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100 Cards in this Set
- Front
- Back
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What am I:
an inflammatory reaction causing intense pain, erythema, and joint swelling from uric acid crystal deposition in the joint spaces |
gout
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What population is most affected by gout?
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midde-aged and older men
postmenopausal women |
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How is gout inherited?
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x-linked
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What are the causes of gout?
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uric acid metabolism abnormality
medications diseases chemotherapy |
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80% of patients have what type of gout?
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underexcretion
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Renal insufficiency and diuretics causes what type of gout?
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underexcretion
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multiple myeloma and cancers causes what type of gout?
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overproduction
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At what serum uric acid concentration can gout be diagnosed?
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>7mg/dL
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At what serum uric acid concentration would the likelihood of gout development be increased in the next 5 years?
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> 10mg/dL
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Patients with asymptomatic hyperuricemia needs what type of treatment?
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none
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What drugs can cause hyperuricemia?
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niacin
thiazide like diuretics loop diuretics pyrazinamide cyclosporine levodopa bumetanide low dose aspirin occasionally |
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antiretrovirals, ethanol, pancreatic enzymes, and ribavirin interferon causes what type of gout?
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overproduction
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what drug can give a false positive gout reading?
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theophylline
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cyclosporine, cytotoxic chemotherapy, diuretics, ethambutol, filgrastin, isotretinoin, levodopa, niacin, pyrazinamide, aspirin, tacrolimus, and teriparatide causes what type of gout?
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underexcretion
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What are teh gout risk factors?
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excess protein intake
obesity excess ethanol use dyslipidemia CKD patients |
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What diseases causes gout (13)?
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diabetes
down syndrome HF kidney dysfunction leukemia lymphoma lung cancer obesity psoriasis severe illness/injury starvation thyroid disorders untreated HTN |
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CKD patients have what type of gout?
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underexcretion
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What type of test is used to determine a definitive diagnosis of gout?
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aspiration of affected joint fluid
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What type of test is used to determine if a patient is an overproducer or underexcretor?
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24-hour urine collection
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>800mg of uric acid excreted in a 24 hours urine collection is what type of gout?
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overproducer
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<600mg of uric acid excreted in a 24 hours urine collection is what type of gout?
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underexcretor
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What diagnostic tool is used to characterized the appearance of gout?
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radiographs
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What are the 12 criterias used to diagnose gout?
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1 acute attack of arthritis
development of maximum inflammation within 24 hours episode of monarticular arthritis redness over joint area painful and swollen first metatarsophalangeal joint unilateral attach on first metatarsophalangeal joint unilateral attach on tarsal joint suspicion or presence of tophus hyperuricemia asymptomatic swelling in a joint negative joint culture joint cysts and/or erosions without osteopenia on x-ray |
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How many of the 12 criterais must a patient have to be diagnosed with gout?
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6 or more
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What are the four stages of gout?
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asymptomatic
acute intercritical chronic |
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What are the long term complications of gout?
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joint destruction
tophi nephrolithiasis |
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What are the desired treatment outcome of acute gout?
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achieve rapid and effective pain relief
maintain joint function prevent disease complications avoid treatment ADR provide cost-effective therapy improve QOL |
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What are the desired treatment outcome of gouty arthritis?
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symtom relief
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What are the nonpharmacological treatment of gout?
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reduce intake of meats high in purines
reduce saturated fat weight loss in obese patients increase fluid consumption decrease salt consumption restrict alcohol intake avoid drugs causing gout |
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What are the drugs used to treat acute gout?
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NSAIDs
colchicine local corticosteroids systemic corticosteroids |
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What are the drugs used to treat chronic gout?
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Febuxostat
allopurinl probenecid |
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What is the first line drug treatment for gout?
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NSAIDs
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How should NSAIDs be administered for gout treatment?
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start at onset of symptoms, then taper over 2-3 days
5-8 days of treatment may be needed |
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Which NSAIDs are indicated for gout?
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indomethacin
sulindac |
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What dose of Ibuprofen is used to treat gout?I
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600-800mg QID
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What dose of indomethacin is used to treat gout?
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150-200mg daily X 3 days divided into 3 doses
then 100mg daily x 4-7 days divided BID then 50mg TID |
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What dose of naproxen is given to treat gout?
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1000mg daily x 3 days
then 500mg daily x 7 days or 750mg now, then 250mg q8h |
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What dose of piroxicam is given to treat gout?
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40mg daily
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what dose of sulindac is given to treat gout?
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200mg BID x 7-10 days
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what dose of celecoxib is given to treat gout?
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200mg bid
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what dose of meloxicam is given to treat gout?
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7.5-15mg daily
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What diseases should be taken into account in patients using NSAID therapy?
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history of peptic ulcer disease
CHF uncontrolled HTN renal insufficiency CAD anticoagulation therapy |
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What are the monitoring parameters for NSAIDs in the treatment of gout?
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epigastric pain
dark/tarry stool dizziness/light-headedness development of edema SOB decreased urine output by more than 50% in 24hours period |
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What drug am I:
second line treatment for gout when NSAIDs can't be used Bind to tubulin dimer and interfere with miotic spindles function to inhibit phagocytic activity |
colchicine
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How is colchicine metabolized?
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extensively by the liver
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How is colchicine absorbed?
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rapidly by the GI tract
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Within how many hours of symptom onset should colchicine be initiated to induce a favorable response?
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24 hours
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True or False: higher dose colchicine is more effective than lower dose
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False: low dose is just as effective as high dose
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What is the key to colchicine toxicity?
