Gout

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Author:
timothy.pdlt
ID:
211888
Filename:
Gout
Updated:
2013-04-07 03:35:07
Tags:
gout
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Description:
therapeutic, side-effects, drug interactions
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  1. GoT of gout Tx
    • Acute phase
    • 1. rapid S/S relief
    • 2. stop an acute attack

    • Prevention
    • 1. prevent recurrence
    • 2. prevent complications
    • 3. prevent crystal formation
    • 4. promote crystal dissolution
    • 5. serum urate <360uM
  2. Gout staging
    • 1. asymptomatic hyperuricemia (>360uM)
    • 2. acute gouty arthritis
    • 3. intercritical gout (gout recur w/in 6-24months)
    • 4. chronic tophaceous gout
  3. Risk factors of gout
    • previous attacks
    • age
    • male
    • obesity
    • diet (alcohol/meat/shellfish)
    • medications
    • co-morbidities (HTN, DM, CKD, CVD, dyslipidemia)
  4. Urate elevating drugs
    • diuretics
    • low dose salicylates (<2g/d)
    • pyrazinamide
    • ethambutol
    • levodopa
    • cytotoxic drugs
    • cyclosporine
    • theophylline
  5. Non-Pharm for gout
    • weight loss
    • ice packs
    • rest
    • low purine diet (ie. less alcohol/meat/shellfish)
  6. NSAID doses for management of acute gout
    • 1. naproxen 750mg STAT then 500mg BID x4-5d
    • 2. ibuprofen 800mg STAT then 600mg QID x4-5d
  7. Glucocorticoid doses for management of acute gout
    • 1. prednisone PO 30mg x3d
    • 2. triamcinolone IA 2-20mg
  8. Colchicine doses for management of acute gout
    colchicine 1.2mg STAT then 0.6mg in 1 hour

    • reduce dose if CrCl<50mL/min
    • CI if CrCl<10mL/min
  9. S/E of colchicine
    • N/V/D (common)
    • myelosuppression
    • peripheral neuropathy
    • myopathy
    • CI: neutropenia, renal+hepatic insufficiency
  10. Colchicine DI
    P-gp= clarithromycin, erythromycin, cyclosporine, verapamil
  11. Indications for gout prophylaxis
    • recurrent attacks
    • arthopathy
    • tophi
    • radiographic changes
    • multi-joint involvement
  12. Allopurinol (XOI) doses for gout prophylaxis
    allopurinol 100mg QD then increase by 100mg q2-4weeks PRN

    *may need to add colchicine 0.6-1.2mg PO QD or NSAIDs to prevent acute attacks
  13. S/E of allopurinol
    • rash
    • leukopenia
    • GI upset
    • hepatotoxicity
    • allopurinol hypersensitivity syndrome (rash, fever, hepatitis, eosinophilia, decrease renal function)
  14. Uricosuric agents MOA
    • increase renal urate clearance
    • may precipitate attack during the initial phase

    CI: renal dysfunction, kidney stones, urate overproduction (>800-1000mg/24h= increased risk of renal colic)
  15. Uricosuric dose regimen for gout prophylaxis
    probenecid PO 0.5-1g BID

    sulfinpyrazone
  16. S/E of probenecid
    • HA
    • GI upset
    • hypersensitivity
    • kidney stones (drink lots of water)

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