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402 - Exam - Endocrine > Gout > Flashcards

Gout Flashcards

(47 cards)

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1
Q

?

A

Hyperuricemia

Formation of uric crystals inside and around the joint

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2
Q

Symptoms

A

• red/inflammation
• hot to touch
• red shiny skin

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3
Q

As the swelling goes down what happens to the skin of affected joint

A

Flakey, itchy, peeling

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4
Q

Which joint is affected first?

A

Metatarsophalangeal joint - MTP

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5
Q

Which joints can be affected?

A

• big toe
• ankles
• fingers
• elbows
• knees

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6
Q

Is the onset rapid or slow

A

Rapid - will occur in a few hours and last for 3-10 days

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7
Q

Causes

A

• disruption in the metabolism of purines
• hyperuricemia

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8
Q

What are purines made from (atoms)

A

Carbon and nitrogen

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9
Q

Where are they found in the body of living things

A

Nucleus - DNA and RNA

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10
Q

Foods with high content of purines which should be avoided?

A

• sea food
• kidneys, liver and heart

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11
Q

Foods with medium content of purines which should be avoided?

A

Meat - beef, lamb, pork

Beer

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12
Q

Foods with low content of purines which should be avoided?

A

Dairy foods
Carbs

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13
Q

When alcohol is being metabolised what happens to urate

A

It contributes to the retention of uriate

(Alcohol also contributes to obesity which can under excretion of urate

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14
Q

Gout risk factors

A

• men
• post menopausal women >45
• CVD, HTN, diabeties
• obesity, hyperlipidemia
• drugs - thiazide diuretics, low dose aspirin

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15
Q

Stages of Gout - asymptomatic

A

Long periods of no asymptomatic Hyperuricemia before gout occurs

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16
Q

Stage - acute

A

Sudden onset of pain and swelling lasts 3-10 days

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17
Q

Stages - Intercritical gout

A

The period between gout attacks (can be 10 years) whilst there’s this formation of crystals

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18
Q

Stages - Chronic

A

Permanent damage

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19
Q

Which test are used

Study These Flashcards
A

• serum uric acid (wait 2-4 weeks after attack because uric acid levels are not raised during attacks)

^this shouldn’t be used alone

Joint aspiration and microscopy of synovial fluid OR X-ray, CT, ultrasound

20
Q

Which urate level indicate gouts

21
Q

What is the treatment of acute gout

Study These Flashcards
A

1st - NSAIDs - ibuprofen or Naproxen

(Give PPI)

2nd - Colchicine

3rd
- oral prednisone
- IM methylprednisolone

22
Q

Colchicine MOA

Study These Flashcards
A

Inhibits polymerisation of tublin to microtubules

Inhibitors activation of neutrophils

23
Q

When should acute treatment be started

24
Q

How long after attack has resolved should it be continues for?

25
Who may not NSAIDs be suitable for
• HF • hx of peptic ulcers • on anticoagulants- warfarin
26
Which drug would be suite in acute gout with HF
Colchicine
27
Which drugs interact with colchicine
CYP4A3 inhibitors Examples - • vir - HIV drugs • zole - antifungals • clarythromycin
28
A side effect of colchicine is gi upset how would you councel a patient on this
Take with or after food
29
What sort of patients can receive treatment if chronic gout/prevtion ULT - uric acid lowering therapy
• CKD 3-5 • 2+ flares in one year • tophi • on diuretics
30
What is the MOA ULT
Xanithine oxidase inhibitors
31
1st and 2nd line ?
Allopurinol And Febuxostat
32
What is the max dose of of Allopurolol
900mg/day
33
How long after would you monitor sUA
4 weeks (If over 360 increase dose) Same for febuxostat
34
What should be co prescribed for both ULT
Colchicine 500mcg BD for 6 months
35
What is a common side effect of Allopurinol
Hypersensitive rash
36
Should it be continued after this rash
No STOP
37
What does Allopurolol interact with
Azithroprine - azithroprine toxicity ACEI or thiazide and amoxicillin
38
What does Febuxostat interact with
Azithroprine
39
What complications can occur?
• renal stones • chronic arthritis • tophi
40
Can ULT continued if gout attacks occurs
Yes treat attack separately
41
In acute gout treatment for someone with reduced eGFR what should be given
Colchicine
42
What is the most definite test for foot
Joint aspiration and microscopy of synovial fluid
43
What is the target sUA levels in foot
<300
44
Example of a uricosuric agent
Probenecid
45
Which monitoring is key in ULT
Creatin and renal
46
Why shouldn’t UKT be started during an attack
Because it can exacerbate it Wait 3-4 weeks?
47
Why should Colchine or NSAID be co prescribed
To avoid triggering acute attack

402 - Exam - Endocrine (7 decks)

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