Gout

Question 1

Gout characterized by

Answer 1

Characterized biochemically by extracellular fluid urate saturation
Hyperuricemia – serum > 6.8 mg/DL

Question 2

Gout is not just a

Answer 2

Not just a bone and joint issue

Question 3

gout can cause

Answer 3

Increased hypertension (HTN) and cardiovascular (CV) risks associated with higher uric acid level
Dietary Approaches to Stop Hypertension (DASH) diet not only helps in heart disease but also gout

Question 4

old gout diets ar

Answer 4

Old gout diets not supported by evidence

Question 5

gout what is key

Answer 5

Fluid intake is key

Question 6

Gout managment

Answer 6

Acute management of gout flare-ups
Systemic and intra-articualar glucocorticoids, NSAIDs, and colchicine
Prevention of re-current gout flares and damage to joints and other tissues
Urate-lower drugs

Question 7

Gout - drug examples

Answer 7

Colchicine and Probenecid, pegloticase, and lesinurad impact uric acid excretion (probenecid) or change it into inert substances

Question 8

Colchicine does not

Answer 8

Does not impact purine metabolism

Question 9

Colchicine major issue

Answer 9

Major issue of impacting granulocytes, but this does reduce deposits of uric formation

Question 10

Colchicine is

Answer 10

Is pain med, but not an analgesic

Is anti-inflammatory

Question 11

Colchicine mostly used

Answer 11

used as prophylactic or during acute attack

Question 12

Probenecid, pegloticase, and lesinurad impact uric acid excretion (probenecid) or change it into inert substances
Deposits are

Answer 12

reduced and deposition retarded

NOT monotherapy drugs

Question 13

Xanthine Oxidase - Uses on

Answer 13

Uses on patients with gout
To inhibit inflammation
Prevent synthesis of uric acid
Must not disrupt the biosynthesis of vital purines

Question 14

Xanthine Oxidase do not need

Answer 14

for inflammatory agents (indocin) and steroids (in advanced renal disease)

Question 15

Gout meds not used

Answer 15

in pregnancy except for probenecid

Question 16

Gout Meds not used in childern except

Answer 16

children except for uricemia of malignancy

Question 17

Uric acid crystals when

Answer 17

crystals when mobilized can precipitate renal stones

Question 18

Gastrointestinal (GI) disturbances

Answer 18

Gastrointestinal (GI) disturbances abound, and peptic ulcers can occur

Question 19

Probenecid is

Answer 19

Probenecid is sulfa based

Question 20

Allopurinol causes

Answer 20

causes hypersensitivity rash (higher in blacks and Hispanics)

Question 21

Colchicine results in

Answer 21

Colchicine results in myopathy, weakness, neuropathy and malabsorption of B12

Question 22

Uric acid more toxic

Answer 22

Uric acid more toxic in older adults
Probenecid is drug of choice
Allopurinal can be used for renal impairment
More likely toxic when combined with thiazides

Question 23

Off-label use of chochicine in

Answer 23

pericarditis and sclerodema (seek consultation)

Question 24

Bone loss occurs when there is imbalance

Answer 24

between osteoblast and osteoclast activities.

Question 25

Osteoporosis is diagnosed when bone density is

Answer 25

2.5 standard deviations below average.

Question 26

Bone is histologically and biochemically

Answer 26

normal

Question 27

Osteoporosis risk for

Answer 27

fractures, especially at areas of stress, increases.

Question 28

Osteoporosis Risk Factors

Answer 28

``` Family history, Age greater than 70 years Slight build Fair complexion Low calcium and/or vitamin D diet Minimal sun exposure Weight less than 70 kg Sedentary lifestyle ```

Question 29

osteoprosis risk factors continueed

Answer 29

Glucocorticoid use greater than 5 mg/day for longer than 3 months Anticonvulsants (phenobarbitol, phenytoin, carbamazepine) Long-term proton pump inhibitor Heavy tobacco or alcohol use Aromatase inhibitors Young African American women have higher bone density, but risk increases with age. Traditionally have lower calcium intake Asian women are at high risk. Traditionally consume inadequate calcium Hispanic women have similar risk as white women

Question 30

Pharmacodynamics - Estrogen prevents

Answer 30

bone resorption action of PTH.

Question 31

bone resorption action of PTH.

Answer 31

Have estrogenic effects on bone | Raloxifene (Evista)

Question 32

Bisphosphonates reduce bone

Answer 32

resorption by inhibiting osteoclast activity.

Question 33

Calcium and vitamin D together

Answer 33

not individually) prevent and treat osteoporosis.

Question 34

Osteoperosis what is the best treatment

Answer 34

Prevention is the best treatment. Adequate calcium intake with vitamin D Low-impact bone-strengthening exercise (not swimming)

Question 35

osteoprosis no evidence of

Answer 35

optimal time of duration Some molecules have 10-year half-life! Starting medications in osteopenia status no longer considered good practice for most patients This may vary with oncology patients on aromatase inhibitors

Question 36

Estrogen - low

Answer 36

Low-dose therapy maintains bone mineral density (BMD)

Question 37

calcium combination of

Answer 37

Combination of diet and calcium supplement to meet daily requirement Vitamin D required to enhance absorption

Question 38

bisphonates no

Answer 38

longer used for preventative therapy! First-line therapy for postmenopausal women with osteoporosis First-line therapy for men older than age 70 years with osteoporosis

Question 39

Selective estrogen receptor modulators (SERMs):

Answer 39

Reloxifene (Evista) is prototype, newer agents available | Also protective against breast cancer

Question 40

Teriparatide (human PTH)

Answer 40

Reserved for highest-risk patients who cannot take bisphosphonates or do not respond to them Questionable cancer risk

Question 41

Denosumab: expensive

Answer 41

All the risks of other biologicals

Question 42

Before treatment, rule out other disorders that may cause further low bone density. such as

Answer 42

Hyperparathyroidsim Vitamin D deficiency Hyperthyroidism Renal disease

Question 43

Measure BMD | loss and gold standard

Answer 43

Measure BMD

Question 44

DEXA Screening sholuld be used for

Answer 44

Women who are long-term estrogen deficient Women and men with vertebral abnormalities Monitoring treatment of osteoporosis No firm guideline for how often to do so Patients on long-term glucocorticoid or thyroid therapy Patients with diseases that have the risk of osteoporosis development Women older than age 40 years who have a fracture

Question 45

dexa screening all women older than

Answer 45

65 for baseline evaluation

Question 46

Additional considerations | for Dexa

Answer 46

Body weight less than 127 lb or body mass index (BMI) of 20 or less Current smoker Surgical menopause at age less than 40 years Amenorrhea for more than a year in premenopausal female Immobility for over 1 year

Question 47

Osteopenia begins

Answer 47

Osteopenia 2 to 5 years after menopause if no HRT/estrogen therapy No evidence for how fast or IF patient will progress to osteoporosis

Question 48

Consider referral for

Answer 48

complex cases or those who do not respond to therapy