Assisst. Prof. Hassan Khuder Rajab 2nd Class - Gouty Arthritis
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Questions and Answers

What is the recommended initial oral dose of colchicine for acute attacks of gouty arthritis?

  • 0.5 mg
  • 2 mg
  • 3 mg
  • 1 mg (correct)

    • Why should IV colchicine be avoided?

  • Because it leads to increased renal function
  • Due to bone marrow suppression (correct)
  • To prevent tissue necrosis from local extravasation
  • For treating disseminated intravascular coagulation

    • How should the initial IV dose of colchicine be administered?

  • Slowly over 10 to 20 minutes in a secure IV line (correct)
  • Mixed with a high concentration of dextrose for rapid infusion
  • Rapidly in a large single bolus injection
  • Administered as a push via a peripheral IV line

    • After completing a full IV course of colchicine, how long should patients wait before receiving colchicine by any route?

    <p>At least 7 days</p> Signup and view all the answers

    In what situations are corticosteroids primarily reserved for the treatment of acute gouty arthritis attacks?

    <p>Patients who are unresponsive to NSAID or colchicine therapy</p> Signup and view all the answers

    What is the recommended dose of prednisone for treating acute attacks of gouty arthritis?

    <p>30-60 mg</p> Signup and view all the answers

    Why are corticosteroids also used in patients with multiple-joint involvement in gouty arthritis?

    <p>To provide additional pain relief</p> Signup and view all the answers

    What is a potential serious adverse effect associated with IV colchicine administration?

    <p>Renal failure</p> Signup and view all the answers

    What is the recommended approach for tapering the dose of corticosteroids to avoid rebound attacks?

    <p>Gradually taper the dose by 5 mg over 10 to 14 days and then discontinue</p> Signup and view all the answers

    Which route of administration can be used as an alternative to oral corticosteroids if patients are unable to take oral therapy?

    <p>Intramuscular injection of a long-acting corticosteroid</p> Signup and view all the answers

    What adjunctive therapy can be used with injectable corticosteroids to prevent rebound flare-ups, if not contraindicated?

    <p>Colchicine at a low dose</p> Signup and view all the answers

    For acute gout limited to one or two joints, which intraarticular administration is recommended?

    <p>Triamcinolone hexacetonide 20 to 40 mg</p> Signup and view all the answers

    What is the recommended dosage and administration schedule for adrenocorticotropic hormone (ACTH) gel in the treatment of gout?

    <p>40 to 80 USP units, intramuscularly every 6 to 8 hours for 2 to 3 days</p> Signup and view all the answers

    Under what circumstances should prophylactic treatment for gout be withheld?

    <p>If the first episode of acute gouty arthritis was mild, responded promptly to treatment, the serum urate concentration was only minimally elevated, and the 24-hour urinary uric acid excretion was not excessive</p> Signup and view all the answers

    Which of the following is a contraindication for the use of ACTH gel in the treatment of gout?

    <p>All of the above</p> Signup and view all the answers

    What is the recommended duration for the administration of ACTH gel in the treatment of gout?

    <p>2 to 3 days, then discontinued</p> Signup and view all the answers

    What is the primary purpose of alkalinizing the urine during uricosuric therapy?

    <p>To increase the solubility of uric acid, reducing the risk of stone formation</p> Signup and view all the answers

    What is the initial recommended dosage of probenecid for uricosuric therapy?

    <p>250 mg twice daily</p> Signup and view all the answers

    What is the maximum recommended daily dose of probenecid for uricosuric therapy?

    <p>2 g/day</p> Signup and view all the answers

    What is the initial recommended dosage of sulfinpyrazone for uricosuric therapy?

    <p>50 mg twice daily</p> Signup and view all the answers

    What is the maximum recommended daily dose of sulfinpyrazone for uricosuric therapy?

    <p>800 mg/day</p> Signup and view all the answers

    Which of the following is NOT a common side effect associated with uricosuric therapy?

    <p>Hepatotoxicity</p> Signup and view all the answers

    In which patient population are uricosuric drugs contraindicated?

    <p>Patients with impaired renal function</p> Signup and view all the answers

    What is the primary mechanism of action of uricosuric drugs in the treatment of hyperuricemia?

    <p>Promotion of uric acid excretion through the kidneys</p> Signup and view all the answers

    What is the most effective nonpharmacologic therapy for acute gouty arthritis?

    <p>Joint rest for 1 to 2 days</p> Signup and view all the answers

    When should colchicine ideally be started for an acute gout attack?

    <p>Within the first 24 hours</p> Signup and view all the answers

    What percentage of patients may experience gastrointestinal adverse effects with oral colchicine?

