Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Humber Cardio FINAL > Gout > Flashcards

Gout Flashcards

1
Q

Signs and Sx’s of gout ?
1) Recurrent attacks of ?
2) 50% of cases affect the ?
3) T, K, U
4) Sequalae : __,__,___

A
  1. acute, painful, inflamm in one or more joints
  2. metatarsal-phalangeal joint
  3. tophi, kidney stones, urate nephropathy
  4. fever, fatigue, leukocytosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hyperuricemia : Hallmark

Whats the normal level in men ?
What’s the normal level in women premenopausal?

Elevated levels of uric acid causes?

What are the 2 ways that hyperuricemia can occur ?

Does hyperuricemia = gout?

If you have asx hyperuricemia do u need tx?

A

7mg/dL
6 mg/dL

crystallization/deposition in joints, tendons, tissues which triggers local inflamm rxn

underexcretion by kidneys (60-70%)
Overproduction of urate (10%)

It does not equal gout but it incr the risk of gout and acute attacks.

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What score indicates a positive gout diagnosis?

A

EULAR score of 8 or higher

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Risk factors for Gout?

Advancing ___
Gender?
What race?
Family ___
___ syndrome
___ insufficiency
D
Hyper___
H___
O
Incr intake of ? (4)
Medications

A

age
male gender
african american
history of the condition
metabolic
renal
diabetes
hypertension
heart failure
organ transplantation
dietary purines (meat and seafood), beer and spirits, soft drinks and fructose

Medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which medications can lead to increased serum urate concentrations?
(12)
T, A, N, C, C,T ,R AND I, P AND E, L, F, T, E

A

-Thiazide diuretics
* Aspirin (low-dose)
* Niacin
* Cytotoxic chemotherapy
* Cyclsporine
* Tacrolimus
* Ribavirin and interferon
* Pyrazinamide and
ethambutol
* Levodopa
* Filgrastrim
* Teriparatide
* Ethanol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Acute management and prevention of Gouty Arthritis :

1) what’s the initial pharmacotherapy for monotherapy ? (3)

2) Initial pharmacother for combination therapy? (3)

A

1) Nsaids, systemic corticosteroid, colchicine

2) Colchicine + nsaid
-Colchicine + oral corticosteroid
-Intra articular steroid + oral agent (colchicine, NSAID, corticosteroid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Acute Gout

1) control the __ and ___ in acute attack
2) Initiate pharmacother within ___ of onset of sx’s
3) NSAIDS are ____ , potential ___, caution in ? (7)

A
  1. pain, swelling
  2. 24 hrs
  3. first line
    -cost saving
    -elderly, renal insufficiency, hf, PUD, anticoag therapy, liver disease, asthma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Corticosteroids :
-also ___
-Intra articular TOC if only ?

-Avoid use if ?

Dose, Route, Freq, Duration

  1. Prednisone or Prednisolone
  2. Methylpred
  3. Methylpred
  4. Triamcinolone
A

First line

1-2 large joints involved

septic joint not excluded

  1. 0.5 mg/kg/day PO DAILY, 5-10 DAYS OR 2-5 DAYS FOLLOWED BY 7-10 DAY TAPER
  2. 20-40 MG, IA, 1 DOSE
  3. 80-120 MG IM 1 DOSE
  4. TRIAMCINOLONE 60 MG, IM 1 DOSE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

NSAID DOSING : For each, state dose, route, frequency, duration

  1. Indomethacin
  2. naproxen
  3. ibuprofen
  4. celecoxib
A
  1. 50 mg, PO TID, 4-10 days
  2. 500 mg , PO, BID, 4-10 days
  3. 800 mg, PO, QID, 4-10 days
  4. Initial dose of 800 mg, followed by 400 mg on day 1, then 400 mg BID
    , PO, Daily -BID, 7-10 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

COLCHICINE
-also ___
-most effective if used in ?
-AE’s?
-Serious AE’s?
-DDI’s?
-Reduce prophylactic maintenance doses by 50% if?

A

first line

-first 24 hrs

-N/V/D

  • BMS and neuromyopathy in severe renal/hepatic impairment and IV admin
  • erythromycin, simvastatin, cyclosporine

->= age 70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Colchicine Dosing
1) If Acute Gout attack ?

2) If prophylaxis against acute gout attack b4 initiating antihyper-uricemic therapy (after initial acute attack)
- ClCr >= 50
-ClCr 35-40
-ClCr 10-34
-ClCr <10 mL/min

A
  1. 1.2 mg PO at the first sign of gout flare followed by 0.6 mg 1 hr later
  2. 0.6 mg PO daily-BID
    -0.6 mg PO daily
    -0.6 mg PO q2-3 days
    -Avoid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Use monotherapy for patients with ?

use combo therapy for pt’s with ?

A
  1. Mild to mod disease (<=6 of 10 on a 0-10 pain visual analogue scale) –> nsaids, systemic corticosteroids, oral colchicine
  2. severe disease, characterized by intense pain and often a polyarticular presentation
    -colch and nsaids
    -oral cortico and colch
    -intra-articular steroids w/each of other options
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

First line for Chronic Gout :
1. xanthine oxidase inhibs such as ?
2. Start these during ___, after ___, monitor ___
3. target serum urate?

