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BCPS study guide

gout

QuestionAnswer
what serum urate level indicates gout >6.8 mg/dL
why don't you want to try to diagnose gout using serum urate levels during a flare. when is a better time. what is a better diagnostic method and why isnt it used more because serum uric acid is low during a flare, you should check ~2 weeks after a flare. better to do a joint aspirate during a flare but patients typically won't allow this.
options for monotherapy treatment of acute gout attacks NSAIDs, colchicine, oral corticosteroids. can try intra-articular steroids or IM triamcinolone if 1 or more large joints are involved. ACTH is also an option if patient can't take oral meds
options for combination therapy treatment of acute gout attacks colchicine and NSAIDS; colchicine and oral corticosteroids; intra-articular steroids and [colchicine, NSAIDS or oral corticosteroids.
indications for urate lowering therapy tophi by exam or imaging, 2 or more gouty attacks per year, CKD stage 2 or greater, past urolithiasis,
first line for chronic urate lowering therapy xanthine oxidase inhibitor - i.e. allopurinol or febuxastat
alternative agents for chronic urate lowering therapy probenecid, losartan, fenofibrate
when is it not appropriate to use probenecid as an alternative to xanthine oxidase inhibtors for suppression of gout CrCl <50 or a history of urolithiasis
What are risk factors for allopurinol hypersensitivity syndrome thiazides, decreased renal function and ethnic factors
what should you expect to see in patients who are started on urate lowering therapy and how should you treat this after initiation of urate lowering therapy, expect to see an increase in gout flares. use prophylaxis to deal with this. colchicine, NSAIDs + PPI, or oral corticosteroids. start within 36 hours of flare.
if persistent hyperuricemia occurs despite treatment with standard therapies what can you add and what precautions are necessary pegloticase can be started but all other gout meds must be stopped. causes hypersensitivity, pretreat with antihistamine and steroids
what NSAIDS are approved for use in gout naproxen, sulindac and indomethacin
Created by: mjuhlin