    <p>50% to 80%</p> Signup and view all the answers

    Which condition may be worsened in patients taking colchicine along with statins?

    <p>Axonal neuromyopathy</p> Signup and view all the answers

    Why should colchicine not be used concurrently with macrolide antibiotics?

    <p>Elevated plasma colchicine levels</p> Signup and view all the answers

    What is the primary benefit of starting colchicine early in the course of an acute gout attack?

    <p>Higher likelihood of patient response</p> Signup and view all the answers

    Which organ meats are high in purines and should be reduced in the diet for gout patients?

    <p>Beef liver</p> Signup and view all the answers

    What is the recommended prophylactic treatment for patients with frequent attacks of gouty arthritis?

    <p>Colchicine in low oral doses (0.5 to 0.6 mg twice daily)</p> Signup and view all the answers

    In patients with renal or hepatic dysfunction, what is the recommended dosage of colchicine for prophylactic treatment?

    <p>No more than 0.6 mg daily or every other day</p> Signup and view all the answers

    If a patient on prophylactic treatment senses the onset of an acute attack, what is the recommended dosage of colchicine?

    <p>1 mg every 2 hours</p> Signup and view all the answers

    When can prophylactic treatment for gouty arthritis be discontinued?

    <p>After 1 year of normal serum urate concentration and no symptoms</p> Signup and view all the answers

    Which drugs are uricosuric agents that increase the renal clearance of uric acid?

    <p>Probenecid and sulfinpyrazone</p> Signup and view all the answers

    When should uricosuric drugs be used for the treatment of gout?

    <p>In patients with underexcretion of uric acid</p> Signup and view all the answers

    What is the recommended approach when starting therapy with uricosuric drugs?

    <p>Start with a low dose to avoid marked uricosuria and possible stone formation</p> Signup and view all the answers

    Which of the following serum uric acid levels or urinary excretion of uric acid would indicate the need for prophylactic treatment?

    <p>Serum uric acid greater than 10 mg/dL or 24-hour urinary excretion of uric acid of more than 1,000 mg</p> Signup and view all the answers

    What is the primary concern with the use of nonsteroidal antiinflammatory drugs (NSAIDs) in the treatment of rheumatoid arthritis?

    <p>They have no impact on disease progression.</p> Signup and view all the answers

    Why should corticosteroids seldom be used as monotherapy for rheumatoid arthritis?

    <p>They pose the risk of long-term complications.</p> Signup and view all the answers

    What adverse effect of methotrexate (MTX) requires monitoring in patients undergoing treatment for rheumatoid arthritis?

    <p>Gastrointestinal toxicities</p> Signup and view all the answers

    Which combination is considered particularly effective in the treatment of rheumatoid arthritis?

    <p>MTX plus cyclosporine</p> Signup and view all the answers

    Which property of methotrexate (MTX) contributes to its antiinflammatory effects in the treatment of rheumatoid arthritis?

    <p>Inhibition of purine biosynthesis</p> Signup and view all the answers

    Why are nonsteroidal antiinflammatory drugs (NSAIDs) used for symptomatic relief in rheumatoid arthritis?

    <p>To provide rapid improvement compared to DMARDs</p> Signup and view all the answers

    What role does folic acid play in the treatment of methotrexate (MTX) toxicity during rheumatoid arthritis therapy?

    <p>It reduces some adverse effects without loss of efficacy.</p> Signup and view all the answers

    What distinguishes corticosteroids from disease-modifying antirheumatic drugs (DMARDs) in their treatment approach for rheumatoid arthritis?

    <p>DMARDs target disease progression while corticosteroids offer rapid symptom relief.</p> Signup and view all the answers

    Which of the following is NOT a recommended first-line disease-modifying antirheumatic drug (DMARD) for the treatment of rheumatoid arthritis?

    <p>Azathioprine</p> Signup and view all the answers

    What is the primary benefit of using biologic agents for the treatment of rheumatoid arthritis?

    <p>Ability to treat patients who have failed treatment with other DMARDs</p> Signup and view all the answers

    What is the primary mechanism of action of uricosuric drugs in the treatment of hyperuricemia?

    <p>Increasing the renal clearance of uric acid</p> Signup and view all the answers

    Which of the following is a potential serious adverse effect associated with intravenous administration of colchicine?

    <p>Bone marrow suppression</p> Signup and view all the answers

    What is the primary purpose of alkalinizing the urine during uricosuric therapy for the treatment of gout?

    <p>To increase the solubility of uric acid in the urine</p> Signup and view all the answers

    Which of the following is NOT a recommended nonpharmacologic therapy for the management of rheumatoid arthritis?

    <p>Corticosteroid injections</p> Signup and view all the answers

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