Gout

Question 1

What is Gout?

Answer 1

• type of Arthritis caused by a build up of uric acid in the joints (uric acid is made from purine synthesis metabolisim - later card)

Question 2

In what location of the body does gout normally attack at?

Answer 2

• Metatarsophalangeal joint or the Big Toe Joint

Question 3

What are some risk factors for Gout?

Answer 3

• Male
• Obesity
• Excessive alcohol (i.e.; Beer)
• Hypertension
• CKD
• Elderly
• Medications

Question 4

What medications can increase uric acid in the body resutling in possible Gout?

Answer 4

• Aspirin (low doses)
• Cyclosporine
• Diuretics (loops and Thiazides)
• Niacin
• Pyrazinamide

Question 5

What are some treatment options to help with the acute gout attacks?

Answer 5

• Colchicine (colcrys)
• NSAIDs
• Steroids
• Interleukin-1 Antagonists [For those that cant tolerate the other 3 options here]

Question 6

What are some contraindications for Colchicine used for Gout?

Answer 6

• DO NOT use with P-gp or 3A4 Inhibitors with renal and/or hepatic impairment (Fatal Toxicity)

Question 7

What are some warnings for colchicine used for Gout?

Answer 7

• Myelosuppression
• Increased Myopathy Risk (when taking with: cycolsproine, diltiazem, verapamil, gemdibrozil, statins)

Question 8

What are some side effects for colchicine used for Gout?

Answer 8

• Diarrhea, Nausea, Myopathy, Neuropathy (dose limiting), decreased Vit B12

Question 9

What are some additional notes for Colchicine used for Gout?

Answer 9

• Start within 36 hours of symptom onset
• Wait 12 hours after treatment before resuming prophylaxis dosing

Question 10

What are some NSAIDs that are used for Gout?

Answer 10

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

Question 11

What are some additional notes for NSAIDs used for Gout?

Answer 11

• Avoid use in severe renal disease and CVD risk
• Other NSAIDs can be used too

Question 12

What are some Steroids that are used for gout?

Answer 12

• Prednisone/Prednisolone
• Methylprednisolone (Medrol, Solu-Medrol)

Question 13

What are some additional notes for steroids used for Gout?

Answer 13

• Increases BG, BP, Insomnia, Appetite
• Can be PO, IM, IV, Intra-articular (if 1-2 joints)

Question 14

What are some of the prophylactic treatment options for gout?

Answer 14

• Colchicine, NSAIDs, Steroids (reduce risk of attacks)
• Allopurinol (1st line)
• +/- Probenecid
• +/- Pegloticase

Question 15

What is the way that uric acid/gout forms within the body?

Answer 15

• Adenosine –> Hypoxanthine –xanthine oxidase–> Xanthine –xanthine oxidase–> Uric Acid (–> allantoin or renal clearence) = GOUT

Question 16

What is the MOA for Allopurinol?

Answer 16

• Blocks xanthine oxidase from producing Uric Acid and makes a non-toxic end product

Question 17

What are some warnings for allopurinol used for Gout?

Answer 17

• Hypersensitivity reactions (severe rash): need to get HLA-B * 5801 testing before using (esp. in asian descent, african americans…) and DO NOT use if positive
• Hepatotoxicity

Question 18

What are some side effects for allopurinol used for Gout?

Answer 18

• Ras, Gout flare, Nausea

Question 19

What are some additional notes for allopurinol used for Gout?

Answer 19

• Titrate dose up until UA level are < 6
• Due to gout flare, Colchicine or NSAIDs are given for the first 3 - 6 months

Question 20

What are some boxed warnings for febuxostat used for Gout?

Answer 20

• Increased CV death compared to those taking allopurinol; should limit to those that cant tolerate allopurinol

Question 21

What are some warnings for febuxostat used for Gout?

Answer 21

• Hepatotoxicity
• Serious skin reactions

Question 22

What are some side effects for febuxostat used for Gout?

Answer 22

• Rash, Nausea, increased LFTs, Arthralgia

Question 23

What are some additional notes for febuxostat used for Gout?

Answer 23

• Due to Gout flare; Colchicine or NSAIDs are given for the first 3 - 6 months

Question 24

What is the MOA of probenecid ?

Answer 24

• Inhibits reabsorption of uric acid in the kidneys = incresing excretion

Question 25

What are some **additional notes** for **prodenecid** used for **Gout**?

Answer 25

- Can help **increase beta-lactam levels**

Question 26

What is the **MOA** of **Pegloticase**?

Answer 26

- **converts** uric acid to **allantoin** which gets excreted

Question 27

What are some **Boxed warnings** for **pegloticase** used for **Gout**?

Answer 27

- **Anaphylactic Reactions** (premedicate with Antihistamines & steroids)

Question 28

What are some **contraindications** for **pegloticase** used for **Gout**?

Answer 28

- G6PD Deficiency

Question 29

What are some **additional notes** for **pegloticase** used for **Gout**?

Answer 29

- DO NOT use with allopurinol, febuxostat or probenecid