Therapeutics Exam 4 Gout Flashcards
(44 cards)
What is gout?
An inflammatory process in response to crystallization of monosodium urate (MSU) in articular and non-articular tissues
What uric acid level signals hyperuricemia?
> 6.8 mg/dL
*and symptomatic
What is uric acid?
The main end product in purine degradation
What is allantoin?
Soluble byproduct from uric acid breakdown
-more soluble form of uric acid
What are the 3 main medications that can increase uric acid levels?
Diuretics (thiazides or any)
Cytotoxic drugs (chemo, methotrexate)
Salicylates
What is the presentation of acute gouty arthritis?
Podagra- (first metatarsal joint on foot involved)
Uric acid can deposit elsewhere (fingers, wrists, cartilage, tendons, kidneys)
WBC at what level could signify infection?
> 11,000
What are the complications of acute gouty arthritis?
Tophi (deposits of monosodium urate, form nodules)
Nephrolithiasis (kidney stones)
Gouty nephropathy (kidney disease)
What is the only way to get a definitive gout diagnosis?
Synovial fluid aspiration
-not done much
What are the 3 steps in gout treatment?
-Treat pain and inflammation
-Urate-lowering therapy (ULT) to prevent recurrence
-Anti-inflammatory prophylaxis
What is a possible non-pharm therapy for acute gouty arthritis?
Apply ice to the affected area
What are the 3 options for pharmacologic therapy for acute gout treatment?
NSAIDs
Corticosteroids
Colchicine
What are the NSAIDs that can be used in gout treatment?
Indomethacin
Naproxen
Ibuprofen (not approved but commonly used)
Sulindac
What is the key to NSAID use in gout?
Early initiation
What corticosteroids are used in gout treatment?
PO:
-Methylprednisolone
-Prednisone
IM:
-Triamcinolone
-Methylprednisolone
Intra-articular:
-Triamcinolone
If using an IM or IA corticosteroid, what needs to happen?
Follow up with subsequent anti-inflammatory agent (NSAID or po Corticosteroid)
What are the important considerations with corticosteroid treatment?
Need to taper doses
Limit treatment duration
Increased risk of GI bleed and peptic ulcer disease
Monitor diabetes for increased BG
Avoid intra-articular injections if infection is suspected
What is the MOA of colchicine?
Disrupts cytoskeletal functions
-inhibits B-tubulin polymerization into microtubules
-this prevents migration of neutrophils to sites of inflammation that cause gout symptoms
Colchicine must be administered within how many hours of an acute gout attack?
24 hours
-because otherwise the neutrophils have already reached the site of the gout
What is the dosing of colchicine?
Day 1: 1.2 mg po once, then 0.6mg one hour later
Day 2+: 0.6 mg BID until attack resolves
How do we adjust colchicine dosing for renal impairment?
CrCl >/=30: No adjustment
CrCl < 30: 1.2 mg at onset, then 0.6 mg 1 hour later
*0.6 mg dose is only given once!!!
Only repeat every 2 weeks
Dialysis: A single 0.6 mg dose, only repeat every 2 weeks
What two agents should we try to avoid combining?
NSAIDs
Corticosteroids
What are the abortive gout agents?
NSAIDs
Colchicine
-patients can use the “pill in pocket” method
Who is not a candidate for Urate Lowering Therapy (ULT)?
Asymptomatic hyperuricemia with no prior gout flares or tophi
First gout attack without risk factors
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