Gout Flashcards
(42 cards)
What is gout
A type of arthritis caused by monosodium urate (MSU) crystals
Why is there not a build up of uric acid in other mammals
Other mammals have an enzyme called uricase that metabolizes uric acid to allantoin that is readily eliminated (humans have no uricase)
What factors increase the risk of gout
Age, Increased Scr, Increased BUN, Male gender, high blood pressure, high body weight, alcohol intake, serum uric acid greater than 7 mg/dL, family history
What are the two ways that normal uric acid is eliminated
GI excretion after enzymatic degradation by colonic bacteria (1/3) , Urine excretion (2/3)
What are the two main causes of UNDEREXCRETION of uric acid
CKD and Diabetes
What are 3 purine sources that are used to make nucleic acid or uric acid leading to OVERPRODUCTION
Conversion of tissue nucleic acid to purine nucleotides, De novo synthesis, dietary purine
T/F: High dietary purine intake alone will increase serum uric acid
False: Vast majority of overproduction is increased breakdown of tissue nucleic acids due to increased cell turnover
What medications are associated with getting gout
Salicylates, diuretics, cytotoxic drugs
What causes the pain from GOUT
inflammatory attack due to uric acid deposition mediated by leukocytes
T/F: The most common clinical presentation is in the big toe BUT can be present in other joints such as the feet, knees, hands, or elbows
True
What joint in the big toe is most often affected by gout
Metatarso-phalangeal joint (MTP)
What would be found if aspiration form the synovial fluid was possible for the patient
Urate crystals inside synovial fluid leukocytes, large numbers of polymorphonuclear leukocytes
What are the 11 criteria (need 6) that needs to be met to be diagnosed with gout
More than 1 acute attack of arthritis Exquisite pain involving joint Joint inflammation maximal with one day Oligoarthritis Erythema over involved joints Tophi Podagra (unilateral) Hyperuricemia MSU crystals in joint fluid during attack Joint fluid negative for organisms Asymmetric selling in a join and/or subcortical cysts
What non pharmacological treatment can aid initially for a Gout attack
Ice and joint rest
What is the MOA desired for drugs treating gout acutely, what are the meds, when should they be initiated
Reducing the inflammation/ NSAIDs, corticosteroids, cholchicine/ 24 hours
`T/F: Though indomethacin is the most favored NSAID there is NO evidence that any given NSAID is superior to the others
True
`What cautions/contrainidicatons for using NSAIDs to treat a patient
CHF, CKD, history of GI bleed, asthma, anticoagulation
What is the most potent anti-inflammatory drugs used for resistant cases but could also be used first line
Corticosteriods
What are the corticosteriods that can be given for gout
Prednisone (0.5 mg/kg/day for 2-5 dyas then taper for 7-10 days to prevent rebound attack), Methylprednisolone pack, Triamcinolone acetonide 20-40 mg (intra-articular administration)
What are the adverse effects of corticosteroids
fluid retention and HTN, mood swings, hyperglycemia, infection, GI
What are cautions/contraindications of using corticosteroids
Infection (latent or active), HTN, cirrhosis, CHF
What is the drug that was FDA approved for gout in 2015, what is the FDA approved dose
Colchicine: 1.2 mg (two 0.6 mg tablets) once, then 0.6 mg one hour later
What are tips for colchicine administration
Wait 12 hours to resume prophylactic dose, DON’T take another course within 3 days, CrCl less than 30 do not give another coure for 14 days
What CYP3A4 inhibitors should be monitored when co-administered with colchicine
protease inhibitors, Macrolides (clarithromycin and erythromycin), antifungals (irtraconazole, ketoconazole, flucanozole), non-DHP CCBs (dilitazem and verapmil), grapefruit juice
