vitohuxo's version from 2016-03-17 21:47


Question Answer
uric acid is produced frompurine metabolism.
risk factors for goutmales, obesity, alcohol (beer), hypertension, CKD, advanced age, meds
medicines that can increase uric acid aspirin higher doses, diuretics, niacin, pyrazinamide, ribavirin, tacrolimus, cyclosporine
do not start treatment until gout has occured...asymptomatic hyperuricemia is not treated
treatment goal uric acid levelunder 6
acute gout attack treatmentnsaids, colchicine, or systemic corticosteroid. if severe then combination with colch + nsaid, colch + oral steroids, or intra-articular injection ....topical ice therapy as needed
colchicine treatment dose1.2mg orally then in 1 hr another 0.6 if needed. no more than 1.8 in 1 hr or 2.4mg daily. does to be repeatd no earlier than 3 days.
colchicine CIstrong p glyco inhib or 3A4 use concomitantly
colchicine SEnausea, diarrhea, myleosuppresion, nueropathy, increased myopathy risk
nsaids that are usedindomethacin, naproxen, celebrex. remember CVD risk and avoid in patients renal disease
steroids givenprednisone or methylprednisolone.
first line agents for prophylaxisxanthine oxidase inhibitors allopurinol and febuxostat= stop production of uric acid at earlier step and make non-toxic end product
allopurinol titration slow!
high risk of hypersensitivity should be tested for HLA-B *5801 allele allopurinol (asian populations). can cause severe rash
probenacid2nd line agent gout if other not working or can be added on. inhibits reabsorption of uric acid in kidney. you must have adequate renal function.
pegloticase reserved for refractory severe disease. recombinant uricase enyzme which converts uric acid to inactive water soluble metabolite easily excreted.
allopurinol/febuxostat use nsaids or cholchicine for how long when starting it3-6 months. can get worsening of gout initially with the agents use.
warning for febuxostatliver toxicity
pegloticase boxed warninganaphylactic reactions, premedicate with antihistamines and corticosteroids
do not use in combo with allopurinolpegloticase
febuxostat lower risk hyeprsensitivit than allopurinol, costs more and reserved refractory,