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IPDM I WK 7 Gout Part 1

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alchemist04's version from 2016-05-20 00:32

Section

Question Answer
What are the risk factors associated with gout? (1)(1) elevated serum urate level (> 6.8 mg/dL)
What are the risk factors associated with gout? (2)(2) Obesity
What are the risk factors associated with gout? (3)(3) Alcohol, sugar, beverages, red meat, food high in purine content
What are the risk factors associated with gout? (4)(4) Sedentary lifestyle
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Question Answer
What are the risk factors associated with gout? (5)(5) Family history
What are the risk factors associated with gout? (6)(6) Medication induced
What are the risk factors associated with gout? (7)(7) Renal impairment
What are the risk factors associated with gout? (8)(8) gender and age
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Question Answer
What is the relationship btw hyperuricemia and gout treatment? (1)(1) Hyperuricemia DOES NOT always lead to gout
What is the relationship btw hyperuricemia and gout treatment? (2)(2) Many patients with hyperuricemia remain asymptomatic
What is the diagnostic evaluation of gout? (1)(1) Definitive diagnosis requires aspiration of synovial fluid from the affected joint and identification of intracellular crystals of monosodium urate (MSU)
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What is the diagnostic evaluation of gout? (2) Differential diagnosis (cellulitis, septic arhritis, seronegative (inflammatory arthritis, Pseudogout)

 

Question Answer
How do you identify Acute Gouty Arthritis? (1)(1) typically located at Monoarticular (e.g Podagra = big toe)
How do you identify Acute Gouty Arthritis? (2)(2) could be at other joints like ankle, heel, knee, wrist, finger, elbow
How do you identify Acute Gouty Arthritis? (3)(3) Rapid onset
How do you identify Acute Gouty Arthritis? (4)(4) Excruciating pain w/ inflammation like redness (Rubor), Swelling (Tumor), Heat (Calor), Pain (Dolor), Loss of action (functio laesa)
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Question Answer
What is the non-pharmacological treatment for Acute Gouty Arthritis?Local application of ice
What is the pharmacologic therapy?(1) NSAIDs (2) Corticosteroids (systemic or intraarticular) (3) Colchine
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Question Answer
Indomethacin (NSAIDs), brand and dosing?Indocin, 50 mg TID
Naproxen (NSAIDs), brand and dosing?Naprosyn, 750 mg f/b 250 mg Q8hr
Sulindac (NSAIDs), brand and dosing?Clinoril, 200 mg BID
Etodolac (NSAIDs), brand and dosing?Lodine, 300-500mg BID
Naproxen (NSAIDs), brand and dosing?Advil, Motrin, 400-800 mg TID-QID
Piroxicam (NSAIDs), brand and dosing?Feldene, 20 mg QD
Celecoxib (NSAIDs), brand and dosing?Celebrex, 800 mg f/b 400 mg on day one then 400 mg BID x1 wk
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Question Answer
MOA of NSAIDs?(1) Reversibly inhibit COX-1 and COX-2 (2) Inhibit prostaglandin synthesis
What are the adverse effects of NSAIDs? (1)(1) GI bleeding, less with COX-2 (Naproxen) take w/ food
What are the adverse effects of NSAIDs? (2)(2) Edema
What are the adverse effects of NSAIDs? (3)(3) Increased bleeding, increase w/ alcohol consumption and >/= 60 yo w/ blood thinner or systemic steroid drugs
What are the adverse effects of NSAIDs? (4)(4) Renal impairment
What are the adverse effects of NSAIDs? (5)(5) Increased risk of CV and Thromboembolic events with long term use
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Question Answer
What are the adverse effects of NSAIDs? (6)(6) have 3 or more/day with concomitant NSAIDs use
What are the adverse effects of NSAIDs? (7)(7) History of stomach ulcers or bleeding problems
What are the adverse effects of NSAIDs? (8)(8) Taking other drugs containing NSAIDs
What are the adverse effects of NSAIDs? (9)(9) Take more NSAIDS or for a longer time than directed
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Question Answer
True or false? Corticosteroids is anti-inflammatoryFalse, it is a pro-inflammatory
Examples of Corticosteroids(1) Prednisone, PO (2) Triamcinolone Methylprednisolone IM (3) Triamcinolone - Intraarticular (into the joint)
Prednisone, dosing range, comment30-60 mg PO QD for 3-5 days than taper in 5 mg increments over 10-14 days. May consider Methylprednisolone dose pack as alternative
Triamcinolone Methylprednisone, dosing range, comment60 mg (IM) once, 100-150 mg (IM) for 1-2 days. May be followed by PO prednisone
Triamcinolone (Intraarticular into the joint)For large joint use 10-40 mg, for small joint use 5-20 mg. Acceptable when only one to two joints involved and should be in combination with NSAIDs, colchicine, or oral corticosteroids
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Question Answer
Pt counseling for Corticosteroids (1)(1) It can cause stomach upset, take with food
Pt counseling for Corticosteroids (2)(2) It can cause insomnia, take in the morning
Pt counseling for Corticosteroids (3)(3) It increases blood sugar, monitor blood sugar more often in diabetic patients
Pt counseling for Corticosteroids (4)(4) It causes fluid retention/increases blood pressure, monitor blood pressure more often in patients with HTN
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What is the MNEMONIC for adverse effects of Corticosteroids: CUSHINGOID
Question Answer
Adverse effects for Corticosteroids (1)(1) Cataracts, Cushing syndrome (2) Ulcers (3) Stretch marks, Skin thinning (4) HTN, Hirsutism (5) Immunosuppression and infection
Adverse effects for Corticosteroids (2)(1) Necrosis of femoral heads (2) Glucose elevation, GI upset (3) Osteoporosis, Obesity (4) Impaired wound healing, Insomnia (5) Depression/mood changes
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Question Answer
Colchicine brand?Colcrys
Colcrys dose1.2 mg PO initially and 0.6 mg PO 1 hr later. Only once and stop.
What are the adverse effects of Colchicine?(1) Diarrhea, (2) Nausea, (3) Vomiting, (4) Myelosuppression
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What is the DDI of Colcrys? Dose reduction recommended when used with strong CYP 3A4 and P-glycoprotein inhibitors

 

Question Answer
Patient Counseling for Colchicine (1)(1) Start therapy 36 hrs of symptom onset
Patient Counseling for Colchicine (2)(2) Avoid use if you have been using Cochicine for treatment of acute gout attack in the last 14 days
Patient Counseling for Colchicine (3)(3) Colchicine can be used for both acute gout attack and prophylaxis but at different doses
Patient Counseling for Colchicine (4)(3) It is not an analgesic and shd not be used to treat pain from other causes
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