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NAPLEX review 2024 RXPrep Book > Pain/Related Conditions: Gout > Flashcards

Pain/Related Conditions: Gout Flashcards

1
Q

Gout is caused by

A

buildup of uric acid crystals in the joints

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2
Q

Gout attack info

A

usually sudden onset
occurs in one joint, most often big toe

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3
Q

Risk factors for Gout

A

Male sex
obesity
excessive alcohol (mostly beer)
HTN
CKD
Lead intoxication
old age
meds that inc UA

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4
Q

Foods to avoid in Gout

A

organ meats
high fructose corn syrup
alcohol

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5
Q

Drugs used to treat acute pain in Gout

A

Colchicine
Steroids
NSAIDs

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6
Q

Drugs used to prevent future Gout attacks

A

Allopurinol (preferred) or febuxostat = Xanthine oxidase inhibitors

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7
Q

Colchicine Contraindications

A

dont use in combo with P-gp or strong CYP3A4 inhibitor with renal/hepatic impairment

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8
Q

Colchicine (Colcrys) warnings

A

Myelosuppression
inc myopathy risk if suing statins, gemfibrozil, verapamil, diltiazem, cyclosporine

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9
Q

Colchicine side effects

A

Diarrhea
nausea
myopathy
neuropath

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10
Q

Colchine dosing notes

A

start within 36hrs of symptom onset, wait 12hrs till after txm dose before starting prophylaxis dose

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11
Q

NSAIDs for Gout

A

Indomethacin (Indocin)
Naproxen (Aleve)
Celecoxib (Celebrex)

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12
Q

Steroids for Gout

A

Prednisone/Prednisolone
Methylprednisolone

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13
Q

Steroids SE

A

inc BG
inc BP
insomnia
Inc appetite

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14
Q

Colchicine drug interactions

A

CYP3A4 inhibitors = clarithromycin
P-gp inhibitors = cyclosporine

fatal toxicity can occur

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15
Q

Who should start Uric Lowering therapy

A

pts with multiple or frequent Gout attacks
evidence of joint damage
have tophi

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16
Q

What gene should be screened for in pts at high risk of allopurinol hypersensitivity reactions

A

HLA-B* 5801 allele

17
Q

Alternative Xanthine oxidase inhibitor (XOI) if cant use allopurinol

A

Febuxostat

18
Q

second line txm if XOI are contraindicated

A

Probenecid

19
Q

How does Probenecid work?

A

inhabits reabsorption of uric acid, increasing excretion

req good renal function

20
Q

How does allopurinol work

A

blocks xanthine oxidase enzyme, stopping production of Uric Acid and produces non-toxic end product

lower dose if moderate/severe CKD

21
Q

Uric acid goal for gout?

A

< 6mg/dL

22
Q

Options for when UA isn’t at goal

A

Lesinurad = taken with XOI
pegloticase = used for refractory, severe disease

23
Q

Pegloticase MOA

A

recombinant Uricase

inc uric acid conversion to allantoin

24
Q

Allopurinol warnings

A

hypersensitivity reactions, severe rash (SJS/TEN DRESS), screen for HLA-B*5801 b4 start in high risk patients (Asian)

25
Q

Allopurinol side effects

A

Rash
acute gout attacks
nausea
diarrhea

26
Q

Notes on Allopurinol

A

use with colchicine 0.6mg QD/BID or another NSAID for 3-6 months at start

27
Q

Febuxostat Boxed warnings

A

inc risk of CV death compared to allopurinol in CVD patient, use only if cant use allopurinol

28
Q

Febuxostat Contraindications

A

Dont use with mercaptopurine or azathioprine

29
Q

Febuxostat warnings

A

Hepatotoxicity
serious skin reactions = SJS/TEN, DRESS

30
Q

Febuxostat side effects

A

rash
nausea
inc LFTs**

31
Q

Febuxostat max daily dose if CrCl < 30

A

40mg QD

32
Q

Lesinurad (Zurampic) should only be started in pts with CrCl above?

A

> 45 mL/min

33
Q

Pegloticase Boxed warnings

A

Anaphylactic reactions: monitor and premedical w/ antihistamines and steroids

34
Q

Pegloticase Contraindications

A

G6PD deficiency

35
Q

Which Gout meds should Pegloticase not be used with?

A

Dont use in combo with allopurinol, febuxostat or probenecid

36
Q

Other uses for probenecid?

A

inc beta lactam concentration

37
Q

Tumor lysis syndrome

A

when cells get ‘lysed’, they release purines into blood and quickly converted to UA
can cause a bunch of issues, potentially life threatening

38
Q

What’s used for Tumor Lysis Syndrome

A

Rasburicase (Elitek)

Contraindicated: G6PD deficiency

NAPLEX review 2024 RXPrep Book (78 decks)

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