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drug interactions that affect GI absorption and/or hepatic metabolism
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What is the most common unfavorable adverse effects of cochicine?
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N/V
diarrhea abdominal pain |
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When should colchicine not be used?
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serious and potentially fatal systemic effects
moderate or severe renal impairment (CrCl<50) extravasation |
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What should be monitored with colchicine therapy?
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N/V
diarrhea easy bruising cold/flu-like symptoms muscle weakness current meds |
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What dose of colchicine is used to treat gout?
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1.2mg now
then 0.6mg in 1 hours |
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What drugs interact with colchicine?
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P-gp inhibitors
strong Cyp3A4 inhibitors clarithromycin |
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What drug am I:
2nd line treatment for gout when NSAIDs or colchicine can't be used |
corticosteroids
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What are corticosteroids ideally used for?
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1 or 2 affected joints
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Corticosteroids intraarticular injection can be proceeded when there is no infection or crystal idenification in what?
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joint-space
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What dose of prednisone is given to treat gout?
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40-60mg daily
taper over 2 weeks |
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Rebound gouty flares are seen if prednisone is administered in what manner?
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tapered too quickly
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What can be added to prednisone therappy to prevent rebound gout?
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colchicine 0.6mg daily
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What are the short term adverse effects of corticosteroid therapy?
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hyperglycemia (monitor DM pts)
fluid retention weight gain increased risk of infection |
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Who are candidates for maintenance drug therapy?
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recurrent gout attacks
evidence of tophi or joint destruction uric acid nephrolithiasis |
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What drugs are used as maintenance therapy for gout prevention?
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allopurinol
probenecid febuxostat (Uloric) |
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What drug am I:
Drug of choice for gout prophylaxis reduce uric acid production in both overproducers and underecretors |
allopurinol
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What drug am I:
inhibits both the oxidized and reduced forms of xanthine oxidase and lowers serum uric acid levels |
febuxostat (Uloric)
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What dose is the dose of febuxostate used for prophylaxis of gout?
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40mg daily
then increase to 80mg daily if uric acid level not less than 6mg/dL after 2 weeks |
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At what CrCl should febuxostat be used with caution?
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CrCl < 30
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What are the adverse effects of febuxostat?
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liver abnormalities
nausea arthralgia rash |
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What drugs interact with febuxostat?
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theophylline
mecaptopurine azathioprine |
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What can you take with febuxostat to treat gout flare occuring with febuxostat initiation?
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NSAID or colchicine for up to 6 months
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What baseline labs are needed upon initiation of febuxostat?
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serum uric acid level (goal < 6mg/dL)
LFT CBC |
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When should a patient return for follow-up CBC?
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2-4 months after starting
then periodically |
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What is the primary active metabolite of allopurinol?
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oxypurinol
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What drug am I:
prevents oxidation of hypoxanthine and xanthine to uric acid by inhibiting the enzyme xanthine oxidase |
allopurinol
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What dose of allopurinol is used to for prophylaxis of gout?
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start low (100mg/day)
titrate weekly max dose of 800mg/day |
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How is allopurinol cleared?
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renally
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When should allopurinol not be started?
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during gout attack
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What is the adverse effects of allopurinol?
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allopurinol hypersensitivity syndrome
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What is the most common dose of allopurinol for renal insufficiency?
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300mg daily
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What is the target serum uric acid?
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6mg/dL
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When should a follow-up serum uric acid level be taken?
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6 months after initiation of therapy
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What drugs interact with allopurinol?
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warfarin
theophylline azathioprine 6-mercaptopurine |
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What effects on the INR do warfarin and allopurinol have?
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increase INR
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What kind of an interaction does allopurinol have with ampicillin?
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increase likelihood of a rash
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What drug am I:
block tubular reabsortion of uric acid |
probenecid
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Is probenecid used to treat overproduction or underexcretion of uric acid?
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underexcretion
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What is contraindicated with probencid?
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nephropathy
history of acid stones |
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What drug negates the uricosuric effect of probencid?
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low dose ASA
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At what CrCl is the efficacy of probenecid lost?
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< 50
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What are the adverse effects of probenecid?
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vomiting
fever hepatic toxicity rash |
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Patients taking probenecid should be counseled to decrease risk of uric acid stone by doing what?
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maintaining adequate fluid intake
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At what dose is probenecid used for prophylaxis of gout?
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250mg BID x 1-2 weeks
then 50mg BID x 2 weeks then increase 500mg every 1-2 weeks until target serum uric acid concentration or max of 2gm is reached |
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What drug am I:
uricosuric agent that is similiar to probenacid but with more adverse effects |
sulfinpyrazone
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What drug am I:
polyethylene glycol-bonded uricase can be used as an uricosuric agent |
new pipeline agents
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What drug am I:
antihypertensive agent increase uric acid secretion and urine pH |
losartan
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What drug am I:
agent used for dyslipidemia increase uric acid secretion |
fenofibrate
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What outcomes should be evaluated in the treatment of acute gout?
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pain relief
decreased swelling subjective complaints/objective infor for adverse effects review monitoring for adverse effects with new meds |
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What outcomes should be evlauated in the prophylactic treatment of gout?
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monitor and assess new gouty arthritis attacks
monitor and assess development of tophi monitor serum uric acid level (<6) assess adverse effects with allopurinol assess adverse effects with probenacid |
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How often should patients on prophylactic treatment of gout be monitored for serum uric acid levels?
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6 months after starting therapy
then 6-12 months until target goal is reached |
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During what time of allopurinol therapy are patients more likely to develop symptoms of rash, nausea, or new fever?
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first 3 months
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