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30 Cards in this Set
- Front
- Back
List 3 drugs associated with increasing uric acid levels
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Diuretics
Cyclosporin Tacrolimus Niacin Low-dose Salicyclate |
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List 3 drugs associated with a decrease in uric acid levels that are not used to treat gout
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Fenofibrate
Losartan High-dose Salicyclate |
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List 3 conditions that are often associated with hyperuricemia
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Insulin resistance
Alterations in enzyme induced purine metabolism Increase in ATP degradation |
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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
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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
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True or false: acute gouty arthritis usually involves the joints of the lower extremities
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True - but it can also affect upper extremities
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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
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False - joint pain typically presents at night when water reabsorption from joint fluid causes saturation of urate crystals
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What are typically duration of symptoms based on the type of attack? (mild vs. severe)
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Mild attacks: hours
Sever attacks: 3-14 days |
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What are typical lab values associated with a gout attack? Hint: FILM
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Fever
Increased WBC/ESR Level of serum uric acid may increase Monosodium urate crystals |
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What is the first line therapy drug treatment for acute gouty arthritis?
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NSAIDs
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What are contraindications for the first line therapy drug treatment of acute gouty arthritis?
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CKD - do not use in Clcr <30ml/min
CKD - consider different agent if <50ml/min Active GI ulceration/bleed in last 6 months |
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True or false: use of NSAIDs are contraindicated for use in patients with acute gouty arthritis that have a history of heart conditions
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False - since the use of the NSAIDs in this case are considered acute there is no need to avoid their use
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True or false: the absence of an elevated serum uric acid level indicates that the patient does not have acute gouty arthritis
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False - in acute attacks a patient may not present with increased serum uric acid levels
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What are important drug interactions to note with the use of colchicine?
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Strong/moderate CYP3A4 inhibitors
Strong - clarithromycin Moderate - diltiazem/verapamil/grapefruit juice PGP inhibitors - cyclosporin |
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What are the (3) NSAIDs that are FDA approved for treatment of acute gouty arthritis? Hint: SIN
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Suldinac
Indomethacin (most commonly prescribed) Naproxen |
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True or false: colchicine is just as effective as NSAID therapy for the treatment of acute gouty arthritis
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True - however colchicine is most effective if given within 48 hours of onset of symptoms and does not provide any analgesic relief
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What are important ADRs to note with the use of colchicine? Hint: BAD
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Bone marrow suppression
Atrophy of muscle (myopathy) Diarrhea |
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What is another drug class that can be recommended in a patient that cannot use NSAID/colchicine therapy
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Corticosteroids are usually reserved for resistant cases or patients with contraindications to colchicine/NSAID use
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True or false: Prednisone and methylprednisolone are reserved for patients with multi-joint involvement
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True - Triamcinalone is good for patients with 1-2 joint involvement with the system steroids reserved for multi-joint involvement
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True or false: prophylaxis should be started within 6 to 8 weeks of an attack for it to be effective
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False - a patient should wait 6 to 8 weeks before beginning prophylactic treatment.
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Which patients are candidates for prophylactic treatment? Hint: 2CUT
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2 or more attacks in 1 year
Complicated first attack Uric acid levels above 10mg/dL Tophi present |
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True or false: Uricosuric drugs are the drug of choice in patients who are found to be underexcretors
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True - uricosuric drugs increase renal excretion of uric acid by decreasing overall renal tubular reabsorption
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When are (2) key points that contraindicate the use of the uricosuric drug Probenecid?
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Crcl less than 50ml/min
History of uric acid kidney stones |
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True or false: sulfinpyrazone is a uricosuric drug that needs to be used in caution with anti-coagulated patients
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True - sulfinpyrazone is a uricosuric drug that may act as an anti-platelet agent
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How to allopurinol and febuxostat work?
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Allopurinol and febuxostat work by blocking the xanthine oxidase enzyme which results in decreased uric acid production
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Allopurinol is recommended in specific patient populations - identify these (3) populations. Hint: LOU
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Lymp/myelo disorders - given prior to chemotherapy
Overproducers Uric acid kidney stones |
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True or false: rash is a common side effect in allopurinol that can be treated with diphenhydramine
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False - a rash is not common and is indicative that a patient may have allopurinol sensitivity disorder and therapy should be stopped immediately
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What is the advantage of using febuxostat over allopurinol?
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There is no renal adjustment that needs to be done for dosing.
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What is uric acid nephrolithiasis?
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Kidney stones that occur in 10-25% of patients with gout; if a patient presents with kidney stones they should be evaluated with hyperuricemia.
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Which patients are at risk for uric acid nephrolithiasis?
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Concentrated urine
Excessive uric acid excretion Low urine pH Lymphoma treatment with cytotoxic |
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True or false: allopurinol is the mainstay of therapy for recurrent nephrolithiasis
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True - allopurinol is used for treatment of kidney stones
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