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22 Cards in this Set

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Two Types of Hyperuricemia
1. Over producers - excessive diatary intake

2. Underexcretors - defect renal excretion
Hyperuricemia Complications

List 4
Gout
Nephrolithiasis
Nephropathy
Tophaceous gout
4 Clinical Phases of Gout
1. Asymptomatic hyperuricemia
2. Acute gout/recurrent gout
3. Intercritical gout
4. chronic tophaceous gout
Gout Symptoms
1. sudden severe pain
2. inflammation
3. warmth
4. remission and recurrence
5. nocturnal occurence
Gout Diagnosis
Urate Crystal - Needle like crystals

Synovial fluid - decrease in viscosity, increase in nutrophils.
Gout - Goal of Therapy
Uric acid < 6 mg/dl
prevent complications
prevent gouty attack
Drug Therapy

Hyperuricemia
Allopurinol

Probenecid
Allopurinol

MOA and Dose
Xanthine Oxidase Inhibitor

300 mg QD

Dose adjust for renal

Watch for Steven Johnson Syndrome.
Probenecid

MOA and Dose
Increase excretion of uric acid and inhibiting reabsorption.

Dose adjust for renal

Contraindicated for CrCl <50
Allopurinol DDI
Azathioprine - decrese Aza by 50%
ACE-I - predipose sever allopurinol reaction
Warfarin - Increase INR
Cyclophosphamide & Methotrexate - Increase effect
Aluminum Product - space it out.
Febuxostat

MOA and Dose
non-purine selective inhibitor of xanthine oxidase

80~120mg qd

no renal dosing; primarily hepatic
Rasburicase
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
Rasburicase ADR
Hemolytic Anemia
G6PD deficiency - contraindication
Methemoglobinemia
Anaphylaxis
Treatment of Gout

NSAID
Absence of NSAID Risk Factors

> 48 hours

Naproxen and Indomethacin
Treatment of Gout

Colchicine
+ NSAID Risk Factors
Treatment of Gout

Corticosteroids
+ NSAID Risk Factors

More than 1 joint = Predinison

Less than 1 joint = intra-articular teriod injection
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.
Indomethacin

Dose
5- mg tid for 2 to 3 days then taper 5 to 7 days
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
Naproxen

Dose
750 ~ 100mg po daily for 3 days, then 500 ~ 750 mg po for 4 ~ 7 days in 2 divided doses
Sulindac
300 ~ 400 mg po in 2 divided doses for 7 ~ 10 days
Triamcinolone
60 mg IM once