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16 Cards in this Set
- Front
- Back
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What are the goals of therapy for Gout?
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Terminate the acute attack
Prevent recurrent attacks Prevent complications associated with urate crystals in tissue. |
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What agent(s) are used as first line therapy for an acute gout attack?
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NSAIDs, usually Indomethacin
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How would you monitor for efficacy and toxicity of NSAID therapy?
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Efficacy - Resolution of symptoms (swelling, redness, pain), Prevention of future attacks
Toxicity - GI Upset, GI Bleed, Elevated BP, Edema |
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GI Bleed is unlikey in a short course, however you may want to consider using a PPI in these patients.
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Elderly
History of PUD/GI Bleed Anti-coagulant use Alcoholism |
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In what patients do we want to avoid even a short course of NSAID therapy?
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Active PUD
Uncompensated CHF Sever Renal impairment Hypersensitivity to ASA or NSAIDs |
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Describe non-pharmacologic treatment of gout?
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Rest the joint for 1-2 days and apply ice (but avoid heat)
Decrease intake of saturated fats and meals high in purines (organ meats) Increase fluid intake Decrease Na consumption Decrease alcohol consumption Weight loss |
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What are the criteria for starting prophylactic therapy in a patient with gout?
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2 or more attacks/year
Severe attack of gouty arthritis Complicated course of nephrolithiasis Serum uric acid > 10 mg/dL 24 urinary excretion of uric acid > 1000 mg |
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What is the best option for an acute attack when an NSAID has not worked?
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Colchicine
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How would you monitor efficacy and toxicity of colchicine therapy?
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Efficacy - Resolution of symptoms (redness, swelling, pain), Prevention of future attacks
Toxicity - NVD |
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How do you dose Colchicine?
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0.5 mg po Tid until symptoms resolve
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What do you do if the person does not respond to Colchicine therapy?
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Either Systemic Corticosteroids or Intraarticular Corticosteroids
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What is important to know about both of these methods of therapy?
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With systemic Corticosteroids, you must taper them down slowly to avoid a rebound attack
With intraarticular injections, this is only useful if the attack is limited to 1-2 joints |
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What is your best option for prophylactic therapy of gout?
What is the dosing? How is it titrated and what is the max dose? |
Allopurinol 100 mg po daily
Titrate by 100 mg per week until serum uric acid is < 6 mg/dL Max dose 800 mg daily |
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What else might you start for prophylaxis of gout?
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Colchicine
Febuxostat ***You can start Colchicine with Allopurinol for 6 months while Allopurinol begins to work*** |
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How is Allopurinol renally dosed?
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If CrCl < 60, max dose is 200 mg/day
If CrCl < 30, max dose is 100 mg/day |
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What is the dose of Indomethacin and Ibuprofen?
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Indomethacin 25-50 mg qid for 3 days, then taper to twice daily for 4-7 days
Ibuprofen 800 mg qid |
