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Terms in this set (39)
3 steps for managing gout
1. tx acute attacks
2. prophylaxis to prevent flares
3. lower excess stores of urate
Goals of treating acute gout attack
Relieve pain and inflam
When should acute gout tx start?
Do acute attacks have to be treated with meds?
No, symptoms will resolve on their own but will take weeks. Resolves much quicker with immediate tx
Meds of choice for reducing inflammation
What NSAIDs are used for acute gout flares?
Indomethacin or Naproxen
CKD w/ Cr clearance <60, active peptic or gastric ulcer, ongoing tx with anticoagulants
What should indomethacin be taken with?
Food and pepcid (hard on the stomach)
2nd line tx option for acute gout flare
When is Colchicine used instead of NSAIDs?
If pt has NSAID intolerance or they have an absolute contraindication to NSAIDs
MOA of Colchicine
Inhibits neutrophil chemotaxis and inflammatory mediator release
Does Colchicine have pain relief properties?
No, just anti-inflammatory
What should be used for pain if pt is on Colchicine for inflammation?
Tylenol (remember, no NSAIDs if on Colchicine)
3rd line tx option for acute gout flare
What oral glucocorticoid is used for gout flares?
What intra-articular glucocorticoid is used for gout flares?
When should Triamcinolone be used?
Only if 1 or 2 joints are involved (not used for polyarticular gout)
Ways to reduce risk of recurrent gout
1. wt loss
2. reduce ETOH intake
3. discontinue diuretics (loops and thiazides) if possible
4. discontinue ASA if possible
Why can discontinuing diuretics and ASA reduce chances of recurrent gout?
Both cause increase in serum urate so stopping them can decrease urate levels
When should urate lowering therapy be initiated?
Not until at least 2 weeks after a flare
Why shouldn't urate lowering be done until at least 2 wks after a flare?
It can precipitate an attack if give too soon
What is Probenecid used for?
Gout flare prophylaxis
MOA of Probenecid
Promotes renal clearance of uric acid by inhibiting urate-anion exchangers in the proximal tubule that mediates urate reabsorption
What pts can't have Probenecid?
Anyone with nephrolithiasis or impaired renal function
How is Probenecid dosed?
Multiple times a day
What can Probenecid cause?
Kidney stones (if pt gets one, stop the med)
What is Allopurinol used for?
Gout flare prophylaxis
MOA of Allopurinol
Xanthine oxidase inhibitor (and therefore inhibits uric acid production)
What does xanthine oxidase do?
Produces uric acid
SE of Allopurinol
- mild rash (may disappear if stop med then restart)
- GI distress, diarrhea
- severe hypersensitivity syndrome
Signs of severe hypersensitivity reaction
Eosinophilia, fever, hepatitis, poor renal function, erythematous desquamative rash
What can severe hypersensitivity reaction lead to?
Allopurinol + what abx can lead to rash?
What is the newest xanthine oxidase inhibitor?
What is Febuxostat approved for?
Which med is more effective for hyperuricemia: allopurinol or febuxostat?
Can Febuxostat cause a hypersensitivity reaction?
Why is allopurinol still used more often than febuxostat?
It is much cheaper
Tx for CPPD (pseudogout)
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