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Terms in this set (47)
how is Uric acid produced?
as end product of PURINE metabolism
gout typically occurs in what joint?
metatarsophalangeal joint (big toe)
in addition to UA level, what other measurements can be taken?
synovial fluid to identify if UA crystals are present
what foods to AVOID in gout?
high fructose corn syrup
alcohol - beer esp
drugs that increase uric acid
Diuretics - loops, thiazides
Niacin (CI in severe gout)
Aspirin in higher doses (Bufferin)
Pyrazinamide (in RIPE)
Some pancreatic enzymes
some chemo (tumor lysis syndrome- tx prophylactically with allopurinol)
is asymptomatic hyperuricemia treated?
normal UA level?
2-6.5 females, 3.5-7.2 males
what level should you lower UA to?
what drugs are used for acute attacks? what is their purpose?
NSAIDs - indomethacin, naproxen, sulindac, celecoxib, ibuprofen
steroids - prednisone, methylprednisolone, triamcinolone
reduce pain and inflammation
what drugs are used to prevent future gout attacks?
allopurinol (xanthine oxidase inhibitor) - can cause an acute gout attack bc lowers UA level very fast
- so use colchicine/NSAIDs along with allopurinol
what is the purpose of prophylactic drugs in gout?
to reduce UA levels
what is the dosing for colchicine?
when are dose reductions needed?
0.6 mg PO x 2, followed by 0.6 mg 1 hour later ; then 0.6 mg daily or BID (px dosing)
NTE 1.8 mg in 1 hour, NTE 2.4 mg in 24hours
dose repeated no earlier than 3 days
in renal disease, age, DDI - take max 2 tabs (1.2 mg )
CI for colchicine?
do not use in combo with pgp inhibitor (cyclosporine) or 3A4 inhibitors (clarithromycin) with renal/hep impairment
Warnings with colchicine?
-GI symptoms: reduce dose if N/V/D
-neuromuscular toxicity, rhabdo (avoid with gemfibrozil- inhibits statin metabolism)
-avoid cyclosporine, dilt, verapamil, gemfibrozil, statins bc these increase myopathy
-myelosupp - rare
when should colchicine be started?
start within 36 hours of onset of symptoms
after tx dose of colchicine, how long to wait to resume px dosing?
wait 12 hours after tx dosing before resuming px dosing
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