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Pharm Y2S2 Patient > Gout and Nutrition > Flashcards

Gout and Nutrition Flashcards

1
Q

What is gout?

A

A type of inflammatory arthritis that causes pain, discomfort and damage to joints

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2
Q

What causes gout?

A

Deposition of monosodium urate crystals formed by excess uric acid. The crystals are formed from excess uric acid.

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3
Q

What is uric acid?

A

Breakdown product of purine

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4
Q

What are the risk factors for developing gout?

A
  • Genetic predisposition
  • Medicines that raise uric acid
  • Obesity
  • Weight gain
  • Hypertension
  • Dyslipidaemia
  • Alcohol consumption
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5
Q

Which drugs lead to raised uric acid levels?

A
  • Aspirin
  • Ciclosporin
  • Cytotoxic medicines
  • Diuretics
  • Ethambutol
  • Levodopa
  • Pyreizinamide
  • Ribavaran & Interferon
  • Teriparatide
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6
Q

What is the first line treatment for gout?

A

NSAIDs - start at high dose then taper 24 hours after resolution of attack

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7
Q

Which drug can be used in gout patients when NSAIDs are contraindicated?

A

Colchicine

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8
Q

How does Colchicine work?

A

Arrests assemble of microtubules in neutrophils and inhibits many cellular functions

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9
Q

What are the side effects of colchicine?

A
  • Abdominal cramps

- Nausea & vomiting

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10
Q

When should colchine be used with caution?

A

In chronic heart failure patients - can constrict blood vessels and stimulate central vasomotor

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11
Q

When would a corticosteroid be used in gout patients?

A

When NSAIDs and colchicine are contraindicated or ineffective

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12
Q

Give examples of corticosteroids used in gout

A
  • Methlypredinisolone acetate

- Triacinalone acetonide

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13
Q

What the aim of gout prophylaxis?

A

Aim is to maintain serum uric acid levels below saturation point of monosodium urate - if serum rate is low then crystal deposits dissolves

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14
Q

Which drugs can be used prophylactically in gout patients?

A
  • Allopurinol
  • Febuxostat
  • Uricosuric medicines: Benzbromarone and Pegloticase
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15
Q

How does allopurinol work?

A

Inhibits xanthine oxidase which reduces production of uric acid

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16
Q

What does of allopurinol should be given to patients with normal renal function?

A

100mg daily and increase every 2/3 weeks till optimum serum levels are reached

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17
Q

What does allopurinol interact with?

A

Azathioprine

Mercaptopurine

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18
Q

Which patients is febuxostat indicated for?

A

Patients with chronic hyperuricaemia

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19
Q

What are the potential ADRs associated with febuxostat?

A
  • Respiratory infection
  • Nausea
  • Diarrhoea
  • Headache
  • Liver function abnormalities
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20
Q

How do uricosuric medicines work?

A

Increase excretion of gout

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21
Q

Give examples of uricosuric medicines

A

Sulphinpyrazone
Probenacid
Benzbromarone
Pegloticase

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22
Q

Which lifestyle changes should be considered in gout patients?

A
  • Moderate physical exercise
  • Weight loss
  • Purine intake shouldn’t exceed 200mg a day
  • Avoid: shellfish, offal and sardines
  • Reduce alcohol intake
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23
Q

Why are vitamins and minerals required in the body?

A

They play a key role as co-factors or co-enzymes in mot metabolic reactions

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24
Q

Give examples of water soluble vitamins

A 
Vit C - ascorbic acid
Vit B1 - Thiamine 
Vit B2 - Riboflavin 
Vit B3 - Niacin / Nicotinic acid
Vit B5 - Pantothenic acid 
Vit B6 - Pyridoxine 
Vit B7 - Biotin 
Vit B9 - Folic acid 
Vit B12 - Cyanocobalamin
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25
Q

Give examples of fat soluble vitamins

A

Vit A - retinol
Vit D - Cholecalciferol
Vit E - 𝜶 tocopherol
Vit K - Phytomendione

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26
Q

Where are water soluble vitamins absorbed?

A

In the duodenum

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27
Q

Where are fat soluble vitamins absorbed?

A

In the ileum

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28
Q

What absorbed Vit B12?

A

Intrisic factor in the ileum

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29
Q

Apart from the diet, what is another source of Vit D?

A

Sunlight

30
Q

What does Vit A deficiency cause?

A

Poor night vision

31
Q

What does Vit B1 deficiency cause?

A

Wenies encephalopathy

32
Q

What does Vit B7 deficiency cause?

A

Hair loss

Anaemia

33
Q

What does Vit B9 deficiency cause?

A

Megaloblastic anaemia

Neural tube defects

34
Q

What does Vit B12 deficiency cause?

A

Pernicious anaemia

Peripheral neuropathy

35
Q

What does Vit C deficiency cause?

A

Painful joints

Scurvy

36
Q

What does Vit D deficiency cause?

A

Rickets

Osteoporosis

37
Q

What does Vit K deficiency cause?

A

Abnormal clotting

38
Q

What do folic acid supplements do in pregnancy?

