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22 Cards in this Set
- Front
- Back
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Two Types of Hyperuricemia
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1. Over producers - excessive diatary intake
2. Underexcretors - defect renal excretion |
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Hyperuricemia Complications
List 4 |
Gout
Nephrolithiasis Nephropathy Tophaceous gout |
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4 Clinical Phases of Gout
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1. Asymptomatic hyperuricemia
2. Acute gout/recurrent gout 3. Intercritical gout 4. chronic tophaceous gout |
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Gout Symptoms
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1. sudden severe pain
2. inflammation 3. warmth 4. remission and recurrence 5. nocturnal occurence |
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Gout Diagnosis
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Urate Crystal - Needle like crystals
Synovial fluid - decrease in viscosity, increase in nutrophils. |
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Gout - Goal of Therapy
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Uric acid < 6 mg/dl
prevent complications prevent gouty attack |
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Drug Therapy
Hyperuricemia |
Allopurinol
Probenecid |
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Allopurinol
MOA and Dose |
Xanthine Oxidase Inhibitor
300 mg QD Dose adjust for renal Watch for Steven Johnson Syndrome. |
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Probenecid
MOA and Dose |
Increase excretion of uric acid and inhibiting reabsorption.
Dose adjust for renal Contraindicated for CrCl <50 |
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Allopurinol DDI
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Azathioprine - decrese Aza by 50%
ACE-I - predipose sever allopurinol reaction Warfarin - Increase INR Cyclophosphamide & Methotrexate - Increase effect Aluminum Product - space it out. |
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Febuxostat
MOA and Dose |
non-purine selective inhibitor of xanthine oxidase
80~120mg qd no renal dosing; primarily hepatic |
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Rasburicase
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Elitek
Indication: chemotherapy induced hyperuricemia MOA: converts urate to allatonin Dose: 0.15 ~ 0.2mg/kg IV push for 5 ~ 7 days Usually for children |
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Rasburicase ADR
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Hemolytic Anemia
G6PD deficiency - contraindication Methemoglobinemia Anaphylaxis |
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Treatment of Gout
NSAID |
Absence of NSAID Risk Factors
> 48 hours Naproxen and Indomethacin |
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Treatment of Gout
Colchicine |
+ NSAID Risk Factors
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Treatment of Gout
Corticosteroids |
+ NSAID Risk Factors
More than 1 joint = Predinison Less than 1 joint = intra-articular teriod injection |
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Colchicine
Dose |
1.2 mg initially 0.6 mg q2h until pain relief or abdominal discomfort
8 mg po max no more colchicine for 3 days Phophylaxis dose: 0.6 ~ 1.2 mg daily watch renal funtion. |
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Indomethacin
Dose |
5- mg tid for 2 to 3 days then taper 5 to 7 days
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Corticosteriods
Dose |
Intra-articular
Methylpredinisolone 10-20 mg for small joints 20-60 mg for larger joints PO Predinisone 30 ~ 60 mg qd then taper 7 ~ 10 days |
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Naproxen
Dose |
750 ~ 100mg po daily for 3 days, then 500 ~ 750 mg po for 4 ~ 7 days in 2 divided doses
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Sulindac
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300 ~ 400 mg po in 2 divided doses for 7 ~ 10 days
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Triamcinolone
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60 mg IM once
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