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PHRM 825 > PHRM 825: Gout - Wahl > Flashcards

PHRM 825: Gout - Wahl Flashcards

(50 cards)

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1
Q

What is gout caused by?

A

A deposition of monosodium urate crystals in the synovial fluid or tissues

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2
Q

What disease is gout secondary to?

A

Hyperuricemia

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3
Q

What serum urate level diagnoses hyperuricemia?

A

> or = 6.8 mg/dL

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4
Q

What are the two clinical phases of gout?

A
  • Intermittent acute attacks

- Chronic tophaceous gout

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5
Q

What 5 disease states increase your risk for gout?

A
  • HNT
  • T2DM
  • Obesity
  • Metabolic syndrome
  • CKD
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6
Q

What dietary factors increase your risk for gout?

A
  • Alcohol
  • High in purines (meat and seafood)
  • High fructose beverages
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7
Q

What 5 medications increase your risk for gout?

A
  • Thiazide diuretics
  • Loop diuretics
  • Niacin
  • Calcineurin inhibitors
  • Aspirin (<1 g/day)
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8
Q

What 3 medication classes are used during an acute gout attack?

A
  • NSAIDs
  • Colchicine
  • Corticosteroids
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9
Q

What NSAIDs are FDA approved for gout attacks?

A
  • Naproxen
  • Sulindac
  • Indomethacin
  • Celecoxib (COX-2 only)
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10
Q

What is the dosing for Naproxen for an acute gout attack?

A

250mg PO tid

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11
Q

What is the dosing for Sulindac for an acute gout attack?

A

750mg initially, then 250mg q8h

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12
Q

What is the dosing for Indomethacin for an acute gout attack?

A

200mg PO bid

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13
Q

What is the MOA of colchicine?

A

Disruption of microtubule formation – Prevents activation, migration, and degranulation of neutrophils which propagate immune response in affected joint

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14
Q

What is the dosing for Colchicine for an acute gout attack?

A
  1. 2 mg load once, then 0.6 mg an hour later
    * resume/start maintenance 12 hours later

If on HD, 0.6mg once, do not re-dose for 2 weeks

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15
Q

What 5 meds interact with colchicine?

A
  • Protease inhibitors
  • Azole antifungals
  • Clarithromycin
  • Verapamil
  • Statins
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16
Q

When are corticosteroids used for acute gout attacks?

A
  • NSAID/colchicine intolerance
  • Polyarticular involvement
  • Resistant cases
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17
Q

What is the dosing for prednisone for an acute gout attack?

A
  • 0.5 mg/kg/day for 5-10 days

- 0.5 mg/kg/day for 2-5 days then taper for 7-10 days

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18
Q

What is the dosing for methylprednisolone for an acute gout attack?

A

21 day dose pack

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19
Q

What is the dosing for Triamcinolone for an acute gout attack?

A
  • 60 mg IM once, then oral prednisone

- 2.5-40 mg intra-articular injection once

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20
Q

5 adverse effects of corticosteroids

A
  • GI toxicity (bleed/PUD)
  • N/V/D
  • Hyperglycemia
  • Weight gain and increased appetite
  • Fluid retention
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21
Q

Adverse effects of colchicine

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A
  • GI (N/V/D)
  • Bone marrow suppression
  • Neuromuscular
22
Q

Adverse effects of NSAIDs

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A
  • GI (bleed/gastritis)
  • Renal (AKI)
  • Cardiovascular (Sodium/fluid retention, edema)
23
Q

Which 2 treatment options for acute gout attack should not be given together?

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A

NSAIDs and Oral corticosteroids (GI toxicity)

24
Q

When is acute gout attack prophylaxis indicated?

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A

When urate lowering therapy is being initiated

25
What are the goals of therapy for acute gout attacks?
- Relieve attack (preferable withing 24 hours) - Continue urate lowering therapy (ULT) - Patient education
26
What are the goals of therapy for chronic gout management?
- Prevent future attacks | - Reduce serum uric acid levels to < or = 6 mg/dL (or 5 in severe cases)
27
What constitutes a severe case of chronic gout management?
- Polyarticular involvement (4 or more joints) | - Tophi
28
What are 4 indications for ULT?
- Frequent acute attacks (2 or more/year) - Tophi on exam or imaging - Uric acid > 10mg/dL - CKD stage 2 or worse
29
ULT monitoring
- every 2-5 weeks during initiation | - Every 6 months once goal <6 mg/dL achieved
30
What are 3 first-line ULT?
- Xanthine oxidase inhibitors - Allopurinol - Febuxostat
31
What are 2 second-line ULT?
- Uricosurics | - Probenecid
32
What are 2 third-line ULT?
- Uricase agents | - Pegloticase
33
What is the typical first choice xanthine oxidase inhibitor?
Allopurinol
34
Common Allopurinol adverse effects
- GI upset - Skin rash - Leukopenia - Thrombocytopenia - Increased LFTs - HA
35
Allopurinol drug interactions
- Warfarin - Mercaptopurine and azathioprine - Pegloticase
36
What xanthine oxidase inhibitor is chosen when the patient has an allopurinol intolerance?
Febuxostat
37
Common Febuxostat adverse effects
- Rash - Nausea - Abnormal LFTs
38
MOA of probenecid
Inhibits reabsorption of uric acid in convoluted tubule of kidney
39
When is Probenecid used for chronic management of gout?
- Documented underexcretion of urate - Patient resistant/intolerant to allopurinol - Cannot reach target urate on monotherapy with XOI - May also be added to allopurinol
40
Probenecid adverse effects
- Rash, flushing, HA - GI upset - Stone formation (increase fluid intake)
41
Probenecid contraindications
- History of uric acid kidney stones - Concomitant salicylates, especially >325mg/day - Overproducers of uric acid - CrCl <50mL/min
42
MOA of Uricase agents
Metabolizes uric acid to allantoin (excreted 10x more effectively in the urine)
43
When are uricase agents used for chronic management of gout?
- Last-line agent - Indicated for refractory chronic gout (patients with significant disease burden and refractoriness to (or intolerance of) conventional urate lowering therapy)
44
Adverse effects of Pegloticase
- Infusion reactions - Anaphylaxis - Nephrolithiasis - Arthralgias - HF exacerbation - Nausea
45
Contraindications/cautions for Pegloticase
- G6PD deficiency | - HF
46
MOA of Lesinurad
URAT1 inhibitor (enhances uric acid excretion)
47
When is Lesinurad used?
In combo with XOI
48
Adverse effects of Lesinurad
- Black box warning: acute renal failure (monotherapy) - HA - GERD
49
Fenofibrate MOA
Increases clearance of both hypoxanthine and xanthine (decreases urate levels 20-30%)
50
Losartan MOA
Inhibits tubular reabsorption of uric acid increasing urinary excretion

PHRM 825 (36 decks)

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