Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PR3154: Haematological & Musculoskeletal Systems > Gout > Flashcards

Gout Flashcards

1
Q

What causes gout?

A

Imbalances in purine metabolism
Deposition of monosodium urate (MSU) crystals in articular and periarticular tissues –> lead to inflammation, swelling, pain –> gouty attack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Clinical spectrum of diseases due to gout

A
  • Recurrent acute gouty arthritis (assoc. w urate crystals in synovial fluid)
  • Tophi (deposits of monosodium urate crystals in tissue in & surrounding joint) → chronic
  • Interstitial renal disease (gouty nephropathy) → extra articular presentations
  • Uric acid nephrolithiasis (uric acid kidney stones) → extra articular presentations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What dietary and lifestyle factors worsens gout?

A

Alcohol consumption
Sugary beverages
Red meat
Sedentary lifestyle –> obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Does gout occur more freq in male or female?

A

Males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are 2 ways that causes hyperuricemia?

A

Increased purine/urate production
Decrease uric acid clearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some drugs that decrease uric acid clearance?

A

Diuretics
Levodopa
Cyclosporine nad tacrolimus
Ethambutol
Low dose salicylates
Salt restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are presentations of a gout attack?

A
  • Usually monoarticular @ 1st great toe
  • wakes up from sleep by pain
  • severe pain for severe hours
  • swelling and discomfort continues for days to weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why does gout attack commonly start from big toe?

A

Uric acid in cold temp, lowers its solubility causing it to precipitate and since the big toe is furthest from circulatory, it is coldest part of the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Does asymptomatic hyperuricemia suggests gout?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How to diagnose gout?

A

Diagnosis based on presence of monosodium urate crystals in…
- Synovial fluid (detected in joint aspirate)
- Tissue sections of tophaceous deposits (Tophi)
- Joint aspiration → from joint fluid then view under microscope to check for birefringent like crystals (needle shape, yellow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How would the joint aspirate look like in gout attack?

A

Yellow colour and cloudy
Presence of uric acid crystals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Tx goal of gout?

A
  • Provide rapid, SAFE, & effective pain relief
  • Reduce future attacks (reduce SU concentration): do baseline serum urate lvl
  • Address associated comorbidities
  • Prevent joint destruction and tophi formation
  • Increase quality of life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are common pharmacotherapy for acute gout?

A

Colchicine
NSAID
CS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are common pharmacotherapy for chronic gout?

A

Allopurinol
Febuxostat
Probenecid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is usually given for 1st line in acute flares?

A

Colchicine (within 24hrs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is nonpharm for flares?

A

Topical ice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is colchicine dose for acute flares?

A
  • One off treatment with 1mg loading dose, followed by 1 dose of 0.5mg 1hr ltr

OR

  • 0.5mg 2-3times/day until flare resolves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is NSAID dose for acute flares?

A

Celecoxib 400mg LD, 200mg 12hrs ltr on day 1 then continue 200mg BD daily thereafter. Max: 400mg/day. Tx duration usually 5-7days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is CS dose for acute flares?

A

Prednisolone 30-40mg QD or in 2 divided doses for 2-5days or until smx resolves. Then taper down gradually for another 7 days by halving dose then discontinue

Can also dose by weight: 0.5mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Colchicine SE

A

N/V, diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Should colchicine and NSAID be cautioned in renal impairment?

A

Yes.

Consider reducing dose of colchicine.

NSAID is CI in CrCl <30ml/min

22
Q

When should Urate Lowering Therapy (ULT) be initiated?

A
  • Freq acute gout flares (>=2/yr)
  • Presence of any tophus
  • Clinical or imaging findings of gouty arthropathy
  • Hx of urolithiasis
23
Q

What is Tx target for ULT?

A

Non-thopaceous gout: <6mg/dl
Tophaceous gout: <5mg/dl

24
Q

How does allopurinol and febuxostat help in gout?

A

Decrease prdtn of uric acid

25
Q

How does probenecid help in gout?

A

Prevent reabsorption of uric acid which increases uric acid excretion

26
Q

What is the most impt point to counsel for allopurinol?