A

Prevent neural tube defects - spina bifida

39
Q

What dose of folic acid should given to a woman with no previous history of neural tube defects?

A

400µm OD until 12th week

40
Q

When should a woman be given a dose of 5mg folic acid?

A
  • Previous history of neural tube defects

- Epilepsy / on anti-epileptics

41
Q

What are minerals and trace elements required for?

A
  • Formations of bones and teeth
  • Body fluids and tissues
  • Enzyme systems
  • Nerve function
  • Blood constituents
42
Q

Give examples of minerals

A
  • Calcium
  • Magnesium
  • Phosphorous
  • Sodium
  • Potassium
    Required in large amounts
43
Q

Give examples of trace elements

A 
Iron
Zinc
Iodine
Fluoride 
Selenium 
Copper
44
Q

What does potassium and magnesium deficiency cause?

A

Cardiac arrhythmias

45
Q

What does calcium and magnesium deficiency cause?

A

Osteoporosis
Muscle cramps
Tetany

46
Q

What does zinc deficiency cause?

A

Hair loss

Poor wound healing

47
Q

What does iron deficiency cause?

A

Anaemia

48
Q

What does copper deficiency cause?

A

Wilson’s disease

49
Q

What are the problems associated with supplements?

A 
Toxicity / accumulation 
Supplements are expensive 
Complacency 
No control because of legal status 
Difficult to offer advice as they are not medicines
50
Q

What does folic acid interact with?

A

Methortrexate

51
Q

What does vitamin C interact with?

A

Iron

52
Q

What are the consequences of malnutrition?

A
  • Weakness and loss of muscle mass
  • Apathy and depression
  • Reduced immune system
  • Poor wound healing
  • Increased morbidity and mortality
53
Q

What are the normal feeding aims?

A

Energy: 25-35 kcal / kg / day
Protein: 0.8 - 1.5g / kg / day
Fluid: 30 - 35ml / kg / day

54
Q

Which methods can be used to feed patients

A
  • Normla diet
  • Enteral nutrient
  • IV fluids
  • Parenteral nutrition
55
Q

How is enteral nutrition administered?

A

Via GIT

56
Q

What are the benefits of EN?

A
  • More physiological
  • Less risk of infection
  • Maintain GIT
  • Gut bacteria translocation
  • Lower cost
  • Easier for home patients
  • Patient ease
  • Calorie control
57
Q

Which patients would benefit from EN?

A
  • Patients with eating / swallowing difficulties
  • Severe intestinal malabsorption
  • Increased nutritional requirements
  • Eating disorders
  • Self neglecting patients
58
Q

What are the routes of EN administration?

A

Oral
Naso gastric tube
Percutaneous endoscopic gastronomy (tube passed through abdominal wall)
Percutaneous endoscopic jejunostomy

59
Q

What are the problems associated with EN?

A
  • diarrhoea
  • regurgitation
  • abdominal distention
  • blocked feeding tube
  • problems with the pump
  • taste & acceptability
  • dislocation
60
Q

How should drugs be administered in EN patients?

A
  • Use liquid preparation where possible
  • Give each drug separately
  • Flush with >20ml water before and after
  • Crushed tablets may block tube
  • Not MR or e/c
61
Q

Which drug directly interact with EN feed?

A 
Ciprofloxacin
Albumin antacids
Theophylline
Phenytoin 
Penicillamine
62
Q

When should TPN be used?

A
  • When EN is not an option
  • When patient can’t take food in orally
  • Digestion / absorption problems
  • Unavailable GIT
63
Q

What are short term indications for TPN?

A
  • waiting for feeding tubes
  • bowel obstruction
  • excisional surgery
  • ICU patients with multi-organ system failure
  • severe pancreatitis
  • pre-term neonates
  • acute intestinal failure
64
Q

What are long term indications for TPN?

A
  • radiation enteritis
  • Crohns disease
  • motility disorders
  • bowel infarction
  • cancer surgery
  • chronic intestinal failure
65
Q

How is short term TPN administered?

A

via Venflon

66
Q

How is long term TPN administered?

A

Peripherally inserted central catheter (PICC)
Hickman line
Central line : intrajugular, subclavian, femoral

67
Q

What needs to be monitored when a patient is on TPN?

A 
Clinical history 
U&Es
Glucose
Vitamins
LFTs
FBS
Trace elements
Fluid balance 
Weight 
Line iste
68
Q

What are TPN complications?

A
  • air embolism / insertion problems
  • catheter blockage
  • line infections
  • metabolic problems
  • bone disease
  • re-feeding syndrome
69
Q

What is re-feeding syndrome?

A

It is characterised by abnormalities in fluid balance, glucose metabolism, vitamin deficiency, hypophosphatemia, hypermagnesaemia and hypokalaemia

70
Q

How is re-feeding syndrome prevented?

A

By introducing feed at no more than 50% of the normal requirements. Start at 10kcal / kg / day and increase slowly to meet full needs by 4-7 days

Pharm Y2S2 Patient (2 decks)

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