Most common = GI, uric acid nephrolithiasis (Uric Acid kidney stones)

Hemolytic Anemia (in G6PD deficiency in Mediterranean & AA)

22
Q

Probenecid CI

A 
HX of urolithiasis
Overproducer of uric acid
Hypersensitivity to it
Small & Large dose salicylate therapy
Blood dyscrasias
< 2 yrs old
initiation during acute gout attack
23
Q

Probenecid Precautions

A

Disease related: G6PD, PUD, Renal impairment

Drug-related: Methotrexate, penicillin, salicylate

24
Q

Probenecid DI

A

Salicylates
Penicillins/Cephalosporins/Carbapenems
Methotrexate
Pegloticase

25
Q

Probenecid Pt education

A

inc fluid intake

26
Q

Probenecid place in therapy?

A

Add on therapy to XOI in patients not controlled on single agent

XOI is preferred over probenecid for those with > Stage 3 CKD

27
Q

Losartan place in therapy?

A

Add on in patients with HTN who are already on XOI and not controlled

28
Q

Is probenecid for Overproducers or Underexcretors?

A

Under excreters

29
Q

Pegloticase (Krystexxa) MOA

A

pealed recombination modified mammalian rate oxidase (Uricase)

30
Q

What to know about Krystexxa infusion?

A

Premeditate with corticosteroid and antihistamine pre-medication

31
Q

Pegloticase (Krystexxa) SE

A 
Gout flares
Infusion reactions
Nausea 
Vomiting
Bruising
Nasopharyngitis 
Constipation
Chest pain
Anaphylaxis (Black Box for this)
32
Q

Pegloticase (Krystexxa) CI

A

G6PD deficiency

33
Q

Pegloticase (Krystexxa) Precautions

A

Anaphylaxis
Infusion reactions
Gout Flares
CHF

34
Q

When should you stop Krystexxa?

A

When SUA above 6mg/dL for 2 infusion in a row

35
Q

Place of use for Krystexxa

A

used in patients who continue to have elevated SUA > 6mg/dL, and either frequent flares (> 2/yr) or non resolving subcutaneous tophi

36
Q

Chronic ULT Medication selection

A
  1. Depends on response to therapy, tolerability
  2. Genetics
  3. Co-morbid conditions
  4. DI
  5. Cost of therapy
37
Q

ULT guidelines

A
  1. Allopurinol is preferred to all other ULT. should be imitated at low doses, and intesified to SUA < 6 mg/dL
  2. If pt is not responding to XOI at max tolerated or FDA approved dose, change to another OXI over adding on a uricosuric agent
  3. Swapping ULT to pegloticase strongly recommended for those in whom interventions have been unable to achieve SUA target and continue to have frequent flares or subcu top
  4. continue ULT indefinitely
38
Q

Gout self Care

A

can reduce SUA ~ 10-18%

  1. consider alone or in combo with pharm therapy
  2. smoking cessation
  3. patient ed
  4. Hydration
  5. exercise
  6. weight loss
  7. avoidance of risk factors (dietary/meds)
39
Q

Medication Risk factors gout

A

HCTZ = swap to alternative hypertensive if possible
Losartan = preferred anti hyper when possible
Low dose aspirin= dont stop if recommended in pt
Fenofibrate = dont swap to or add in pts with gout

cdm 2 exam 2 (16 decks)

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