Gout Therapy

Question 1

Recurrent episodes of pain and joint inflammation due to formation os crystals and deposition of those crystals in soft tissues is…

Answer 1

Gout

Question 2

What is deposited in gout?

Answer 2

Monosodium urate monohydrate (MSU( crystals

Question 3

What is the cause of gout?

Answer 3

Hyperuricemia

Question 4

Deposition of calcium pyrophosphate (CPP) crystals is associated with…

Answer 4

Pseudogout

Question 5

What disorder is also referred to as Calcium Pyrophosphate Disease (CPPD)

Answer 5

Pseudogout

Question 6

T or F: Humans lack the enzyme uricase.

Answer 6

True

Question 7

Uricase function:

Answer 7

turns uric acid to allantoin (soluble form)

Question 8

What enzyme is responsible for conversion of Hypoxanthine –> Xanthine –> Uric Acid?

Answer 8

Xanthine oxidase

Question 9

What is the drug that acts on xanthine oxidase function?

Answer 9

Allopurinol

Question 10

Intermittent acute attacks that spontaneously resolve typically over a period of 7-10 days with asymptomatic periods between attacks is ______ gout

Answer 10

Phase 1

Question 11

Inadequately treated hyperuricemia can cause a transition to _____ gout

Answer 11

Second Phase

Question 12

Which gout phase is manifested as chronic tophaceous gout which often involves polyarticular attacks, symptoms between attacks, and crystal deposition (tophi) in soft tissues or joints?

Answer 12

Second phase

Question 13

Severe degenerative arthritis, secondary infections, urate or uric acid nephropathy, nerve or spinal chord impingement, increased infection risk, renal stones, and fractures are…

Answer 13

Complications associated with gout

Question 14

In acute gout, the aim is to…

Answer 14

relieve pain, prevent disease progression, and prevent tissue deposition of uric acid

Question 15

Top four options for managing acute gout attacks are:

Answer 15

NSAIDs
Colchicine
Glucocorticoids
(possibly) corticotropin

Question 16

What are the first line treatments of acute gout attacks?

Answer 16

NSAIDs and colchicine

Question 17

When NSAIDs or colchicine are poorly tolerated, you can use…

Answer 17

glucocorticoids or coticotropin

Question 18

You should not use ____ _____ drugs for treatment of acute gout

Answer 18

Urate lowering drugs

No benefit

Question 19

Is Aspirin indicated for treating acute gout?

Answer 19

NO

low doses –> uric acid retention (bad)

high doses –> uricosuric effect (excretion of uric acid) which seems good but you need HIGH doses which is dangerous

Question 20

Patients with hyperuricemia that have at least two gout attacks per year or presence of tophi (clinically or radiographically) have…

Answer 20

Chronic gout

Question 21

What is the aim for treatment of chronic gout?

Answer 21

lowering the serum urate levels

Question 22

What drugs are used for chronic gout?

Answer 22

Urate lowering therapy (ULT) continued indefinitely

Question 23

What urate level are you trying to maintain?

Answer 23

less than 6mg/dL

Question 24

What are the three classes of agents used for ULT?

Answer 24

Xanthine oxidase inhibitors

Uricosuric agents

Uricase agents

Question 25

Drugs that block production of uric acid?

Answer 25

Xanthine oxidase inhibitors

Question 26

Drugs that increase secretion of uric acid by increasing its concentration in urine?

Answer 26

Uricosuric agents

Question 27

Drugs that promote conversion to soluble form allantoin?

Answer 27

Uricase agents

Question 28

What ULT drug is first-line therapy?

Answer 28

xanthine oxidase inhibitors

Question 29

Allopurinol

Answer 29

Xanthine oxidase inhibitor

Question 30

Febuxostat

Answer 30

Xanthine oxidase inhibitor

Question 31

Probenecid and Lesinurad

Answer 31

Uricosuric Drugs

Question 32

What drugs are used less frequently than xanthine oxidase inhibitors and are contraindicated in patients with nephrolithiasis?

Answer 32

Uricosuric Drugs

Question 33

What drug is a combination of Uricosuric drug, Lesinurad, and a xanthine oxidase inhibitor, Allopurinol?

Answer 33

Duzallo Fixed-dose oral combination for treatment of hyperuricemia Used when patients don't respond to only allopurinol

Question 34

Pegloticase

Answer 34

Uricase Agent Polyethylene glycolated modified porcine recombinant uricase

Question 35

How is pegloticase administered?

Answer 35

Intravenously Uricase agent

Question 36

Infusion reactions are common for...

Answer 36

Uricase agent, Pegloticase, which is given IV

Question 37

What are some non-pharmacologic therapies for gout treatment?

Answer 37

To decrease serum urate levels, you can avoid alcohol or modify diet by eating less meat (high purine --> uric acid)

Question 38

What diet is associated with less consumption of red meat and more consumption of fruits and vegetables?

Answer 38

DASH diet fruits and veggies --> increase vit C

Question 39

In pseudogout, do you see elevated serum urate levels?

Answer 39

No! It's different from gout. You have CPP depositions that are rhomboid shaped

Question 40

Colchicine MOA is...

Answer 40

inhibition of microtubule assembly

Question 41

Colchicine should NOT be used in patients with...

Answer 41

Advanced renal or hepatic impairment

Question 42

If a patient has active peptic ulcer disease or history of NSAID intolerance, what drug should you use to treat acute gout flares?

Answer 42

Colchicine

Question 43

What drug has a symptom of mild rash, can cause leukopenia or thrombocytopenia, diarrhea, acute gouty arthritis?

Answer 43

Allopurinol

Question 44

Allopurinol is used more than febuxostat because...

Answer 44

it is less expensive

Question 45

Probenecid MOA is...

Answer 45

Promotes renal clearance of uric acid by inhibiting urate anion exchanges (including URAT1) in the proximal tubule that mediates urate reabsorption Increases urate excretion Uricosuric agent

Question 46

Nephrolithiasis or uric acid nephropathy are contraindications for...

Answer 46

Probenecid Uricosuric agent

Question 47

MOA of Lesinurad is...

Answer 47

Inhibits activity of URAT1 and OAT4 in vitro, does not inhibit GLUT9 or ABCG2 Unlike probenecid, it doesn't inhibit OAT1 or OAT3 in clinical setting

Question 48

What drug is often administered with allopurinol?

Answer 48

Lesinurad

Question 49

Pegloticase

Answer 49

Recombinant uricase agent which converts uric acid to allantoin