Flashcards in Gout Deck (37)
Risk of gout is defined as what level of uric acid in women?
Risk of gout is defined as what level of uric acid in men?
What accounts for 90% of the reason/pathophys for gout in pt's?
Underexcretion of uric acid:
Relative decrease in renal excretion of uric acid for an unknown reason=Primary Idiopathic hyperuricemia
List high and moderately high purine rich foods (5-100 mg/3.5 oz serving)
1. Meats: beef, seafood
2. Fast-growing vegetables: spinach, asparagus
List very high purine rich foods (1,000 mg/3.5 oz serving)
How much purines does the average daily US diet contain?
List the drugs that can induce hyperuricemia
1. Cytotoxic drugs
7. Nicotinic acid
How long does an acute gout attack last for?
List the two components of chronic gout
2. Tophaceous Gout: Monosodium urate in soft tissues and joints
What is the definitive diagnosis for gout?
Tapping joint and microscopic exam for uric acid crystals
List the anti-inflammatory of choice in the treatment of gout
List the treatment for acute gout
List the treatment for chronic gout
2. Probenicid (uricosuric)
3. Allopurinol, febuxostat: xanthine oxidase inhibitors
1. Decreases macrophage migration and phagocytosis
2. Inhibits leukotriene B4=Decreases inflammation
When does Colchicine need to be administered?
Within 36 hrs. of acute attack onset
1.2 mg followed by 0.6 mg in 1 hr
Dose-dependent GI ADE's: N/V/D
When is dose adjustment recommended in Colchicine?
When used with:
1. Selected CYP3A4
2. P-glycoprotein inhibitors
List the oral form of corticosteroids used in gout
Oral Methylprednisolone dose pack
List the IM form of corticosteroids used in gout
IM Triamcinolone: to be followed by oral prednisone or prednisolone
When would you consider using intra-articular (TAC-Kenalog) administration?
Only 1-2 joints are involved
Used in combo with NSAIDs, Colchicine or oral corticosteroids
What type of medications are needed during the initiation of rate-lowering therapy? for how long?
@ least 6 months OR
3-6 months after achieving target serum uric acid
What are the anti-inflammatory options during the initiation of rate-lowering therapy
1. Colchicine 0.6 mg 1-2x daily
2. Low dose NSAIDs w/ PPI
3. Prednisone <10 mg/day
What is efficacious for the prophylaxis of recurrent gout attacks in BOTH underexcreters and overprices of uric acid?
Xanthine Oxidase Inhibitors (XOI):
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
What ADE do you want to educate your patients about when using Allopurinol?
Acute Hypersensitivity Syndrome (AHS)
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
IRREVERSIBLY inhibits xanthine oxidase=lowers uric acid production
REVERSIBLE inhibitor of xanthine oxidase
Febuxostat is CI with the use of what?
Liver enzyme elevation
1. Liver function test
2. Renal function
*BUT NO dose adjustments in pt's with mild/mod renal (CrCL 30-89) or hepatic impairment
What is the effect of Probenecid?
Increase uric acid excretion
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
When would you consider using for refractory gout to conventional therapy?
What must you use with Lesinurad? Why?
Combo w/ XOI's d/t increased risk of acute renal failure with mono therapy