Therapeutics - Gout Flashcards by amanda kastel

true or false

not every patient with gout has hyperuricemia, and not every patient with hyperuricemia has gout

true - not known why this is the case

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gout itself is not life threatening, but when does it become a concern?

can cause kidney damage which can be fatal

nephrolithiasis (kidney stones)
gouty nephropathy

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what is pseudogout

the crystals are different and the attacks are longer

in gout, they are monosodium urate crystals
in pseudogout, they are calcium pyrophosphate dihydrate crystals

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true or false

someone with gout vs pseudogout gets very different treatment

false - similar treatment

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true or false

uric acid has NO biologic function

TRUE

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how is uric acid excreted?
it is the end product of what?

renally

purine metabolism

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what is NORMAL UA serum concentration

2-7mg/dL

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around what % of patients with hyperuricemia are underexcretors vs overproducers?

around 90% are under excretors and around 10% are overproducers

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name some ways someone can be an overproducer of uric acid

if they have a high cell turnover due to numerous diseases like psoriasis, chemotherapy (tumor lysis), lymphomas, genetics related to purine metabolism, myeloproliferative disorders

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name some ways someone can be an underexcretor of gout

name 3 drugs that can cause this

genetics, chronic kidney disease, hypertension

thiazides/loop diuretics, aspirin (not really a problem. low dose aspirin not an issue), and cyclosporine A

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someone’s diet and alcohol use can make them a _______ of uric acid

overproducer

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TRUE OR FALSE

gout is the most common inflammatory arthritis

true

osteoarthritis is the most common DEGENERATIVE arthritis

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what is average onset age for gout

58 – late 50s

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is gout more likely in men or women

7-9 times more likely in men

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true or false

the risk for gout increases with age

true

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true or false

obesity is a risk factor for gout

true

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name some risk factors for gout

HTN
obesity
diabetes/metabolic syndrome
CKD
diet rich in meat/seafood
alc and drugs

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name 2 drugs used for TB treatment that can induce hyperuricemia

pyrazinamide and ethambutol

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name 2 uricosuric drugs

losartan and fenofibrate

so, for HTN, use losartan over HCTZ

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true or false

low dose aspirin needs to be discontinued if patient is experiencing hyperuricemia

FALSE - not really an issue

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a symptom of gout is erythema of the joint

around when does it reach its peak intensity

within 6-12 hours

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name the joint typically affected by acute gout (50% of cases)

the monoarticular joint of the big toe (connects toe to foot)

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aside from big toe, name 2 other joints typically affected by gout

knee and ankle, sometimes the hands

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the onset of gout pain is typically at what time of day and why?

at night

water is resorbed into the body at night and any urate will deposit

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acute gout is EPISODIC without treatment, how long does it typically last

3-14 days

are fever and flu-like symptoms possible in an acute gout attack

it's rare, but possible

long term consequences of gout if acute attacks continually occur

joint destruction, tophi formation ,and nephrolithiasis (kidney stones)

clinical presentation of acute gout

red, hot, swollen joint, typically of big toe recurrent attacks may be polyarticular (mult joints) and last longer than the initial attack

how can diagnosis of gout be confirmed? is this ideal?

by aspirating the joint fluid and seeing lot of WBC and monosodium urate crystals NOT IDEAL - this would hurt like a B in a joint affected by gout. we can still treat gout without doing all this

what are tophi and when do they typically occur

occur later in the disease they are urate deposits in the soft tissue arounf the joint - may cause soft tissue damage and may ulcerate and get infected. they can ooze a white goo

name some factors that can EXACERBATE an acute gouty attack

exercise (for ppl that dont do so regularly) alcohol trauma drugs infection

explain geriatric gout

older, post-menopausal women more likely to get it than younger women also, in geriatrics, more than 1 joint is typically involved and the small joints of fingers affected early in the disease they also develop tophi sooner

how to identify tophi by looking at picture

a white nodule

true or false, in pseudogout, uric acid is not the cause

true

what ages are typically affected by gout in each gender

men - greater than 35 women of postmenopausal age

true or false the prevalence of gout between men and women is pretty evenly distributed

FALSE more common in men PSEUDOGOUT is pretty even

typical affected joint of gout vs pseudogout

gout - first MTP joint (metatarsophalangeal) pseudo - the knee

SHORT TERM goals of gout therapy what about long term

stop the acute attack and relieve the pain and inflammation long term - prevent recurrences, prevent complications of UA deposition (joint deformity and kidney issues) and get UA levels to less than 6 mg/dL

long term goal of gout therapy is to decerase uric acid levels below....

