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Pharm II-Exam 3 > Gout > Flashcards

Gout Flashcards

1
Q

Risk of gout is defined as what level of uric acid in women?

A

> 7 mg/dL

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2
Q

Risk of gout is defined as what level of uric acid in men?

A

> 6 mg/dL

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3
Q

What accounts for 90% of the reason/pathophys for gout in pt’s?

A

Underexcretion of uric acid:

Relative decrease in renal excretion of uric acid for an unknown reason=Primary Idiopathic hyperuricemia

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4
Q

List high and moderately high purine rich foods (5-100 mg/3.5 oz serving)

A
  1. Meats: beef, seafood

2. Fast-growing vegetables: spinach, asparagus

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5
Q

List very high purine rich foods (1,000 mg/3.5 oz serving)

A

Anchovies
Organ meats
Sardines

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6
Q

How much purines does the average daily US diet contain?

A

600-1,000 mg

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7
Q

List the drugs that can induce hyperuricemia

A
  1. Cytotoxic drugs
  2. Cyclosporine
  3. Diuretics
  4. Ethanol
  5. Ethambutol
  6. Levodopa
  7. Nicotinic acid
  8. Pyrazinamide
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8
Q

How long does an acute gout attack last for?

A

3-10 days

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9
Q

List the two components of chronic gout

A
  1. Rheumatoid-like

2. Tophaceous Gout: Monosodium urate in soft tissues and joints

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10
Q

What is the definitive diagnosis for gout?

A

Tapping joint and microscopic exam for uric acid crystals

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11
Q

List the anti-inflammatory of choice in the treatment of gout

A

DMARDs

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12
Q

List the treatment for acute gout

A
  1. NSAIDs

2. Corticosteroids

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13
Q

List the treatment for chronic gout

A
  1. Colchicine
  2. Probenicid (uricosuric)
  3. Allopurinol, febuxostat: xanthine oxidase inhibitors
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14
Q

Colchicine MOA

A
  1. Decreases macrophage migration and phagocytosis

2. Inhibits leukotriene B4=Decreases inflammation

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15
Q

When does Colchicine need to be administered?

A

Within 36 hrs. of acute attack onset

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16
Q

Colchicine dosing

A

1.2 mg followed by 0.6 mg in 1 hr

17
Q

Colchicine ADE’s

A

Dose-dependent GI ADE’s: N/V/D

18
Q

When is dose adjustment recommended in Colchicine?

A

When used with:

  1. Selected CYP3A4
  2. P-glycoprotein inhibitors
19
Q

List the oral form of corticosteroids used in gout

A

Oral Methylprednisolone dose pack

20
Q

List the IM form of corticosteroids used in gout

A

IM Triamcinolone: to be followed by oral prednisone or prednisolone

21
Q

When would you consider using intra-articular (TAC-Kenalog) administration?

A

Only 1-2 joints are involved

Used in combo with NSAIDs, Colchicine or oral corticosteroids

22
Q

What type of medications are needed during the initiation of rate-lowering therapy? for how long?

A

Anti-inflammatories:
@ least 6 months OR
3-6 months after achieving target serum uric acid

23
Q

What are the anti-inflammatory options during the initiation of rate-lowering therapy

A
  1. Colchicine 0.6 mg 1-2x daily
  2. Low dose NSAIDs w/ PPI
  3. Prednisone <10 mg/day
24
Q

What is efficacious for the prophylaxis of recurrent gout attacks in BOTH underexcreters and overprices of uric acid?

A

Xanthine Oxidase Inhibitors (XOI):

  1. Allopurinol
  2. Febuxostat
25
What are the indications for initiating Allopurinol or Febuxostat (XOI's)
1. 2 or more gout attack per year 2. 1 or more tophus 3. CKD (stage II or worse) 4. Hx urolithiasis
26
What ADE do you want to educate your patients about when using Allopurinol?
Acute Hypersensitivity Syndrome (AHS)
27
What high risk populations (for AHS) do you consider genetic testing in?
1. Koreans w/ CKD | 2. Han Chinese and Thai irrespective of renal function
28
Allopurinol MOA
IRREVERSIBLY inhibits xanthine oxidase=lowers uric acid production
29
Febuxostat MOA
REVERSIBLE inhibitor of xanthine oxidase
30
Febuxostat is CI with the use of what?
Azathioprine
31
Febuxostat ADE
Liver enzyme elevation
32
Febuxostat toxicities
1. Liver function test 2. Renal function *BUT NO dose adjustments in pt's with mild/mod renal (CrCL 30-89) or hepatic impairment
33
What is the effect of Probenecid?
Increase uric acid excretion
34
What is the benefits and considerations in using XOI + Fenofibrate or losartan?
1. Augments uric acid excretion | 2. Beneficial in pt's with other disorders
35
When would you consider using for refractory gout to conventional therapy?
Pegloticase= Biologic
36
What must you use with Lesinurad? Why?
Combo w/ XOI's d/t increased risk of acute renal failure with mono therapy
37
List the Interleukin-1 Inhibitors and indications for them
Anakinra Rilonacept Canakinumab ACUTE gout Refractory to traditional therapy CI to current tx's

Pharm II-Exam 3 (4 decks)

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