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Flashcards in Gout Deck (28)
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1
Q

Normal serum values of uric acid

A

2-7 mg/dL but this is not diagnostic

2
Q

Gout-contributing factors

A

heredity, gender, age, diet, alcohol, low fluid intake, cancer, radiation therapy

3
Q

Drug induced gout

A

diuretics, nicotinic acid, salicylates, EtOH, glucocorticoids, levodopa, chemotherapy, sulfa antibiotics

4
Q

4 stages of gout

A

asymptomatic hyperuricemia, acute gouty arthritis, interval gout, chronic taophaceous gout

5
Q

2 types of gout

A

over-producers or under excretors

6
Q

Non-pharmacological approach to gout treatment

A

drink lots of water, avoid EtOH, weight loss, dietary changes

7
Q

Drugs for gout

A

NSAIDs (INdometacin, ibuprofen, naproxen), calchicine (Colcrys), corticosteroids (prednisone, methylpredneisolone), probenecid (Benemid), Allopurinol (Zyloprim), Febuxostat (Uloric)

8
Q

Treatment for acute gouty attacks

A

NSAIDs, Colchicine, corticosteroids

9
Q

Colchicine (Colcrys) MOA

A

inhibits migration of granulocytes, which ultimately prevent uric acid deposits

10
Q

Colchicine (Colcrys) ADRs

A

Diarrhea, N/V/abdpain

11
Q

Colchicine (Colcrys) dosing

A

must wait 3 days before another course can be given, must adjust if CrCl

12
Q

Contraindication of Colchicine (Colcrys)

A

if anuric

13
Q

NSAIDs MOA

A

inhibit prostaglandin synthesis

14
Q

NSAID most studied for gout

A

Indomethacin

15
Q

Other NSAIDs for gout

A

naproxen or ibuprofen

16
Q

Corticosteroids for gout

A

reserved for pt that fail colchicine or NSAIDs, prednisone, methylprednisolone, triamcinolone

17
Q

Intraarticular injection of corticosteroid

A

Triamcinolone

18
Q

Initiate prophylactic treatment if

A

severe attack of gouty arthritis, complicated course, serum uric acid level greater than 10 mg/dL, 24 hour urinary excretion greater than 1000mg, pt has 2-3 attacks/year

19
Q

Colchicine (Colcrys) for prophylactic treatment

A

only give once daily, d/c if sx free for >1 year

20
Q

Allopurinol (Zyloprim) MOA

A

xanthine oxidase inhibitor, preventing synthesis of uric acid

21
Q

Allopurinol (Zyloprim)

A

ideal for over-producers, not for acute attack, adjust renal

22
Q

Allopurinol (Zyloprim) ADRs

A

rash, can lead to Steven’s Johnson syndrome

23
Q

Febuxostat (Uloric)

A

Me too, $$$, once daily, no adjust, niche: more effective than allopurinol

24
Q

Febuxostat (Uloric) MOA

A

xanhine oxidase inhibitor, prevent synthesis of uric acid

25
Q

Febuxostat (Uloric) ADR

A

elevated liver enzymes

26
Q

Probenecid (Benemid)

A

good for under excretors, do not use if CrCl

27
Q

Probenecid (Benemid) MOA

A

Competitive inhibition of reabsorption of uric acid in the proximal convoluted tubule of the nephron, promoting urinary excretion of uric acid

28
Q

Probenecid (Benemid) ADRs

A

GI upset (take with food), renal uric acid stones, usually well-tolerated