6mg/dL (norm is 2-7)

name 3 drugs only used if patient is an UNDEREXCRETOR

probenecid (uricosuric) if they have the conditions - losartan/fenofibrate

name 7 drugs that are used as general treatment in gout, whether the person is an overproducer or an underexcretor

NSAIDS colchicine corticosteroids allopurinol febuxostat pegloticase lesinurad (WITH XO INHIBITOR)

acute gouty arthritis attack: should be treated with drugs preferably within how long of the attack onset? name a NON pharmacologic therapy

within 24 hours is preferred - gives the best benefit can ice the affected joint

a patient is currently on urate lowering therapy and despite this, suffers from an acute gout attack. should the urate therapy be stopped or continued

still continue it

patient suffers an acute attack with mild-moderate pain with only 1 or a few SMALL JOINTS or 2-3 large joints affected name the 3 MONOTHERAPY agents that can be used - 1st, 2nd, and 3rd line

1st line = NSAIDS 2nd = colchicine 3rd = systemic corticosteroids

as mentioned, for an acute gout attack, first line is NSAIDS, then colchicine, then systemic steroids what is the patient has inadequate response to this? what is considered inadequate response?

less than 20% improvement in pain score within 24 hours, or 50% at over 24 hours either switch to alternative monotherapy OR add something else as combination therapy

NSAIDS and colchicine both cant be used what to do if: -greater than 2 joints involved -no greater than 2 joints involved

if greater than 2, use systemic corticosteroids if not, use IA corticosteroids

explain when NSAID therapy should NOT be used in gout patients

renal issues peptic ulcer disease on anticoagulants (risk of bleeding) hypertension (if not well controlled) congestive heart failure history GI bleeds

if the acute gout symptoms have not resolved after proper treatment, what should be done

reevaluate the diagnosis and if they were adherent to the regiman

true or false NSAIDS are the drug of choice for acute gout attacks and can be used for repeat attacks

true

how do NSAIDS work to treat gout? do they affect the disease itself?

they reduce joint pain and swelling do NOT alter the course of the disease - do not affect UA levels

when using NSAIDS for acute gout attack, when should the therapy be discontinued?

2-3 days after the symptoms have resolved

which NSAID should be avoided in older adults for acute gout and why

INDOMETHACIN has more CNS and GI side effects

in GENERAL, the duration of NSAID therapy is what range?

5-7 days (stop 2-3 days after symptoms resolve)

what should be added to NSAID therapy in some scenarios?

a PPI if patient has a history of GI issues

GI upset is a side effect of NSAIDS what can be done to prevent

take WITH FOOD

which NSAID is actually used off label for acute gout attack

celecoxib

true or false any NSAID can be used for acute gout attack

true - just avoid indomethacin in older patients most common are naproxen, celecoxib, and indomethacin

how many x a day are naproxen and celecoxib given? what about indomethacine

naproxen and celecoxib = BID indomethacin = Q8 hours

name 3 systems negatively affected by NSAIDS and the system only affected by INDOMETHACIN

GI, renal, CV CNS = indomethacin

why are NSAIDS not used in CHF patients

can exacerbate it - causes sodium and water retention that's why also not given to someone with uncontrolled HTN

caution should be used in giving NSAIDS to pts with creatinine clearance less than...

60mL/min

true or false if you don't have gout, colchicine will still work

FALSE - will not this is why it can be used to help diagnose gout

colchicine is useful if the pt has a contraindication to....

NSAIDS

how long to respond after given colchicine? when are the best effects observed?

response within hours best if given within 24 hrs of symptom onset

FDA approved colchicine dosing for acute gout attack what is the pt was already on it for prevention

1.2mg (2 tabs) STAT then 0.6mg in 1 hour (total is 1.8mg) if pt was already on for prevention, wait 12 hours after taking attack dose ^^ and then resume the prophylactic dose of 0.6mg QD or BID

off label dosing for acute gout attach

0.6mg TID on day of flare and then 0.6mg QD or BID until resolution

when giving colchicine for acute gout attack, cannot give another course of it for how long?

3 days

adverse events of colchicine (not severe)

NVD abdominal pain increased risk myopathy if given with statin peripheral neuropathy

TRUE OR FALSE an overdose of colchicine can be life threatening

true

name some SEVERE colchicine toxicity

blood cytopenia rhabdomyolisis peropheral nephropathy liver failure cutaneous eruption IF USED LONG TERM - decreased B12 absorption -- need supplements to prevent macrocytic anemia

Therapeutics - Gout Flashcards

(71 cards)