lose weight, stay hydrated, smoking cessation, exercise, healthy diet
What are the non-pharmacological treatments for Hyperuricemia? (5)
organ meats (liver, kidney), sweet bread, high fructose corn syrup, alcohol overuse(avoid in periods of frequent gout attacks )
Which foods should patients with Hyperuricemia avoid? (4)
2 or more gout attacks, > 1 tophus, CKD stage 2, history of urolithiasis
What patient factors does ACR recommend Urate Lowering Therapy (ULT) for? (4)
maintain concentration of 6mg/dL; below 5mg/dl is preferred
What is the goal serum uric acid concentration for ULT?
false; can be started if anti-inflammatory prophylaxis has started
ULT cannot be initiated during acute gout attacks. T/F?
probenecid, losartan, fenofibrate
What are the uricosuric agents?
xanthine oxidase inhibitors
________ are recommended as 1st-line therapies.
combination therapy + uricosuric agent
What is the treatment for refractory cases?
severe cases when patient can't tolerate/not responding to other meds
When is Pegloticase recommended?
allopurinol, febuxostat, pegloticase
Which medications are used for overproducers AND under-excretors? (3)
probenecid
Which medication is used for under-excretors?
b
Which is 1st line?
a) febuxostat
b) allopurinol
c) pegloticase
d) probenecid
d
Which one should NOT be used in patients with a history of kidney stones?
a) febuxostat
b) allopurinol
c) pegloticase
d) probenecid
impaired renal function (CrCl <50ml/min), overproducers of uric acid
Probenecid Contraindications? (2)
maintain urine flow, alkalize urine during first few days
How can we prevent kidney stone formation in patients on Probenecid? (2)
2 gm
What is the maximum dose of Probenecid?
d
Which should be avoided with Salicylates?
a) febuxostat
b) allopurinol
c) pegloticase
d) probenecid
c
Which is the agent of last resort?
a) febuxostat
b) allopurinol
c) pegloticase
d) probenecid
bi-weekly infusions, administer over no less than 2 hours, pretreatment with antihistamines/corticosteroids
Pegloticase dosing instructions? (3)
fenofibrate or losartan + XO inhibitor
ACR guidelines for patients with refractory disease?
low dose colchicine + low dose NSAID
What is the 1st line-ACR prophylactic treatments?
3 months after achieving uric acid levels or 6 months total
How long does prophylactic treatment last?
every 2-5 weeks until target achieved; every 6 months after
If a patient is doing ULT therapy, how often do we check their Uric Acid levels?