Module 2 gout

Question 1

Gout patho

Answer 1

alteration in purine metabolism resulting in hyperuricemia and deposition of urate crystals in tissues

• 30-50 y/o
• men > women

Question 2

gout s/s

Answer 2

sudden pain
erythema
limited range of motion
swelling in joint

Question 3

primary gout

Answer 3

defect in purine metabolism and or uric acid excretion

Question 4

secondary gout

Answer 4

r/t

• cancer
• CRF
• drugs
• • salicylates, antineoplastics, diuretics, ethambutol, nicotinic acid, cyclosporin, ethanol

Question 5

Gout pharmacological pain tx

Answer 5

NSAID

corticosteroids

Question 6

Antigout medication

Answer 6

colchicine
allopurinol
febuxastat

Question 7

uricosuric agents

Answer 7

probenecid

sulfinpyrazone

Question 8

colchicine MOA

Answer 8

disruption of urate deposition and subsequent inflammatory reaction

Question 9

Colchicine use

Answer 9

acute gout attack

prophylaxis with chronic gout

Question 10

colchicine AE

Answer 10

adb. pain

N/V/D

Question 11

colchicine interactions

Answer 11

cyclosporine
tacrolimus
verapamil

Question 12

colchicine administration

Answer 12

acute attack:
- 1.2mg x 1, 0.6-1.2mg q1-2hr till relief of diarrhea

Maintenance:

• < 1 attack/year: 0.6mg 3-4x/week
• > 1 attack/year: 0.6-1.2mg/day
• serious case: 1.2-1.8mg/day

No effect on uric acid levels

Question 13

probenecid use

Answer 13

uricosuric agent
prophylactic gout tx
prevention of disease progression

Question 14

probenecid MOA

Answer 14

dec. urate reabsorption in PCT

non-selective blockade of active renal transport of organic acids

Question 15

probenecid AE

Answer 15

hypersensitivity
GI upset
Urate kidney stones

Question 16

probenecid precaustions

Answer 16

do not start during acute attack
inc. attacks may occur with first 6-12mo 
to minimize risk of urate kidney stones
- inc. fluids, min. of 2L/day
- alkaline urine: NaHCO3

Question 17

probenecid interactions

Answer 17

penicillin

naproxen

Question 18

allopurinol MOA

Answer 18

antigout
inhibits uric acid production
- Prodrug: converted by xanthine oxidase

Question 19

allopurinol interactions

Answer 19

azathioprine: 6-metcaptopurine toxicity

Question 20

allopurinol education

Answer 20

as uric acid levels dec
-> dissolution of deposits
-> acute attacks
Can take with colchicine

Question 21

febuxostat MOA

Answer 21

antigout
inhibits xanthine oxidase
- prevents uric acid production

Question 22

febuxostat AE

Answer 22

elevated LFT

Question 23

febuxostat precautions

Answer 23

inc. risk gouty attacks with tx initiation

- take with NSAID or Colchicine

Question 24

sulfinpyrazone MOA

Answer 24

inhibit renal tubular reabsorption of urate and thus inc. renal excretion

Question 25

sulfinpyrazone use

Answer 25

gout

- when probenecid and allopurinol are not tolerated

Question 26

sulfinpyrazone AE

Answer 26

GI upset

- take with food

Question 27

sulfinpyrazone contraindications

Answer 27

sulfa allergy

avoid aspirin

Question 28

asymptomatic hyperuricemia features

Answer 28

plasma urate:
> 6.0 mg/dL in women
> 7.0 mg/dL in men

Question 29

acute gout features

Answer 29

acute arthritis
typically metatarsophalangeal joints
excruciating pain

Question 30

acute gout Rx

Answer 30

NSAID
colcichine
glucocorticoids

Question 31

intercritical phase features

Answer 31

asymptomatic hyperuricemia

10% may never have another attack

Question 32

intercritical phase Rx

Answer 32

none

Question 33

chronic gout features

Answer 33

hyperuricemia
development of tophi
recurrent attacks of acute gout

Question 34

chronic gout Rx

Answer 34

allopurinal
probenecid
sulfinpyrazone