A
  1. Allopurinol, febuxostat
  2. acute attack, inflamm phase (1-2 days) , every 2-5 weeks,
  3. < 6 mg/dL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Who should get chronic therapy ?
1) patients with gout who have any 1 of the following signs : (3)

2) Conditional for pt’s with ? (2)

3) Recommended AGAINST the initiation of ULT(urate lowering therapy) for pt’s who ? (3)

A
  1. including subcutaneous tophi (≥1)
    * evidence of radiographic damage
    * frequent gout flare occurrence (>2 times/y)
  2. with a previous history of infrequent gout flares (<2 flares/y)
    * with urolithiasis, stage ≥3 chronic kidney disease (CKD), and/or serum urate
    concentration >9 mg/dL
  3. -who experience their first gout flare.
    * with asymptomatic hyperuricemia (SU, >6.8 mg/dL and no previous gout
    flares or subcutaneous tophi)
    * including those with comorbid CKD, cardiovascular disease, urolithiasis, or
    hypertension.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

For all pt’s on CHRONIC ULT?

1) SU target ?
2) Continue ULT for how long?

A
  1. < 6 mg/dL
  2. Indefinitely
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ALLOPURINOL

  1. use which dose?
  2. describe dosing
  3. max dose?
  4. maintenance dose for mild gout vs mod/severe?
  5. Prophylactic therapy (nsaids or colchicine) recc for how long?
  6. COnsider screening for ? in high risk pt’s
A
  1. lowest effective dose
  2. initially 100 mg once a day (<= 100 mg per day and at lower dose for pt’s with CKD stage 3 and up)
  3. 800 mg/day
  4. mild 200-300 mg/day
    mod or severe 400-600 mg/day
  5. 3- 6 months
  6. HLA-B*5801 , aa, korean, han chinese, thai
17
Q

Allupurinol
1) advantages? (3)

2) Precautions
-Can cause precipitation of ?
-G
-P
-Caution in ___
-DDI’s (3)
-Severe ___ syndrome that is rare and ___, life threatening ____, f, e, d,h,r,v
-inr risk of this in ___ and doses ___

A
  1. convenience
    -efficacy irrespective of cause of hyperuricemia
    -can be efficacious in pt’s w/renal insuffiency
    • acute gout
      - GI (N/V) , incr LFTS
      - Pruritis, rash
      -renal failure
      -Azathioprine, mercaptopurine, warfarin
      -hypersensitivity
      -dose dependent
      -multiorgan failure
      -fever, eosinophilia, dermatities, hepatic dysfunction, renal failure, vasculitis
  • renal failure and doses > 200-400 mg /day
18
Q

Febuxostat

  1. Dose?
  2. Increase to what dose after 2-5 weeks until target serum uric acid level achieved?

-Adjustments for mild or mod renal or hepatic dysfunction?

-Caution in severe hepatic/renal since not studied

  1. consider NOT using in which patients?
A
  1. 40 mg PO DAILY
  2. 80 mg PO daily

-None

  1. new or history of ASCVD event
19
Q

Febuxostat (Uloric)
1) Precautions because it can increase what during initiation ?

2) use prophylactic therapy for how long?

3) CI with ?

4) AE’s?

A
  1. gout flares
  2. NSAIDS/ colchicine for 3-6 months
  3. XO substrate drugs : azathioprine, mercaptopurine, thoephylline
  4. Incr cardiovasc thromboembolic events , incr liver enzymes (monitor every 2 months)
    -liver function abnormalities
    -nausea
    -arthralgia
    -rash
20
Q

Uricosuric Agents
1) What place are they in therapy ?
2) Patients that are ___ of ___
and in combination for ___
3) name 3 drugs

A
  1. second line therapy
  2. intolerant of xanthine oxidase inhibitors , refractory hyperuricemia
  3. probenacid, pegloticase, lesinurad
21
Q

Probenacid
1) Advantages

Precautions

  1. Precipitation of ___
  2. CI in ?
  3. Avoid in pt’s with ?
  4. modifies ___ of other drugs
  5. DDI’s with ? (3)

Dosing
1. Only if CrCL is ?
2. Dosing ?

  1. Dose adjust based on ?
A
  1. no life threatening hypersensitivity rxns
  2. acute gout
  3. history of urolithiasis
  4. 24 h urine uric acid >= 700 mg
  5. renal clearance of other drugs
  6. Heparin, salicylates, abx
  7. > 50 mL/min
  8. 500 mg PO Qdaily to BID
  9. pt response and tolerance
22
Q

Krystexxa (pegloticase)

1) approved for ?
2) Define refractory gout ?
3) Dose ?
4) Precautions? A, I, G, H
5) CI?

6) What are the BBW’s?
7) what program
8) AE’s?

A
  1. chronic gout refractory to conventional therapies
  2. tx failure gout that has ongoing sx’s of active disease
    -cant maintain serum urate < 6 mg/dL
    -DECR QOL, functional impairment, joint destruction
  3. 8 mg IV infusion over 120 min q 2 weeks
  4. Anaphylaxis, infusion rxns, gout flares (during 1st 3 months of tx) –> start gout flare px with nsaid or colch 1 week before initiation , HEART FAILURE
  5. G6PD deficiency
  6. Anaphylaxis and infusion rxns
  7. REMS
  8. N/V, ecchymosis, nasopharyngitis, constipation and chest pain
23
Q

Non pharm TX

1) Acute attacks (2)
2) Chronic prevention ? (3)
3) foods to avoid?
limit?
Encouraged?

A
  1. rest and ice for inflamm.
  2. Diet, lifestyle (weight , smoking, exercise) ,
    -avoid drugs causing hyperuricemia (Ethanol, vit b12, cyclosporine, thiazide and loop diuretics, ethambutol, aspirin, levodopa)

-Organ meats, high fructose corn syrup and excess ETOH
-Large portions of meat or seafood , sugar
-Lowfat or non fat dairy + veggies

24
Q

Special pop and what to be cautious of

A

See chart

Humber Cardio FINAL (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions