GOUT and Fibromyalgia

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Metabolic disease associated with abnormal amounts of uric acid
GOUT

What recurrence characterizes having gout? Where does it most commonly occur?
– acute arthritis
– Large toe

What are characteristic lesions in GOUT?
Tophi (nodular deposits)

What are two forms of dieting have reversible causes of hyperuricemia?
High purine diet, meats (organ tissue and red meats) and Alcohol (ribonucleotides)

What non-pharmacological treatment is essential in GOUT treatment?
hydration and adequate urine flow

Which medications precipitate gouty attacks?
Thiazide and loop diuretics (conc. uric acid)
Aspirin (low dose) and Niacin

In order to decrease stones in GOUT pts, what must happen to the urine? What is able to do this?
– Alkalinization
– Na bicarb or shohl’s solution

How do allopurinols work against GOUT?
blocks formation of uric acid.

How does uricase work against GOUT?
Breaks down uric acid

How do probenecid work against GOUT?
Increase excretion of uric acid in urine

Which medications reduce the degree of inflammation in GOUT?
NSAIDs, colchicine, cortocosteroids

What is the treatment of choice of acute gout? Name a specific med.
NSAIDS –> indomethacin

What provides dramatic symptom relief in acute episodes & will control most attacks?
Corticosteroids (prednisone)

Which drug used for gout is an anti-inflammatory that does not affect uric acid clearance and is not an analgesic?
Colchicine

Which drug binds microtubules of neutrophils disrupting mitotic spindle formation?
colchicine

What is colchicine effective against?
only gouty arthritis

When is colchicine most effective?
Acute use: when uriosuric meds are initiated to suppress attacks by changes in serum uric acid levels.

What is the highest dose of colchicine?
Initial dose

Which medications increase renal clearance of uric acid by inhibiting renal tubular reabsorption?
Uricosuric medications

Name the uricosuric medications.
Probenecid and sulfinpyrazone

Why must uricosuric medications be started at a low dose?
avoid marked uricosuria –> possible stone formation

What is very important to monitor with uricosuric medications
Maintain urine output and alkalizing urine

What is a major AE of uricosuric medications?
precipitation of gouty arthritis and stone formation

What is Probenecid used for?
Prevent gouty arthritis, hyperuricemia
and prolong penicillin effects.

What DI does Probenecid have?
increase effect of methotrexate, quinolines, beta lactam, NSAIDs

What are major renal SE of probenecid?
Nephrotic syndrome and renal calculi

Which medication inhibits xanthine oxidase decreasing uric acid production?
Allopurinol

What is the DOC in patients with a history of urinary stones or impaired renal fxn?
Allopurinol

What is the most commonly used drug for the prevention of gout?
Allopurinol

Which drug is used for in UA over-producers, tophaceous gout, patients unresponsive to uricosuric regimens?
Allopurinol

Allopurinol is a pre-treatment in cytotoxic therapy to prevent what?
Uric acid nephropathy

What is an AE allopurinol that is minimal and may become progressive? If this SE develops, what should be done?
– Skin rash — may progress to TEN/SJS
– discontinue

What is a rare reaction with allopurinol that causes Severe skin lesions, high fever, hepatic dysfunction, renal failure with high mortality rate?
Allopurinol hypersensitivity syndrome

When should allopurinol NOT be started? Why?
During an acute gout attack b/c it precipitates it.

Which immunosuppressant is contraindicated with allopurinol? Why?
– Azathioprine
– increase risk of bone marrow suppression

Which medications increase the effects of allopurinol? Decreases the effects of allopurinol?
– warfarin and theophylline
– ethanol

When using probenecid and allopurinol, would you need higher or lower doses of allopurinol?
higher

What is starting dose based on for allopurinol?
CrCl/ renal fxn

What is used for the treatment of hyperuricemia?
Rasburicase

Which analgesics are used to treat fibromyalgia?
Acetaminophen, tramadol, and NSAIDs

Which classes of medication are used to treat fibromyalgia?
Analgesics, Anti-depressants, Anti-seizure medications

Which Anti-depressants are used to treat fibromyalgia?
Fluoxetine/Duloxetine
Milancipran

Which Anti-seizure are used to treat fibromyalgia?
Gabapentin and pregabalin

What is milacipran used to treat? What does it do?
Fibromyalgia
Serotonin and NE reuptake inhibitor

Other than fibromyalgia, what else can Gabapentin treat?
Partial seizures and neuropathic pain

What is the chronic inflammatory disease of the skeletal muscle and skin?
Polymyositis

What must be monitored in polymyositis?
Serum creatnine kinase concentrations and electromyography abnormalities

What is the first line therapy for polymyositis?
Prednisone

What is used to treat refractory polymyositis patients?
Azathioprine and IVIG

What is ANCA associate vasculitides characterized by?
inflammation of BV and has the prescence of autoantibodies against neutrophils cytoplasmic constituents

Name the large vessel ANCA associated vasculitides?
Giant cell Arteritis, Takayasu’s arteritis

Name the small vessel ANCA associated vasculitides?
Wegner’s, Chrug-strauss, Microscopic polyangitis

If any of the ANCA associated vasculitides patients have a life threatening event, what must be done?
removal of the antibody –> Plasma exchange, IViG, high dose corticosteroids

What is the maintenance therapy for ANCA associated vasculitides?
Immunosuppression –> cyclophosphamide, rituximab

What decreases relapse rate of ANCA associated vasculitides?
SMX/TMP (Bactrim)

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