Gout

Question 1

Metabolic disease that is characterized by recurrent episodes of acute arthritis due to deposits of monosodium urate in joints and cartilages

Answer 1

Gout

Question 2

T or F: Gout is a disease characterized by recurrent chronic arthritis

Answer 2

False, acute

Question 3

Gout is a systemic disease caused by the buildup of ____ in the ____ causing inflammation, swelling, and pain

Answer 3

uric acid, joints

Question 4

Hyperuricemia levels in men and women

Answer 4

Men = >8 mg/dL
Women = 7 mg/dL

Question 5

Most common first symptom of gout

Answer 5

Pain in joints of lower extremities

Question 6

Type of gout which is a result of an innate defect in purine metabolism of uric acid excretion
- uric acid overproduction
- impaired renal clearance of uric acid
- combination

Answer 6

Primary Gout

Question 7

Type of gout which is characterized by hematologic disorders

Answer 7

Secondary Gout

Question 8

Treatment goals for Gout

Answer 8

1. Relieve pain and inflammation
2. Reduce serum uric acid concentration
3. Prevent recurrent gout attacks

Question 9

Alkaloid isolated from colchicum autumnale

Answer 9

Colchicine

Question 10

Antimitotic drug effective in relieving acute gout attack

Answer 10

Colchicine

Question 11

When is Colchicine most effective?

Answer 11

When initiated within 12-36 hours of the attack

Question 12

T or F: Colchicine has a high benefit-to-risk ratio

Answer 12

False, low –> that’s why it used less often than NSAIDs

Question 13

Can Colchicine be taken with or without food?

Answer 13

Yes

Question 14

Colchicine duration of action

Answer 14

12-24 hours without altering urate metabolism

Question 15

Mainstay therapy for acute gouty attacks

Answer 15

NSAIDs

Question 16

Most common adverse effects of NSAIDs are related where?

Answer 16

GI system (gastritis, bleeding, perforation)

Question 17

Most extensively studied NSAIDs for the treatment of acute gouty attacks

Answer 17

Indomethacin

Question 18

MOA of NSAIDs

Answer 18

1. inhibits PG synthesis
2. inhibits urate crystal phagocytosis
3. reduces inflammation and pain in acute gout flare

Question 19

T or F: All NSAIDs effective for treating acute gouty arthritis attacks

Answer 19

False, exceptions include aspirin, salicylates, tolmetin

Question 20

T or F: Oxaprozin lowers serum uric acid

Answer 20

True

Question 21

Equivalent to NSAIDs in the treatment of acute gout flares

Answer 21

Corticosteroids

Question 22

Corticosteroids are effective when given into what routes?

Answer 22

Intra-articular, IV, oral

Question 23

Route of Prednisone

Answer 23

Oral

Question 24

Route of Triamcinolone acetonide or Methylprednisone

Answer 24

Intra-articular or IM

Question 25

Decreases activation, proliferation, survival of various inflammatory cells as well as decrease mitigation of neutrophils, inhibits prostaglandins, and proinflammatory cytokines (IL-1B)

Answer 25

Corticosteroids

Question 26

Indication of Corticosteroids

Answer 26

Alternative for patients contraindicated to NSAIDs or Colchicine as well as those with renal impairment or CKD

Question 27

T or F: Corticosteroids can sometimes be used for severe symptomatic gout

Answer 27

True

Question 28

What is the goal urate levels of Uric Acid Lowering Therapy?

Answer 28

< 6 mg/dL, preferably < 5 mg/dL

Question 29

Reduction of serum urate concentration can be done by?

Answer 29

1. Decreasing uric acid synthesis - xanthine oxidase inhibitors 2. Increasing renal excretion of uric acid - uricosurics

Question 30

Can xanthine oxidase inhibitors and uricosurics be used during acute gouty arthritis attacks?

Answer 30

No

Question 31

Reduces uric acids by impairing conversion of hypoxanthine to xanthine and ultimately xanthine to uric acid

Answer 31

Xanthine oxidase inhibitors

Question 32

T or F: XO inhibitors are effective for overproducers of uric acids only

Answer 32

False, effective for both over- and underproducers

Question 33

Most widely prescribed agents for long-term prevention of recurrent gout attacks

Answer 33

XO inhibitors

Question 34

Purine analog that inhibits xanthine oxidase resulting in a decreased level of plasma urate level

Answer 34

Allopurinol

Question 35

What is the result of XO inhibition?

Answer 35

Build up of its substrates = more soluble xanthine and hypoxanthine

Question 36

T or F: Allopurinol is the first-line agent for the treatment of acute gout attacks

Answer 36

False, chronic gout attacks

Question 37

Potent selective non-purine XO inhibitor, reducing xanthine and uric acid levels without affecting other enzymes in purine or pyrimidine pathway

Answer 37

Febuxostat

Question 38

Example of Uricosuric Drugs

Answer 38

Probenecid

Question 39

Uricosuric drugs that have been discontinued in the USA

Answer 39

Sulfinpyrazone and Lesinurad

Question 40

MOA of Uricosuric drugs

Answer 40

Increases renal excretion of uric acid through inhibition of post-secretory renal proximal tubular reabsorption of uric acid

Question 41

T or F: Probenecid can be given as monotherapy or in combination with XO inhibitors

Answer 41

True

Question 42

Interleukin-1 inhibitors

Answer 42

Canakinumab Anakinra Rilonacept

Question 43

MOA of IL-1 inhibitors

Answer 43

inhibits IL-1 receptors

Question 44

Main proinflammatory cytokines responsible for crystal-induced inflammation of gout

Answer 44

IL-1B

Question 45

Are Interleukin-1 inhibitors already FDA approved?

Answer 45

Not yet

Question 46

Route of administration for Interleukin-1 inhibitors

Answer 46

SubQ