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Therapy: year 3 > Gout > Flashcards

Gout Flashcards

(52 cards)

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1
Q

Is gout an inflammatory or noninflammatory disorder?

A

inflammatory

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2
Q

what is the main cause of gout?

A

hyperurecimeia

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3
Q

what concentrations of uric acid are indicative of gout in men and females?

A

416 mew mol for men
357 mew mol for women

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4
Q

does elevated uric acid levels always lead to gout?

A

we can have asymptomatic gout!

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5
Q

what are some risk factors for gout?

A
  • men (3 times as common)
  • 40 (for men) and 60 (for females)
  • sedentary lifestyle, obesity
  • food high in purines (alchol)
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6
Q

what stage of purine degradation is uric acid?

A

the final stage

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7
Q

talk about limits of solubility

A

normal serum uric acid level are already at the limit of solubility so it takes very little to shift this balance

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8
Q

hyperurcemia is the cause of what?

A

over production or underextrection of uric acid (under excration is most commonly the cause)

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9
Q

discuss what can lead to over production?

A
  • cell death (cells have a lot of uric acid in them) - meds used to treat blood cancer cause cell death
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10
Q

can diet cause over production?

A

rarely

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11
Q

what are the two types of drugs that affect uric acid production?

A
  • xanthine oxidase inhibitors (allopurinol, and febuxostat)
  • renal reabsorption
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12
Q

discuss what can lead to under execration?

A
  • dehydration - we retain Na and therefore we also retain uric acid
  • drugs can affect it ( thiazide diruretics)
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13
Q

how much uric acod is excreted through the renal system?

A

2/3

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14
Q

do we know why underexcretion of gout patients ahppnes?

A

not always - 90% unknown but as mentioned

dehydration and drugs can affect the excretion

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15
Q

what are the 4 clinical spectrums of the disease?

A
  1. asymtomatic
  2. gouty flare
  3. prophylaxis of flares
  4. chronic gouty arthitis (crystals formed in joints)
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16
Q

what is the treament for asymtopmatic gout?

A

non-phram

  • no meds
  • lifestyle changes (exercise, food less high in purines)
  • identify drugs that may be leading to disccus and discuss changing them
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17
Q

what is the treament for a gout flare? what drugs can we use?

A
  • treat within 24 hours
  • NSAIDS
  • Colchinie
  • Oral steroids
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18
Q

what two drugs for treament of flares can never be combine?

A

NSAIDS and Oral steroids ( could cause toxicity)

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19
Q

monotherapy or two agents? also what are the options

A

try one agent but we can add another if needed

NSAID + colchinie
Colchine and oral steroid
IA steroid or NSAIS + colchine

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20
Q

what are the signs of a gout flare?

A

excruatiating pain, inflammation, sweeling

  • fever elevated wbc
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21
Q

is it monarticular or biartiuclar?

Study These Flashcards
A

monoarticular usualy

22
Q

where does it often happen?

Study These Flashcards
A

big toes, ankle, heel, knees, wrist, fingers, elbow (rarely)

23
Q

distinguish between a presumptive diagnosis and a definitive diagnosis

Study These Flashcards
A

presumptive - lab work (high uric acid), pain, inflammation of the big toe

definitive - take sample of synovial fluid and chvcek for presence of cystrals

24
Q

when is combo therpay indicated?

Study These Flashcards
A

severe gout >7 on pain scale

25
NSAID used? monitoring ? dosing?
indomethacin (has CNS SE) , if pain doesn't get better in 7 days see a doc , dosing (loading dose so big amount to start then titrate down)
26
When should we start colchine?
within 36 hours - can give patient a PRN supple if they ahve repesetd gout attacks
27
What special consideration should we take when dosing elderly and those who are renally impaired with colchine?
reduce dose
28
what are some side effects common and rare of colchine?
common (in high doses) - abdominal pain and cramps, diarrhea, nausea and vomiting Rare: neuropathy, myopathy, bone marrow suppression (a worry for those with renal insifficney)
29
Drug interactions for colchicine
- Statins level may increase so monitor for myotoxicity (muscle weakness, pain) - If taking knonw CYP 3A4 inhibotrs, decrease dose and moniot for fever, leukopenia, GI symptoms) - these could be clarithyrmycin, - azonles
30
what is an important counseling point for colchine
avoid graphfruit
31
Oral or IA corticosteroid use?
Both
32
when is oral vs IA corticosteroid use indicated?
oral when more than two joints are affected IA when 1-2 joints are involved and they must be big joints
33
what is the dosing for oral corticosteroids like?
prednisone - large dose to start off for 5 to 10 days, if used for less then 10- days no need for titrating down before discontinuing BUT beware that rebound attacks may occur
34
what are the two goal styles for prophylaxis therapy?
treat to target - less then 300 mew mol SUA, 360 for those with severe gout treat to manage symptoms
35
when is uric lowering therapy indicated?
-when more then 2 gout attacks per year - presence of uric acid stones - presence of calcifcation tophi, tophus - reduced kidney fucntion less then 90 mL/min
36
what does ULt therpay look like?
1. start ULt therpay with allopurinol or febuxostat 2. start low dose NSAID or colchine for 3-6 months after initiation ULT
37
does ULT risk or decrease risk for gout attacks
can increease thus we need NSAID and colchine for first 3-6 months
38
what is first line for ULT
allopurinol
39
what risk factors should we be cautious of in allopurinol use?
- elderly - hepatic impariment - renal impairment - CKD
40
common side effects of Allopurinol?
Gi upset can preciptate gout attack
41
serious side effects of allopuirnol
IF YOU DEVELOP A RASH OR ITCH STOP DRUG USE AND SEE HCP - Steven johnson syndrom - ten - DRESS
42
how should we dose allopurinol? and moniotr
start low and go slow - can increase every 2-4 weeks chcek lab values for SUA and renal function
43
what dose of allopurinol is usually needed to be effective?
300 mg/day
44
when is febuxostat/uloric indicated?
when we fail allopurinal or there is severe renal impriament
45
what are some drug interaction with allopurinol to note?
Azathipine and mercaptopurine - thiopruity toxicity - bone marrow suppression
46
Why is febuxostat indicated for renal insuffeincy?
very little is excreted renally
47
what has more flares during initiation, allopurinol or febuxostat?
febuxostat
48
drug interactions with febuxostat
azathioprine and mercaptopurine (CI) Theophyline?
49
AE of febuxostat
- abnorlmities in LFTS - Gi upset - may increase cv risk
50
what is the moniotring for both phrophylauxs agents
2-4 weeks chcek SUA and increase dose, chcke renal function as well 3-6 once target reached LFTS- if taking febuxostat
51
if renally impaired (crcl less then 90ml/min) what do we do for acute and prophylaxis therpay?
acute -colchicine or steroids - avoid NSAIDs Prophylactic - febuxostat - allopurinol - with a dose adjustment
52
if CV comordbidities what do we do for acute and prophylaxis therapy?
acute: - colchicine - avoid NSAIDS and steroids for those in heart fialure Prophylactic - allopurinol - febuxostat avoid

Therapy: year 3 (14 decks)

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