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Flashcards in Gout Deck (37)
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1

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

>7 mg/dL

2

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

>6 mg/dL

3

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

4

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

5

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

Anchovies
Organ meats
Sardines

6

How much purines does the average daily US diet contain?

600-1,000 mg

7

List the drugs that can induce hyperuricemia

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

8

How long does an acute gout attack last for?

3-10 days

9

List the two components of chronic gout

1. Rheumatoid-like
2. Tophaceous Gout: Monosodium urate in soft tissues and joints

10

What is the definitive diagnosis for gout?

Tapping joint and microscopic exam for uric acid crystals

11

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

DMARDs

12

List the treatment for acute gout

1. NSAIDs
2. Corticosteroids

13

List the treatment for chronic gout

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

14

Colchicine MOA

1. Decreases macrophage migration and phagocytosis
2. Inhibits leukotriene B4=Decreases inflammation

15

When does Colchicine need to be administered?

Within 36 hrs. of acute attack onset

16

Colchicine dosing

1.2 mg followed by 0.6 mg in 1 hr

17

Colchicine ADE's

Dose-dependent GI ADE's: N/V/D

18

When is dose adjustment recommended in Colchicine?

When used with:
1. Selected CYP3A4
2. P-glycoprotein inhibitors

19

List the oral form of corticosteroids used in gout

Oral Methylprednisolone dose pack

20

List the IM form of corticosteroids used in gout

IM Triamcinolone: to be followed by oral prednisone or prednisolone

21

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

22

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

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

23

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

24

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

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