Module 15 - Gout

Question 1

• Risk Factors

Answer 1

Comorbidities:
* CV disease and DM
* Hyperurcemia
* High triglycerides and cholesterol
* Menopause
* Obesity
* Renal disease
* DIURETIC USE (LOOP and THIAZIDE)

Demographics:
* Indigenous Taiwanese (Eastern Asia)
* Pacific Islander
* New Zealand
* Male > Female

Dietary:
* Purine Rich Foods
* scallops, mussels, anchovies, sardines, bacon, liver, veal, venison, beef, turkey
* ETOH beer > wine and liquor
* Meats
* Seafood
* Fructose rich (diet soda doesnt seem to be problematic)

Question 2

• Acute Treatment: NSAIDs

Answer 2

FIRST LINE
- Normal Dose: Use NSAID until attack is gone
* ibuprofen: 400-800mg x 3-4 days
* max NSAIDs 3200mg/day
* naproxen 500mg BID
* indomethacin 50mg TID

• No specific NSAID preferred
• DON NOT USE ASA: It can alter uric acid levels and can intensify or promote gout attack)
• Celebrex: Limited Evidence
• tapered

dont need to know dosages

Question 3

• Acute Treatment: Steroids

Answer 3

FIRST LINE
- PO
* Prednisone/-solone 30-40mg daily x 5 days
* OR given until flare resolve begins (then taper)
* Can be given intraarticular or IM
* Site reaction for injections
* Short term steroids not typically associated with significant adverse effects
* Hyperglycemia

Question 4

• Acute Treatment: Colchicine

Answer 4

FIRST LINE
- Normal Dose: 1.2mg PO x 1 dose then single dose of 0.6mg 1 hour later
- Must be taken within first signs of Gout attack
* 24-36 hours
- Less desirable treatment 2/2 side effects
- CAN be combined with steroid or NSAID in severe attacks

• S/E:
• GI upset
• Thrombocytopenia, Leukopenia, Agranulocytosis
• Muscle pain or weakness, possible Rhabdo

Question 5

• Allopurinol

Answer 5

Drug of Choice - first line?
- Xanthine oxidase inhibitor (inhibits uric acid production)
- Dosing: Initial 100mg/day, can adjust in 100mg increments per week q 2-4 weeks
- Max Dose: 800mg/day
- Dosages >300mg/day in divided doses after meals

LOWERS URIC ACID BY 2-3.5mg/dL
URIC ACID GOAL OF < 6mg/dL

Question 6

• Probenecid (benemid)

Answer 6

• INCREASES URINARY ELIMINATION OF URIC ACID
• Alternative for patients who fail/contraindications/unable to tolerate allopurinol and febuxostat
• Risk of kidney stones (~9%)
• avoid monotherapy in pts with nephrolithiasis
• drug/drug interactions
• NSAID, benzos, antivirals

Question 7

Which medications increase risk of hyperuricemia and gout

Answer 7

thiazide diuretics (hydrochlorothiazide)

Question 8

Which of the following meds is first line for chronic gout to prevent reoccurence of symptoms during its quiescent phase?

Answer 8

allopurinol