Gout

Question 1

Composition of Gout Crystals

Answer 1

Sodium Urate

Question 2

What is tumor lysis syndrome

Answer 2

Massive tumor lysis
Release of nucleotides
Hyperuricemia
Renal injury

Question 3

What is the DOC for gout pain

Answer 3

Indomethacin

Question 4

What can be given to control pain in gout

Answer 4

Indomethacin
NSAIDs
Colchicine
Glucocorticoids

Question 5

What can be given to treat gout (reduce serum urate)

Answer 5

Allopurinol
Probenecid
Sulfinpyrazone
Rasburicase

Question 6

What suppresses leukocyte recruitment and activation

Answer 6

Indomethacin
NSAIDs
Colchicine
Glucocorticoids

Question 7

Why are COX-2 inhibitor use limited

Answer 7

Increased CV risk

Question 8

What are the AE for Indomethacin

Answer 8

Bleeding
Na, H2O retention
Renal Insufficiency

Question 9

What do you never give for gout pain

Answer 9

Low dose Aspirin

Competes with urate for PT secretion

Question 10

How does Colchicine work

Answer 10

Bind tubulin to inhibit MT production
Disrupts mitotic spindle
Inhibition of synth/release of LTs

Question 11

Do we give Colchicine anymore

Answer 11

No…Then why the fuck are we learning this

Question 12

Main Colchicine AE

Answer 12

Diarrhea

Question 13

Other Colchicine AE

Answer 13

Pain
N/V
Myopathy, neutropenia, aplastic anemia, alopecia

Question 14

When should Colchicine be given with caution

Answer 14

Hepatic, Renal, CV disease

Question 15

What decreases uric acid synthesis

Answer 15

Allopurinol

Question 16

How does Allopurinol work

Answer 16

Inhibits xanthine oxidase

Dissolutes tophi

Question 17

What is Allopurinol an analog of

Answer 17

Purine

Question 18

What is the initial effect of Allopurinol

Answer 18

Increase attacks

Mobilization of tissue stores of urate

Question 19

What do you co-administer Allopurinol with

Answer 19

NSAID

Colchicine

Question 20

What are the main AE of Allopurinol

Answer 20

HS

Skin rash –> S-J syndrome

Question 21

Allopurinol with rash next step

Answer 21

Stop the damn Allopurinol

Question 22

What prevents renal damage during cancer therapy

Answer 22

Allopurinol

Rasburicase

Question 23

Reduces doses of 6-MP and Azathioprine

Answer 23

Allopurinol

Question 24

How does Allopurinol decrease doses of 6-MP and Azathioprine

Answer 24

Xanthine oxidase metabolizes them normally

Question 25

What enhances urate excretion

Answer 25

Probenecid | Sulfinpyrazone

Question 26

How do Uricosuric agents work

Answer 26

Compete with urate for transporter blocking reabsorption

Question 27

What do you coadminister uricosuric agents with

Answer 27

NSAIDs

Question 28

Main AE of Sulfinpyrazone

Answer 28

Decrease hematopoesis | Inhibit Warfarin metabolism

Question 29

What are the Uricosuric agent AEs

Answer 29

GI irritation HS Renal stones

Question 30

When are Uricosuric agents contraindicated

Answer 30

Gout pt with nephrolithiasis/urate overproduction | Blood dyscrasia

Question 31

How does Rasburicase work

Answer 31

Oxidizes uric acid to allantoin | Easily excreted

Question 32

What is a recombinant Aspergillus uricase

Answer 32

Rasburicase