Exam 5 - Gout - Pcp 2011

Front 1

List 3 drugs associated with increasing uric acid levels

Back 1

Diuretics
Cyclosporin
Tacrolimus
Niacin
Low-dose Salicyclate

Front 2

List 3 drugs associated with a decrease in uric acid levels that are not used to treat gout

Back 2

Fenofibrate
Losartan
High-dose Salicyclate

Front 3

List 3 conditions that are often associated with hyperuricemia

Back 3

Insulin resistance
Alterations in enzyme induced purine metabolism
Increase in ATP degradation

Front 4

True or false: in the first attack of acute gouty arthritis there is a rapid onset of excruciating pain, swelling, and inflammation within multiple joints

Back 4

False - the rapid onset of pain, swelling and inflammation usually occurs in a single joint for the FIRST attack with the big toe being the most common site

Front 5

True or false: acute gouty arthritis usually involves the joints of the lower extremities

Back 5

True - but it can also affect upper extremities

Front 6

True or false: the joint pain from acute gouty arthritis typically occurs during the day when the joints are placed under a lot of activity and stress

Back 6

False - joint pain typically presents at night when water reabsorption from joint fluid causes saturation of urate crystals

Front 7

What are typically duration of symptoms based on the type of attack? (mild vs. severe)

Back 7

Mild attacks: hours
Sever attacks: 3-14 days

Front 8

What are typical lab values associated with a gout attack? Hint: FILM

Back 8

Fever
Increased WBC/ESR
Level of serum uric acid may increase
Monosodium urate crystals

Front 9

What is the first line therapy drug treatment for acute gouty arthritis?

Back 9

NSAIDs

Front 10

What are contraindications for the first line therapy drug treatment of acute gouty arthritis?

Back 10

CKD - do not use in Clcr <30ml/min
CKD - consider different agent if <50ml/min
Active GI ulceration/bleed in last 6 months

Front 11

True or false: use of NSAIDs are contraindicated for use in patients with acute gouty arthritis that have a history of heart conditions

Back 11

False - since the use of the NSAIDs in this case are considered acute there is no need to avoid their use

Front 12

True or false: the absence of an elevated serum uric acid level indicates that the patient does not have acute gouty arthritis

Back 12

False - in acute attacks a patient may not present with increased serum uric acid levels

Front 13

What are important drug interactions to note with the use of colchicine?

Back 13

Strong/moderate CYP3A4 inhibitors
Strong - clarithromycin
Moderate - diltiazem/verapamil/grapefruit juice
PGP inhibitors - cyclosporin

Front 14

What are the (3) NSAIDs that are FDA approved for treatment of acute gouty arthritis? Hint: SIN

Back 14

Suldinac
Indomethacin (most commonly prescribed)
Naproxen

Front 15

True or false: colchicine is just as effective as NSAID therapy for the treatment of acute gouty arthritis

Back 15

True - however colchicine is most effective if given within 48 hours of onset of symptoms and does not provide any analgesic relief

Front 16

What are important ADRs to note with the use of colchicine? Hint: BAD

Back 16

Bone marrow suppression
Atrophy of muscle (myopathy)
Diarrhea

Front 17

What is another drug class that can be recommended in a patient that cannot use NSAID/colchicine therapy

Back 17

Corticosteroids are usually reserved for resistant cases or patients with contraindications to colchicine/NSAID use

Front 18

True or false: Prednisone and methylprednisolone are reserved for patients with multi-joint involvement

Back 18

True - Triamcinalone is good for patients with 1-2 joint involvement with the system steroids reserved for multi-joint involvement

Front 19

True or false: prophylaxis should be started within 6 to 8 weeks of an attack for it to be effective

Back 19

False - a patient should wait 6 to 8 weeks before beginning prophylactic treatment.

Front 20

Which patients are candidates for prophylactic treatment? Hint: 2CUT

Back 20

2 or more attacks in 1 year
Complicated first attack
Uric acid levels above 10mg/dL
Tophi present

Front 21

True or false: Uricosuric drugs are the drug of choice in patients who are found to be underexcretors

Back 21

True - uricosuric drugs increase renal excretion of uric acid by decreasing overall renal tubular reabsorption

Front 22

When are (2) key points that contraindicate the use of the uricosuric drug Probenecid?

Back 22

Crcl less than 50ml/min
History of uric acid kidney stones

Front 23

True or false: sulfinpyrazone is a uricosuric drug that needs to be used in caution with anti-coagulated patients

Back 23

True - sulfinpyrazone is a uricosuric drug that may act as an anti-platelet agent

Front 24

How to allopurinol and febuxostat work?

Back 24

Allopurinol and febuxostat work by blocking the xanthine oxidase enzyme which results in decreased uric acid production

Front 25

Allopurinol is recommended in specific patient populations - identify these (3) populations. Hint: LOU

Back 25

Lymp/myelo disorders - given prior to chemotherapy
Overproducers
Uric acid kidney stones

Front 26

True or false: rash is a common side effect in allopurinol that can be treated with diphenhydramine

Back 26

False - a rash is not common and is indicative that a patient may have allopurinol sensitivity disorder and therapy should be stopped immediately

Front 27

What is the advantage of using febuxostat over allopurinol?

Back 27

There is no renal adjustment that needs to be done for dosing.

Front 28

What is uric acid nephrolithiasis?

Back 28

Kidney stones that occur in 10-25% of patients with gout; if a patient presents with kidney stones they should be evaluated with hyperuricemia.

Front 29

Which patients are at risk for uric acid nephrolithiasis?

Back 29

Concentrated urine
Excessive uric acid excretion
Low urine pH
Lymphoma treatment with cytotoxic

Front 30

True or false: allopurinol is the mainstay of therapy for recurrent nephrolithiasis

Back 30

True - allopurinol is used for treatment of kidney stones