Therapeutics of Gout and Hyperuricemia

Question 1

RF for Gout

Answer 1

Hyperuricemia
Purine rich diet
Alcohol
Obesity
Kidney damage
Meds
Insulin resistance
OA

Question 2

Low Purine Food

Answer 2

Milk
Green veggies
Fruits

Question 3

High Purine Food

Answer 3

Liver, kidney
Alcoholic beverages
Bacon
Turkey

Question 4

Triggers for attack

Answer 4

IV contrast
Acidosis
Rapid changes
Lower body temperature
Psoriasis
Surgery

Question 5

Treatment principles

Answer 5

Terminate attack
Prevent attack
Prevent complications with urate deposition
Minimize side effects

Question 6

Non-Pharmacologic Modalities

Answer 6

Local, topical cold therapy
Weight reduction
Decrease alcohol
Dietary changes

Question 7

1st line of attack is?

Answer 7

NSAIDs Naproxen, indomethacin, sulindac MAX dose and taper

Question 8

Celecoxib?

Answer 8

Pts with increase risk of GI bleed

Question 9

2nd line of attack?

Answer 9

Colchicine within <36 hrs after attack

Question 10

Colchicine dosing

Answer 10

2 tablets at onset, 1 tablet 1 hr later

12 hrs later 0.6 mg PO QD or BID

Question 11

Colchicine Side effects

Answer 11

DIARRHEA

Cyp 450

Question 12

Last line therapy?

Answer 12

Corticosteroids (PO for systemic or IA for 1-2 joints)

Opoids (don’t get rid of inflammation)

Question 13

Monotherapy?

Answer 13

Mild-mod pain

1 large joint or few small joints

Question 14

Combo therapy?

Answer 14

Sever pain

2+ large joints

Question 15

Gout prophylaxis?

Answer 15

Sever gout attack
Nephrolithiasis
Serum uric acid >10
24 urinary uric acid >1000
Tophi present
2+ attack/year
Renal dysfunction

Question 16

Prophylaxis agents

Answer 16

Anti-inflammatory (Colchicine or NSAIDs)
Uricosuric agents
Xanthine Oxidase Inhibitors

Question 17

Duration of Anti-inflammatories

Answer 17

At least 6 months!!!

Question 18

Uricosurics

Answer 18

Acoid in acute gout attack, <50 CrCl, using aspirin
Push fluids with it
Monitor renal, CBC

Question 19

Xanthine Oxidase Inhibitors Agents

Answer 19

Allopurinol

Febuxostat

Question 20

Xanthine Oxidase Inhibitors Use

Answer 20

Combo with NSAIDs

Overlap x 6-12 months

Question 21

Xanthine Oxidase Inhibitors Interactions where you need to decrease dose by half?

Answer 21

Azathioprine
Didanosine
Mercaptopurine
Theophylline

Question 22

Allopurinol Dose

Answer 22

100 mg PO QD and titrate

Consistently check serum uric acid

Question 23

Fubuxostat

Answer 23

Renal impairment and cant increase allopurinol
40 mg PO QD titrate to 80
Increase risk of MI, stroke and CV death!!!

Question 24

Pegloticase

Answer 24

Severe gout burden
Refractory
Intolerance to oral
IV
CHF!!!

Question 25

Rasburicase

Answer 25

Urate oxidase enzyme

BAAAAD black box warnings