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Flashcards in Gout Deck (57)
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1

T/F: All individuals with hyperuricemia will at some point develop a clinical event from urate crystal deposition

FALSE

Most individuals w/ hyperuricemia may never develop a clinical event from urate crystal deposition

(so don't tx hyperuricemia if no h/o gout!)

2

Drugs active in gout inhibit what 2 things?

1. Crystal phagocytosis 

2. PMN and macrophage release of inflammatory mediators

3

Is it more common for a person to have overproduction or underexcretion of uric acid?

Underexcretion

4

Where is 2/3 of the daily uric acid production excreted?

In the urine

5

2/3 of the daily uric acid production is excreted in the urine, where is the remainder eliminated?

Through the GI tract after enzymatic degradation by colonic bacteria

6

The following are examples of _____ rich foods:

  • Bacon
  • Beef
  • Chicken
  • Mushrooms
  • etc

Purine rich foods

7

What is the definitive dx of gout?

tapping the joint and microscopic exam of uric acid crystals

8

In the absence of a history of gout, does asymptomatic hyperuricemia require treatment?

no

9

What is acute gout?

Attacks of joint inflammation 

3-10 days

Usually affecting the 1st MTP

10

Which toe does acute gout most commonly affect?

(how many days, area MCly affected?)

1st MTP- Podagra "foot pain"

11

Chronic or acute gout?

  • Rheumatoid-like
  • Tophaceous Gout 

Chronic gout

12

What type of urate is in the soft tissues and joints in Tophaceous gout?

Monosodium urate 

13

What is non-pharmacological treatment for acute gout?

Local ice application 

(most effective as adjunctive tx)

14

What are the 3 acute gout first line treatments? 

1. NSAIDs (Indomethacin, naproxen and Sulindac)

2. Corticosteroids

3. Colchicine

15

Within how many hours of acute gout attack onset should treatment (NSAIDs, colchicine, steroids) be taken and for how many days?

(red)

Within 24 hours

until complete resolution, ~5-8 days after initiating therapy

16

Mechanism of which acute gout med?

  • Inhibition of microtubule assembly decreases macrophage migration and phagocytosis
  • Inhibits leukotriene B4 decreasing inflammation

Colchicine

17

Acute Gout tx:

Colchicine must be used w/in ___ hrs of attack onset to be effective

(red)

36

18

What are the 3 ADEs of Colchicine?

(red)

1. N/V/D

2. Myelosuppression (rare)

3. Neuromyopathy (reversible)

19

Dose adjustment of Colchicine is recommended when used with what 2 groups of meds?

(red)

selected CYP3A4 and P-glycoprotein inhibitors

(so don't give w/ -azoles or -vir)

20

Colchicine inhibits renal tubular secretion of what med?

Methotrexate

21

When is intraarticular corticosteorid (TAC-Kenalog) administration acceptable in the tx of acute gout?

What meds should it be used in combo with?

  • When only 1 or 2 joints involved
  • Should be used in combo w/ NSAIDs, Colchicine or oral corticosteroids

22

What 3 meds can be used for tx of chronic gout?

  • Colchicine
  • Probenicid 
  • Allopurinol, Febuxostat

23

Which med should be used for refractory cases of chronic gout?

Pegloticase (Biologic)

24

What are the 2 xanthine oxidase inhibitors used to tx chronic gout?

Allopurinol

Febuxostat

25

Which chronic gout med currently only has an indication for hyperuricemia in malignancy

Rasburicase

26

What is the main side effect of Colchicine and is often difficult to tolerate?

Dose dependent diarrhea

27

What are the 3 anti-inflammatory regimens that are needed during the initiation of urate-lowering therapy (ULT)?

1. Colchicine

OR

2. Low dose NSAIDs w/ PPI

OR

3. Prednisone

28

Anti-inflammatory regimens (Colchicine, NSAIDs w/ PPI or prednisone) are required during the initiation of urate lowering therapy.

How long should they be continued?

Continue at least 6 months

or

3-6 months after achieving target serum uric acid

29

What are Xanthine osidase inhibitors (allopurinol/febuxostat) efficacious for?

prophylaxis of recurrent gout attacks in both underexcreters and overproducers of uric acid

(red)

30

In what 4 for initiation of allopurinol or febuxostat?

  • 2+ gout attacks per year
  • presence of 1+ tophus
  • CKD (stage 2 or worse)
  • history of urolithiasis