Gout

Question 1

Normal serum values of uric acid

Answer 1

2-7 mg/dL but this is not diagnostic

Question 2

Gout-contributing factors

Answer 2

heredity, gender, age, diet, alcohol, low fluid intake, cancer, radiation therapy

Question 3

Drug induced gout

Answer 3

diuretics, nicotinic acid, salicylates, EtOH, glucocorticoids, levodopa, chemotherapy, sulfa antibiotics

Question 4

4 stages of gout

Answer 4

asymptomatic hyperuricemia, acute gouty arthritis, interval gout, chronic taophaceous gout

Question 5

2 types of gout

Answer 5

over-producers or under excretors

Question 6

Non-pharmacological approach to gout treatment

Answer 6

drink lots of water, avoid EtOH, weight loss, dietary changes

Question 7

Drugs for gout

Answer 7

NSAIDs (INdometacin, ibuprofen, naproxen), calchicine (Colcrys), corticosteroids (prednisone, methylpredneisolone), probenecid (Benemid), Allopurinol (Zyloprim), Febuxostat (Uloric)

Question 8

Treatment for acute gouty attacks

Answer 8

NSAIDs, Colchicine, corticosteroids

Question 9

Colchicine (Colcrys) MOA

Answer 9

inhibits migration of granulocytes, which ultimately prevent uric acid deposits

Question 10

Colchicine (Colcrys) ADRs

Answer 10

Diarrhea, N/V/abdpain

Question 11

Colchicine (Colcrys) dosing

Answer 11

must wait 3 days before another course can be given, must adjust if CrCl

Question 12

Contraindication of Colchicine (Colcrys)

Answer 12

if anuric

Question 13

NSAIDs MOA

Answer 13

inhibit prostaglandin synthesis

Question 14

NSAID most studied for gout

Answer 14

Indomethacin

Question 15

Other NSAIDs for gout

Answer 15

naproxen or ibuprofen

Question 16

Corticosteroids for gout

Answer 16

reserved for pt that fail colchicine or NSAIDs, prednisone, methylprednisolone, triamcinolone

Question 17

Intraarticular injection of corticosteroid

Answer 17

Triamcinolone

Question 18

Initiate prophylactic treatment if

Answer 18

severe attack of gouty arthritis, complicated course, serum uric acid level greater than 10 mg/dL, 24 hour urinary excretion greater than 1000mg, pt has 2-3 attacks/year

Question 19

Colchicine (Colcrys) for prophylactic treatment

Answer 19

only give once daily, d/c if sx free for >1 year

Question 20

Allopurinol (Zyloprim) MOA

Answer 20

xanthine oxidase inhibitor, preventing synthesis of uric acid

Question 21

Allopurinol (Zyloprim)

Answer 21

ideal for over-producers, not for acute attack, adjust renal

Question 22

Allopurinol (Zyloprim) ADRs

Answer 22

rash, can lead to Steven’s Johnson syndrome

Question 23

Febuxostat (Uloric)

Answer 23

Me too, $$$, once daily, no adjust, niche: more effective than allopurinol

Question 24

Febuxostat (Uloric) MOA

Answer 24

xanhine oxidase inhibitor, prevent synthesis of uric acid

Question 25

Febuxostat (Uloric) ADR

Answer 25

elevated liver enzymes

Question 26

Probenecid (Benemid)

Answer 26

good for under excretors, do not use if CrCl

Question 27

Probenecid (Benemid) MOA

Answer 27

Competitive inhibition of reabsorption of uric acid in the proximal convoluted tubule of the nephron, promoting urinary excretion of uric acid

Question 28

Probenecid (Benemid) ADRs

Answer 28

GI upset (take with food), renal uric acid stones, usually well-tolerated