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Questions and Answers
Which enzyme is responsible for the conversion of hypoxanthine to xanthine?
What is the principle cause of gouty arthritis?
Which of the following is NOT a risk factor for gout?
What is the gold standard for diagnosing gout?
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Which medication is the cheapest option for IL-1 antagonists?
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What is the FDA approved dosing for colchicine in prophylaxis of acute gout flares?
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Which medication inhibits IL-1 from binding to its receptor?
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Which medication is a decoy receptor that binds to IL-1B?
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Which of the following is a strongly recommended condition for initiating urate-lowering therapy (ULT)?
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Which of the following is a conditionally recommended against initiating urate-lowering therapy (ULT)?
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Which medication is NOT studied for prophylactic therapy for mobilization flares when initiating urate-lowering therapy (ULT)?
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Which drug is a Xanthine Oxidase inhibitor (XOI) used for initiating Urate Lowering Therapy in gout?
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What is the maximum dose of Allopurinol?
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Which drug has a black box warning for increased cardiovascular death risk in patients with CV disease?
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Which drug is a pegylated recombinant modified mammalian urate oxidase used for refractory gout?
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Study Notes
Treatment Options for Gout: Allopurinol, Febuxostat, Probenecid, and Pegloticase
- Allopurinol and Febuxostat are Xanthine Oxidase inhibitors (XOI) used for initiating Urate Lowering Therapy in gout.
- Allopurinol initial dose is 50-100 mg daily, titrated every 2-5 weeks until uric acid levels are less than 6. Maximum dose is 800 mg.
- Febuxostat initial dose is 40 mg daily, increased to 80 mg daily if no response. Maximum dose is 40 mg in severe renal impairment.
- Both Allopurinol and Febuxostat require renal dose adjustments. Allopurinol also requires lower initial dose in CKD Stage 4 or greater.
- Allopurinol can cause agranulocytosis, aplastic anemia, myelosuppression, thrombocytopenia, renal failure, diarrhea, nausea, acute gout flares, rash, and allopurinol hypersensitivity syndrome.
- Allopurinol hypersensitivity syndrome (AHS) can be severe and fatal. Prevention includes HLA-B*5801 screening.
- Febuxostat can cause abnormal LFTs, nausea, mobilization flares, arthralgia, and rash. It has a black box warning for increased cardiovascular death risk in patients with CV disease.
- Probenecid is a uricosuric drug that competitively inhibits post-secretory renal proximal tubular reabsorption of uric acid.
- Probenecid initial dose is 500 mg daily or twice daily, titrated up to 500-2000 mg/day. It should be avoided in patients with CrCl < 50.
- Probenecid can cause flushing, dizziness, fever, headache, alopecia, dermatitis, pruritus, rash, anorexia, dyspepsia, nausea, anemia, gouty arthritis, and hypersensitivity.
- Pegloticase is a pegylated recombinant modified mammalian urate oxidase used for refractory gout.
- Pegloticase dosing is 8 mg infusion over 2 hours every 2 weeks, premedicated with corticosteroids and antihistamines. It can cause gout flares, infusion reactions, nausea, vomiting, bruising, nasopharyngitis, constipation, chest pain, and anaphylaxis.
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Description
Test your knowledge on the treatment options for gout. Learn about medications such as Allopurinol, Febuxostat, Probenecid, and Pegloticase, their dosing, side effects, and precautions.
