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Clinical 2.0 winter > Gout > Flashcards

Gout Flashcards

1
Q

presentation of gout

A 
sudden 
extreme pain 
redness
systemic - fever and chills 
warmth
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2
Q

modifiable risk factors

A 
hyperuricemia 
hypertension
obesity 
diabetes
alcohol consumption 
high purine intake 
drugs
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3
Q

non modifiable risk factors

A

CKD
male gender
age
family history

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4
Q

hyperuruicemia uric acid levels in males

A

> 480umol/L

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5
Q

hyperuricemia uric acid levels in females and why are they lower than males

A

> 420umol/L
estrogen promotes excretion of uric acid
after menopause closer to male levels

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6
Q

uric acid production

A

breakdown of dna into purines that degrade into uric acid

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7
Q

dietary sources

A

high protein meat
fish
beer

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8
Q

causes of uric acid overproduction

A

diet - only plays a role if secondary metabolic problem
tissue breakdown
metabolic derangement
cancer blast cells have a high death rate do lots of dna being degraded

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9
Q

causes of uric acid underexcretion

A

renal abnormalities

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10
Q

why does poor kidney function affect uric acid levels

A

lots of movement in and out of the kidney

kidney excretes the uric acid

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11
Q

why does gout occur in peripheral sites

A

solubility decreases as the temp of the tissue decreases

as get further from the body the temp is decreased

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12
Q

things you need for gout to occur

A

high uric acid levels
colder temp of the body
joint that has been damaged in some way

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13
Q

how fast does gout occur

A

over night

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14
Q

how long for recovery if left untreated

A

3-14 days

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15
Q

joint affected in gout

A 
toe 
instep
ankle 
heel
knee
wrist
finger 
elbow
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16
Q

precipitating factors for an attack

A 
stress or trauma
alcohol 
infection 
surgery 
rapid lowering of serum uric acid****
drugs that increase uric acid
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17
Q

issues with measuring serum uric acid level

A

will be normal bc the uric acid is redistributed into the joint and draws down the plasma level even tho its normally high

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18
Q

labs to get

A

serum uric acid level
creatinine and BUN
if other sx present that may relate to cancer get a CBC

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19
Q

chronic complications of gout

A

nephrolithiasis (uric acid stones in kidneys)
gouty nephropathy acute or chronic
tophi formation - fluid accumulation

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20
Q

what is chronic tophaceous gout

A

chronic urate deposits in catilage, tendons, and synovial membranes
occur when intercritical periods no longer pain free
intermittent acute gout for 10 years

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21
Q

treatment goals

A

relieve pain and inflammation within 48hrs of an attack
complete resolution of symptoms in 7 days
reduce uric acid levels to below 360umoléL
prevvent recurent attacks
prevent chronic complications

22
Q

drugs for acute gouty arthritis

A

nsaids
cox2 inhibitor
colchicine
corticosteroids

23
Q

short term prophylactic drugs

A

colchicine

nsaid low dose

24
Q

long term prophylactic drugs

A

allopurinol

febuxostat

25
Q

drugs that can cause hyperuricemia

A 
diuretics (thiazide)
salicylates
theophylline
glucocorticoids
ketoconazole
cyclosporin
tacrolimus
26
Q

ibuprofen dose

A

600 QID

27
Q

naproxen dose

A

750 then 500 BID

28
Q

indomethacin dose

A

50 TID

29
Q

celceoxib dose

A

400 BID x 2days then 200 BID

30
Q

initiation and stoping for nsaids in acute flare

A

use max dose at first sign of attack
lower dose as symptoms resolve
leave on until joint pain has resolved totally for 48hrs (10 days )

31
Q

other prescriptions to give with nsaids

A

PPI for gut protection

more for next acute attack

32
Q

colchicine drug interactions

A

cyo 2A4 inhibitors: diltiazem, verapamil, itraconazole, fluconazole, clarithromycin
statins and fibrates increase myalgia

33
Q

colchicine dosing acute flare

A

1.2mg followed by 0.6mg in one hour

if tkaing prophylaxis just stop during treatment and resume in 12 hours

34
Q

prednisone dosing acute

A

20-40mgéday for 4 days then taper over 1-2 weeks

pain relief in 12-48hrs

35
Q

how to determine whether to use prophylactic therapy

A

serum urate concentration after attack has resolved

36
Q

short term prophylaxis in patients with no tophi and normal or slightly elevated uric acid levels

A

colchicine 0.6mg BID

low dose NSAID

37
Q

when to stop short term prophylaxis

A

uric acid normal and patient symptoms free for 6 months

38
Q

when would you consider urate lowering therapy

A

recurrent attack, arthropathy, xray chages
tophi
gout with CKD
recurring renal stones
need for ongoing diuretic treatment after first attack

39
Q

BP lowering therapies to use instead of hydrochlorothiazide, beta blockers, ACEI

A

CCB

losartan

40
Q

goal of urate lowering therapy

A

<360umol/L

41
Q

allopurinol MOA

A

blocks conversion of hypoxanthine to xanthine then uric acid

42
Q

what is allopurinol hypersensitivity syndrome

A

isolated rash

severe cutaneous reactions, fever, eosinophilia, leukocytosis, renal involvement and hepatitis

43
Q

risk factors for allopurinol hypersensitivity syndromr

A

recent onset of therapu
CKD
thiazides

44
Q

initiating urate lowering therapy (prophylaxis)

A

start with rpophylactic therapy for the first 6 months
colchicine 0.6mg BID if crcl>50
or low dose nsaid naproxen 250 BID

45
Q

when to start allopurinol

A

3 weeks after resolution of acute attack

initiat prophylactics 2 weeks before start

46
Q

dosing of allopurinol

A 
100mg OD (50 if <50crcl)
titrate up 100mg every month until target of <360
dose beyond 300mg/day if needed
47
Q

do you dicontinue allopurinol in acute flares

A

no

48
Q

avoid combo of allopurinol or febuoxstat and

A

azathioprine
6 MP
block thier secretion adn get serious toxicity

49
Q

febuxostat MOA

A

potent non purine selective inhibitor of xanthine oxidase

50
Q

febuxostat doseing

A

40mg daily
titrate to 80mg after 2 weeks if serum >360
no dose adjustment in crcl>30
safe in moderate hepatic impaiement

51
Q

when would you use febuxostat

A

allergic to allopurinol

also continue prophylaxis for 6 months withthis

52
Q

non pharms

A

drink dairy?
vit c?
comfortable shoes
reduce alcohol

Clinical 2.0 winter (28 decks)

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