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iPTX III > Gout > Flashcards

Gout Flashcards

1
Q

Gout occurs when what accumulates in joint?

A

Uric acid

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2
Q

How does the body break down uric acid?

A

Dissolves in blood and passes through kidneys

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3
Q

Purines have a (single/double) ring structure

A

Double

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4
Q

Pyrimadines have a (single/double) ring structure

A

Single

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5
Q

Which nitrogenous bases are pyrimadines?

A

Cytosine, thymine, uracil

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6
Q

Uric acid forms when what breaks down?

A

Purines

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7
Q

What enzyme is required to breakdown xanthine into uric acid?

A

Xanthine oxidase

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8
Q

Uric acid is a (weak/strong) acid

A

Weak. Pka = 5.3

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9
Q

Which class of medications are first line for gout?

A

Xanthine oxidase inhibitors

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10
Q

Examples of xanthine oxidase inhibitors

A

Allopurinol, febuxostat

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11
Q

Which classes of medication are second line for gout?

A

.UA degradation
.Increase renal urate excretion

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12
Q

Which compound is an analogues of hypoxanthine and xanthine?
a. Febuxostat
b. Allopurinol
c. Benzbromarone
d. probenecid

A

b. Allopurinol

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13
Q

Which compound is NOT a XO inhibitor
a. Febuxostat
b. Allopurinol
c. Oxypurinol
d. Allantoin

A

d. Allantoin

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14
Q

True or false: Allopurinol is structurally similar to hypoxanthine and it competitively binds at xanthine receptors.

A

True

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15
Q

How many oxygen atoms in uric acid?

A

3

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16
Q

Which way is NOT good for the treatment of hyperuricemia?
a. Inhibiting Xanthine Oxidation
b. Inhibiting Uric acid reabsorption
c. Inhibiting Uric acid oxidation
d. Converting Uric acid to Allantoin

A

c. Inhibiting Uric acid oxidation

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17
Q

Which metal atom in the active site of xanthine oxidase?

A

Molybdenum

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18
Q

Uricosurics MOA

A

Increase renal urate excretion by inhibiting URAT1 and GLUT9 transporters

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19
Q

Examples of uricosurics

A

.Benzbromarone (pulled from market due to death from hepatic failure)
.Probenecid

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20
Q

Cautions with probenecid

A

Has many significant drug interactions (NSAIDs, beta-lactams, heparin, etc.)

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21
Q

List two important transporters for Uric acid reabsorption

A

URAT1 and GLUT9

22
Q

Which part of kidney is important for uric acid reabsorption?

A

Proximal convoluted tubule

23
Q

What is the function of Uricase (Pegloticase)?

A

Convert uric acid to allantoin via oxidation

24
Q

Which form, uric acid or urate, is predominant at pH 7.4?

A

Urate

25
Q

Hyperuricemia Hyperuricemia is defined as uric acid levels above:

A

7 mg/dL for men
6 mg/dL women

26
Q

True or false: Hyperuricemia always causes gout

A

False. Hyperuricemia can be asymptomatic

27
Q

Medications that alter urate balance

A

. Diuretics
. Ethanol
. Salicylates
. Nicotinic acid
. Pyrazinamide
. Cyclosporin

28
Q

Signs/symptoms of gout

A

.Intense pain
.Erythema
.Warmth
.Fever
.Tophi
.Inflammation of joint: toes, knees, fingers, elbows, ankles

29
Q

Possible causes of gout flare

A

.Dehydration
.Stress
.Excessive alcohol intake
.Excessive intake of purine
rich foods
.Increased physical activity
.Use of uric acid lowering agents
.Use of medications that increase uric acid levels

30
Q

Chronic tophaceous gouty arthropathy (CTGA) severity

A

.Mild: 1 joint, stable
.Moderate: 2-4 joints, stable
.Severe: 4 or more joints or unstable, complicated, tophi present)

31
Q

Non-pharmacological modifications for gout

A
  • Limit purine rich foods (meats, seafood)
  • Limit alcohol intake (i.e. beer, fortified
    wines/liquors)
  • Limit high-fructose corn syrup
  • Maintain adequate hydration
  • Weight loss
  • Ice therapy
32
Q

Which NSAIDs are FDA approved for acute gout treatment?

A

.Sulindac
.Indomethacin
.Naproxen

33
Q

True or false: Selective COX-2 inhibitors should be avoided in significant CAD history

A

True. Associated with increased risk of CV events

34
Q

Contraindications for NSAIDs

A

.Decompensated HF
.CrCL less than or equal to 30mL/min

35
Q

True or false: Corticosteroids may be administered when the patient has an active systemic infection

A

False. Corticosteroids are immunosuppressive

36
Q

Colchicine dosing

A

Initial - Day 1: 1.2mg PO once. Day 2: After 12hrs
Maintenance: 0.6mg po 1hr later. 0.6mg PO qd or bid

37
Q

When should colchicine be initiated?

A

.12-36 hours after onset of symptoms
.36+ hrs: consider alternative therapy

38
Q

Colchicine contraindications

A

.Hepatic failure
.CrCl of 10mL/min or less
.Severe cardiac/GI disease
.Blood dyscrasias

39
Q

Urate level goal

A

< 6mg/dL

40
Q

True or false: ULT may be initiated during an acute flare

A

Yes, as long as overlapping prophylaxis is also initiated. And it is not the patient’s first flare

41
Q

ULT is recommended when?

A

.Tophi
.2 or more gout flares a year

42
Q

True or false: BID dosing of colchicine is more effective

A

False. BID dosing has same efficacy, but more side effects

43
Q

How long should treatment be with tophi present?

A

6-12 months

44
Q

How long should treatment be without tophi present?

A

3-6 months

45
Q

Testing for which allele prior to initiating allopurinol is recommended for those of Southeast Asian descent and African American

A

HLA-B*5801

46
Q

True or false: Uricosurics are often initiated as monotherapy

A

False. Rarely used monotherapy, however can if XOI is contraindicated or ineffective

47
Q

Uricosuric contraindications

A

.Moderate-severe renal impairment (don’t use in stage 3 or worse CKD)
.Salicylates may impact probenecid concentrations

48
Q

Pegloticase, a recombinant uricase from a modified strain of E. coli, should be initiated as (monotherapy/ adjunct therapy)

A

Monotherapy ONLY, not with other ULT therapy

49
Q

When to d/c pegloticase

A

Serum urate still over 6 after first administration

50
Q

Alternative gout therapies

A

.Fenofibrate - increase hypoxanthine and xanthine clearance
.Losartan - inhibits tubular resorption of uric acid/increases excretion

51
Q
A

iPTX III (28 decks)

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