GOUT Flashcards

1
Q

gouty attack clinical features

A

sudden onset; nocturnal; precipitating factor; monoarticular; small, peripheral joint; fever

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2
Q

gout differential diagnosis

A

critical: bacterial infection of joint; other: pseudogout, aseptic monoarthritis, trauma; plasma urate level unreliable predictor of gouty attack

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3
Q

gout risk factors

A

OBESITY; high purine (PROTEIN) diet; metabolic factors; excessive alcohol; drug therapy; kidney failure;

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4
Q

pathophysiology of gouty attacks

A

plasma urate - ONE determinant of gouty attack, but inc levels may persist for years w/o attack; slight rise could cause attack

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5
Q

deposition of monosodium urate crystals depends on

A

‘solubilizers’ in plasma; plasma pH (alcoholics -> acidotic); tissue perfusion/temp

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6
Q

summary of gout treatment

A

aspirin competes w/urate for secretion -> inc urate in predisposed ppl! inc fluid intake -> inc excretion; allopurinol - don’t give if prone to attack -> slight inc in purines at start

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7
Q

colchicine characteristics

A

plant alkaloid w/cytostatic properties

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8
Q

colchicine pk

A

oral

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9
Q

colchicine pd

A

binds to tubulin (inhibit microtubule assy) -> depolymerization -> cytostatic effect on leukocytes, inhibit inflammation -> pain relief; NO EFFECT on msu crystals or plasma urate levels

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10
Q

colchicine uses

A

tx acute gouty attack

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11
Q

colchicine adverse effects

A

related to cytostatic properties; acute: GI complaints, pain, DIARRHEA (frequent); chronic: no longterm tx -> alopecia, agranulocytosis, aplastic anemia, myopathy, neuropathy

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12
Q

colchicine contraindications

A

pregnancy

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13
Q

uricostatics: allopurinol pk

A

oral; converted to oxypurinol (alloxanthine) by xanthine oxidase

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14
Q

allopurinol pd

A

competitively inhibit xanthine oxidase -> large dec urate, large inc hypo/xanthine -> more soluble than urate -> dec risk of urate precipitation, inc hypo/xanthine renal excretion

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15
Q

allopurinol adverse effects

A

GI upset; may inc urate at onset; rare: erythema multiforme, stevens-johnson syndrome

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16
Q

allopurinol uses

A

manage chronic gout; NOT in first 1-2 wks after acute episode

17
Q

uricosuric agents

A

probenecid, sulfinpyrazon, (benzbromarone)

18
Q

probenecid, sulfinpyrazon, (benzbromarone) pd

A

block tubular reabsorption of urate at therapeutic conc

19
Q

low doses of uricosuric agents…

A

BLOCK tubular secretion of urate! don’t use after first few weeks of attack

20
Q

probenecid, sulfinpyrazon, (benzbromarone) interactions

A

probenecid inhibits tubular secretion of penicillin, naproxen, ketoprofen, indomethacin (nsaids) -> can’t tolerate co-tx

21
Q

probenecid, sulfinpyrazon, (benzbromarone) adverse effects

A

mild; sulfinpyrazone - GI

22
Q

treatment of chronic hyperuricemia

A

dec of the body urate pool takes months/yrs; maybe lifelong therapy; ensure high fluid turnover; start in symptom-free interval; dec purine-rich food; tx w/uricosuric/static drug; can use nsaid/low dose colchicine at onset of therapy - prevent recurrence; weight loss; urine alkalinization may help -> if overdue -> calcium oxalate stones