Gout

Question 1

What is gout?

Answer 1

The deposition of uric acid crystals in the synovium

Question 2

What is the end product of purines?

Answer 2

Uric acid

Question 3

Where is the most likely place for crystal formation?

Answer 3

Peripheral joints

Question 4

What is Gouty nephropathy?

Answer 4

kidney disorders caused by an increase in uric acid

Question 5

What are the steps of acute gout attack?

Answer 5

Sodium urate crystals form in the join. Phagocytosis by neutrophils and macrophages. Neutrophils activation and release of inflammatory mediators.

Question 6

Which drugs inhibit the formation of uric acid?

Answer 6

Allopurinol and Febuxostat

Question 7

Which drugs increase the excretion of uric acid?

Answer 7

Probenecid

Question 8

What NSAIDs are given for an acute gout attack?

Answer 8

Indomethacin and Ibuprofen

Question 9

What is the mechanism of action of Indomethacin and Ibuprofen?

Answer 9

inhibition of prostaglandin synthesis

Question 10

What are the side effects of Indomethacin?

Answer 10

GI irritation- the increase in acid causes a decrease in mucous in the stomach leading to irritation
Central Nervous System- headache, drowsiness

Question 11

What drug is to be avoided in a gout attack?

Answer 11

Aspirin

Question 12

Why is Aspirin avoided in a gout attack?

Answer 12

Due to its biphasic effect on uric acid excretion

Question 13

What is an injectable NSAID that is mainly used for pain management?

Answer 13

Ketorolac (Toradol)

Question 14

What is an alternative to opioids that is used in treating acute gout attacks?

Answer 14

Ketorolac (Toradol)

Question 15

What are the side effects of Ketorolac (Toradol)?

Answer 15

GI irritation.

Question 16

Where does Colchicine come from?

Answer 16

It is a naturally occurring alkaloid isolated from autumn crocus

Question 17

What is special about Colchicine?

Answer 17

It has a unique anti-inflammatory activity that is specific for gout only

Question 18

What is the mechanism of action for Colchicine?

Answer 18

it binds to tubulin and prevents it’s polymerization to microtubules. It also inhibits the production and release of pro inflammatory glycoproteins from neutrophils.

Question 19

What are the side effects of Colchicine?

Answer 19

Diarrhea, upset GI, nausea, and vomiting. (Side effects may be severe even at therapeutic levels)

Question 20

How is Colchicine administered?

Answer 20

It can be administered orally or given in IV for acute attacks

Question 21

What is the mechanism of action of Allopurinol?

Answer 21

It inhibits the enzyme xanthine oxidase and reduces the formation of uric acid

Question 22

Does Allopurinol stop an acute gout attack?

Answer 22

No it does not stop an acute gout attack however over time it reduces the potential of an attack in the future

Question 23

What are the side effects of Allopurinol?

Answer 23

Increases frequency of gout attack during early stages of therapy due to the breakdown of crystals as uric acid blood levels fall.
Elevation of liver enzymes
Allergic reactions

Question 24

What is Febuxostat?

Answer 24

A new xanthine oxidase inhibitor
(more effective than Allopurinol)

Question 25

How are Allopurinol and Febuxostat similar?

Answer 25

both decrease uric acid levels which increases dissociation of existing crystals

Question 26

what is the difference between Allopurinol and Febuxostat?

Answer 26

Febuxostat generally similar to allopurinol but it is more expensive. It also has less dermatologic and hepatic effects

Question 27

Which drug is not given to a patient with gouty neuropathy?

Answer 27

Probenecid

Question 28

What kind of drugs is given to a patient with gouty nephropathy?

Answer 28

Xanthine oxidase inhibitors

Question 29

What is the mechanism of action for Probenecid?

Answer 29

It inhibits both the secretion and reabsorption of organic acids.

Question 30

What are the side effects of Probenecid?

Answer 30

increase of stone formation in kidney (not effective for treating acute attacks)

Question 31

What is the newest drug approved by the FDA for gout?

Answer 31

Pegloticase

Question 32

What is the mechanism of action of Pegloticase?

Answer 32

It is a recombinant rate oxidase that metabolizes rate to allantoin

Question 33

How is Pegloticase administered?

Answer 33

IV infusion due to it being a foreign protein to the body

Question 34

What is the first drug used to treat acute attacks?

Answer 34

Indomethacin, Ibuprofen or ketorolac Add an oral corticosteroid in severe attacks (methylprednisolone)

Question 35

What drug is used as a last resort in an acute attack?

Answer 35

Colchicine

Question 36

What is the treatment of hyperuricemia of chronic gout?

Answer 36

Dietary modification Uricosuric agent- probenecid