Gout and hyperuricemia day 2 Flashcards
(55 cards)
What agent is first line in acute gout attack?
NSAID
What is the most common NSAID used for treatment of gout?
Indomehacin 50 mg TID but any are good
What is the treatment course of NSAIDS?
start within 24 hours of onset
use maximal doses
continue until complete resolution then tamper over 2-3 days
What are the adverse effects of NSAIDs?
GI
renal impairment
increased BP
When do you use caution with NSAIDs?
peptic ulcer disease HF uncontrolled HTN renal impairment CAD
Based on ACR when is it recommended to give colchicine?
within 36 hours
What is the MOA of Colchicine?
interferes with inflammation
inhibits phagocytosis
blocks release of chemotactic factors
What is the dose of colchicine?
1.2 mg initially then .6 mg an hour later
off label is 1.2 mg initially then .6 12 hours later and continute 1-2x/day until resolved
NO renal adjustments
What are the adverse reactions for colchicine?
N/V/D
neutropenia
neuromyopathy
What are the drug interactions of Colchicine?
dose adjustments with PGP and CYP 3A4 drugs (azoles, macrolides especially clarithromycin)
When is Colchicine contraindicated?
renal or hepatic impairment with PGP or strong CYP 3A4 inhibitor
When do you use corticosteroids?
when no response with NSAIDs or Colchicine
What is the oral dosing of corticosteroids?
prednisone .5 mg/kg QD for 5-10 days
prednisone .5 mg/kg daily for 2-5 days then tampered down
methylprednisolone dose pack (6 days)
What is the Intraarticular dose and when is it used for corticosteroids?
if only 1-2 joints.
Triamcinolone 20-40 mg
What is the dose of IM for corticosteroids?
methylprednisolone single dose and followed by oral
When do you use caution with corticosteroids?
history of GI problems bleeding disorder CV disease DM Pyschiatric dosorder
What 2 classes off treat acute gout?
IL- 1 inhibitors and Corticotropin
What IL-1 inhibitors help with gout and their dose?
Anakinra 100 mg SQ x3
Canakinumab 150 mg SQ for 1 dose
What is the dose of Corticotropin and how does it work?
40- 80 IM every 6-8 hours for 2-3 days
stimulates the adrenal cortex to produce cortisol and corticosterone
What do you use to treat for chronic prophylactic treatment?
Urate lowering therapy
What methods can you used to decrease urate concentration?
decrease synthesis of uric acis (xanthine oxidase inhibitor)
increase renal excretion of uric acid (uricosurics)
When can you use ULTs?
NOT to treat flare
can be started and continued during flare
What agents and doses are used with ULTs?
Colchicine .6 mg BID and .3 mg if renal problems
low dose NSAID (naproxen 250 mg bid)
2nd line: low dose corticosteroid of <10mg/day
how long do you need to use the anti-inflammatory with ULT?
at least 3 months but typically 6 and if have tophi, use for 6 months after target reached
