Pain/Related Conditions: Gout

Question 1

Gout is caused by

Answer 1

buildup of uric acid crystals in the joints

Question 2

Gout attack info

Answer 2

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

Question 3

Risk factors for Gout

Answer 3

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

Question 4

Foods to avoid in Gout

Answer 4

organ meats
high fructose corn syrup
alcohol

Question 5

Drugs used to treat acute pain in Gout

Answer 5

Colchicine
Steroids
NSAIDs

Question 6

Drugs used to prevent future Gout attacks

Answer 6

Allopurinol (preferred) or febuxostat = Xanthine oxidase inhibitors

Question 7

Colchicine Contraindications

Answer 7

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

Question 8

Colchicine (Colcrys) warnings

Answer 8

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

Question 9

Colchicine side effects

Answer 9

Diarrhea
nausea
myopathy
neuropath

Question 10

Colchine notes

Answer 10

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

Question 11

NSAIDs for Gout

Answer 11

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

Question 12

Steroids for Gout

Answer 12

Prednisone/Prednisolone
Methylprednisolone

Question 13

Steroids SE

Answer 13

inc BG
inc BP
insomnia
Inc appetite

Question 14

Colchicine drug interactions

Answer 14

CYP3A4 inhibitors = clarithromycin
P-gp inhibitors = cyclosporine

fatal toxicity can occur

Question 15

Who should start Uric Lowering therapy

Answer 15

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

Question 16

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

Answer 16

HLA-B* 5801 allele

Question 17

Alternative Xanthine oxidase inhibitor (XOI) if cant use allopurinol

Answer 17

Febuxostat

Question 18

second line txm if XOI are contraindicated

Answer 18

Probenecid

Question 19

How does Probenecid work?

Answer 19

inhabits reabsorption of uric acid, increasing excretion

req good renal function

Question 20

How does allopurinol work

Answer 20

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

lower dose if moderate/severe CKD

Question 21

Uric acid goal for gout?

Answer 21

< 6mg/dL

Question 22

Options for when UA isn’t at goal

Answer 22

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

Question 23

Pegloticase MOA

Answer 23

recombinant Uricase

inc uric acid conversion to allantoin

Question 24

Allopurinol warnings

Answer 24

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

Question 25

Allopurinol side effects

Answer 25

Rash
acute gout attacks
nausea
diarrhea

Question 26

Notes on Allopurinol

Answer 26

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

Question 27

Febuxostat Boxed warnings

Answer 27

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

Question 28

Febuxostat Contraindications

Answer 28

Dont use with mercaptopurine or azathioprine

Question 29

Febuxostat warnings

Answer 29

Hepatotoxicity
serious skin reactions = SJS/TEN, DRESS

Question 30

Febuxostat side effects

Answer 30

rash
nausea
inc LFTs**

Question 31

Febuxostat max daily dose if CrCl < 30

Answer 31

40mg QD

Question 32

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

Answer 32

> 45 mL/min

Question 33

Pegloticase Boxed warnings

Answer 33

Anaphylactic reactions: monitor and premedical w/ antihistamines and steroids

Question 34

Pegloticase Contraindications

Answer 34

G6PD deficiency

Question 35

Which Gout meds should Pegloticase not be used with?

Answer 35

Dont use in combo with allopurinol, febuxostat or probenecid

Question 36

Other uses for probenecid?

Answer 36

inc beta lactam concentration

Question 37

Tumor lysis syndrome

Answer 37

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

Question 38

What’s used for Tumor Lysis Syndrome

Answer 38

Rasburicase (Elitek)

Contraindicated: G6PD deficiency