A

Risk of SCAR

27
Q

Febuxostat should be used in caution in what conditions?

A

HF and CHD

28
Q

Probenecid is CI in __ and not rec in __

A

Urolithiasis: prevents tubular reabsorption of urate
Not rec if CrCl < 50ml/min

29
Q

What is first line for ULT?

A

Allopurinol. Cheaper than febuxostat

30
Q

What is allopurinol dose for ULT?

A
  • Initiation: ≤ 100 mg/day [start w lower doses in CKD stage ≥ 3 e.g. ≤ 50 mg/day]
  • Titration: in 50 to 100 mg increments every 2-8 weeks [Monitor serum urate- <6mg/dL, clinical response & drug tox- SCAR]
  • Usual maintenance: > 300 mg/day [ok for renal impairment too]
  • Max dose: 800-900 mg/day [if normal renal function] since we treat to target, can increase dose.
31
Q

What is febuxostat dose for ULT?

A
  • Initiation: ≤ 40 mg/day
  • Titration: 80 mg/day if treatment target not met after 2-4 weeks
32
Q

When will febuxostat be considered over allopurinol?

A

When pt is intolerant to allopurinol i.e SCAR

33
Q

What is probenecid dose for ULT?

A
  • Initiation: 250 mg BD x 1 week, then 500 mg BD
  • Titration: in 500 mg every 4 weeks as tolerated if smx not controlled
  • Usual maintenance: ≤ 2 g/day
34
Q

What to counsel pts on probenecid?

A

Keep hydrated (>=2L of water) to prevent kidney stones from forming –> urolithiasis

35
Q

Why should we “start low, go slow” for ULT?

A

Dont want to precipitate another gout flare

36
Q

Pts w G6PD def on probenecid has a risk of __

A

Hemolytic anemia

37
Q

When does SCAR usually occur after Tx initiation?

A

First few wks to months

38
Q

What is the allele that increases the risk of allopurinol-induced SCAR

A

HLA-B*5801

39
Q

Is routine genotyping done before starting allopurinol and why?

A

No, low positive predictive value (PPV) of 2% & the lack of alternative cost-effective ULT options.

40
Q

Allopurinol genotyping is more useful in pts with __

A

Renal impairment
Older age

41
Q

What smx to counsel pts on SCAR?

A
  • Flu like smx like fever, body aches, unwell
  • Mouth ulcers, sore throat
  • Red or sore eyes
  • Rashes

Usually in first 3 months but may also happen after 3months

42
Q

What DDI w allopurinol increases bone marrow suppression?

A

6-mercaptopurine
Azathioprine
Cyclophosphamide

43
Q

What DDI w allopurinol increases hypersensitivity rxn?

A
  • ACEi
  • Loop diuretics
  • Thiazide / Thiazide-like diuretics
  • Ampicillin/amoxicillin
44
Q

What should you monitor if allopurinol is taken with carbamazepine or warfarin?

A

Carba - SJS/TEN
Warfarin - bleeding

45
Q

ULT-prophylaxis against acute flares treatment

A
  • Colchicine 0.5 mg OD
  • Low-dose oral NSAID / Coxib (e.g. celecoxib 200mg OD)
  • Low-dose oral corticosteroid (e.g. prednisolone 5 – 7.5 mg OD)

For 3 – 6 months

46
Q

Usually when will ULT Tx be stopped

A

No flares for >=1yr and no tophi

47
Q

What is non-pharm to reduce flares?

A

Limit alcohol intake
Limit purine-rich foods
Limit high-fructose corn syrup
Weight management

48
Q

Can you initiate ULT during acute flares?

A

NO

unless pt is alr on ULT, can still continue during flares

49
Q

What foods are high in purine?

A

Asparagus
Cauliflower
Mushroom
Red meat
Anchovies (ikan bilis)
Durain
Peanuts
Organ meat eg. liver
Alcohol

50
Q

Which HTN is preferred in gout?

A

ACEi (enalapril and captopril) or ARB (losartan) has uricosuric effect

Dont give HCTZ

PR3154: Haematological & Musculoskeletal Systems (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions