Term
| What kind of condition is gout? |
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Definition
| An arthritic condition of hyperuricemia, usually in males. Increases with age, declining renal function, HTN, and life choices |
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Term
| What is the etiology behind gout? |
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Definition
Underexcretion of urate due to lifestyle, other factors, or no known reason. Some overproduce urate due to enzyme abnormalities
Serum urate over 9 |
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Term
| How does chemotherapy affect gout? |
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Definition
| Pt is at higher risk for gout while on chemo |
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Term
| What are dietary sources of purines? |
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Definition
| Shellfish, smoked meat, High protein, organ meat, HFCS, Alcohol |
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Term
| What are symptoms and signs of gout? |
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Definition
Pain, warmth, inflammation.
Serum urate > 7. Leukocytosis |
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Term
| Where are common gout attack areas? |
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Definition
- First metatarsophalangeal joint
- Instep
- Ankle, heel
- Knees, wrist, finger, elbow |
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Term
| What are complications from chronic gout? |
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Definition
- Nephrolithiasis - kidney stones. Risk: concentrated urine, pH < 6.0
- Gouty Nephropathy - precitiation of uric acid into ureters leads to renal failure
- Tophii - urate deposits under the skin |
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Term
| What could be confused with gout? |
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Definition
| Septic arthritis, Pseudogout, RA, OA, psoriatic arthritis |
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Term
| What lifestyle modifications can be done with gout? |
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Definition
| Decrease fat intake, intake of HFCS, purine intake. Maintain IBW, reduce salt and alcohol. During attack, apply ice and rest joint. |
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Term
| How are NSAIDs used in gout? |
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Definition
| Decreases pain during acute attack, does not prevent deposits or repeat attacks. Watch BP or PUD. Use SHORT TERM |
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Term
| What NSAIDs are approved for use in gout? |
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Definition
Indomethacin 25-50mg po qid x 3 days, then taper to 25-50mg bid x 4-7 days
Naproxyn 500mg po bid x 3 days, then 250-500mg po qd x 4-7 days
Sulindac 200mg po bid x 7-10 days |
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Term
| What are contraindications for NSAID use? |
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Definition
- Severe/uncompensated CHF
- Severe renal impairment
- Active peptic ulcer disease
- Recent CABG
- Allergy |
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Term
| What is the appropriate use for colchicine? |
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Definition
| Acute attack if NSAIDs or steroids contraindicated, or as a preventative if other agents are not tolerated, or used with urate-lowering drugs to prevent an attack |
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Term
| What is the dose for colcrys? |
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Definition
2 tablets, then 1 tab 1 hour later. Can use prophylactic doses 1 QD or QOD. Not used IV, caution in renal. Metabolized by 3A4 - lower doses w/ Verapamil, Biaxin
Do not use if CrCl<30, active PUD, chronic alcoholism, severe CHF, blood disorder |
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Term
| When and how are steroids used for Gout? |
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Definition
Acute attacks when NSAIDs and Colcrys can't be used, or when they are ineffective. Oral or injected
AE: NA/H20 retention, glucose. Osteoporosis, atrophy, glaucoma, more. |
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Term
| How is allopurinol used for gout? |
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Definition
A xanthine oxidase inhibitor - first line. Usual: 300mg QD, max 800mg QD. May wait 6-8 weeks after 1st attack. Agent of choice for overproduction, also used in underexcretion
Can cause severe hypersensitivity, liver function. Monitor CBC, SCr, BUN, AST/ALT |
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Term
| How is Uloric used for gout? |
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Definition
| Xanthine oxidase inhibitor, but liver metabolized. 40-80mg QD. With or without food. Elevates AST/ALT. Rare CV AEs, do not take with AZA, mercaptopurine, theophylline |
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Term
| How is probenacid used in gout? |
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Definition
| A uricosuric agent, used mostly for under-excreters. 500 - 2000 mg/day, does not work in CrCl < 50. DO NOT USE if they have every had a kidney stone. |
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Term
| How is nephrolithiasis managed? |
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Definition
Hydration, alkalate the urine with acetazolamide or potassium. Do not use sodium bicarb. Reduce dietary intake of mitigating factors.
- Take allopurinol or uloric |
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Term
| When starting a urate-lowering drug, do you used colchicine or NSAIDs? |
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Definition
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