Gout-DUan Flashcards by michelle granstrom

What is the pH like in synovial tissues & leukocytes in patients with gout?

low pH b/c of high lactate production associated with inflammation
the low pH fosters further deposition of uric acid

How well did you know this?

Not at all

Perfectly

What is the relationship w/ gout & kidneys?

uric acid as urate can be deposited in kidney & become kidney stones

How well did you know this?

Not at all

Perfectly

Uric acid is positively correlated with which features in men?

height
weight
BUN/Creatinine
BP
Diabetes, Hyperlipidemia, Alcohol Consumption
Warm Climate 
Social Status
Intelligence

How well did you know this?

Not at all

Perfectly

Which demographic has the highest prevalence of gout?

Men in their 70s

10% of them!

How well did you know this?

Not at all

Perfectly

Describe the process of purine metabolism.

AMP–IMP–>Hypoxanthine–>Xanthine–>Uric Acid–>Urate

How well did you know this?

Not at all

Perfectly

What is the enzyme that turns AMP to IMP in purine metabolism?

adenylate deaminase

How well did you know this?

Not at all

Perfectly

What is the enzyme that recycles hypoxanthine back into IMP?

HPRT: hypoxanthine-guanine phosphoribosyl transferase

need this to work so that you don’t end up with quite as much uric acid!

How well did you know this?

Not at all

Perfectly

What are the 2 forms of primary gout?

Adenosine deaminase deficiency
associated with SCID
HPRT deficiency associated with Lesch-Nyhan syndrome

How well did you know this?

Not at all

Perfectly

What are the features associated with adenosine deaminase deficiency & SCID?

self mutilation
spasticity
choreoathetosis
retardation

How well did you know this?

Not at all

Perfectly

What are the features associated with X-linked Lesch-Nyhan syndrome & HPRT deficiency?

hyperuricemia
nephrolithiasis
gout

How well did you know this?

Not at all

Perfectly

What are normal uric acid levels in men? women?

Men: 3.4-7
women: 2.4-6

How well did you know this?

Not at all

Perfectly

What are the 2 main categories of secondary gout?

Overproduction

Underexcretion

How well did you know this?

Not at all

Perfectly

What are some ways that you can get overproduction of uric acid leading to secondary gout?

increased breakdown of blood cells–leukemia

chemo or radiation

How well did you know this?

Not at all

Perfectly

What are some ways that you can get under excretion of uric acid leading to secondary gout?

alcohol use
thiazide diuretic
low dose aspirin

How well did you know this?

Not at all

Perfectly

What is the disease progression of gout?

Asymptomatic Hyperuricemia
Acute Gout
Intercritical Period
Chronic Tophaceous Gout
Nephrolithiasis: kidney stones

How well did you know this?

Not at all

Perfectly

What is the level of serum urate during asymptomatic hyperuricemia?

7mg/dl

people at risk for developing gout, but haven’t yet.

What happens during the acute gout phase?

painful monoarticular arthritis

usu in 1st metatarsal joint

What happens during the inter critical period in gout?

remission for indeterminate length

What happens when you are experiencing chronic tophaceous gout?

gouty arthritis
crystals in synovium
chalky mass called tophus
erosion of bone
**caused by continued precipitation of sodium urate crystals during attacks of acute gout

What is colchicine used for? How fast does it work?

acute gout attacks

relieves pain 12-24 hrs after oral administration

T/F The MOA of colchicine includes increased renal excretion of uric acid, changing the serum concentration of urate.

False. This is NOT its MOA.

What do we know about the MOA of colchicine?

binds to tubulin, messes with mitotic spindles
depolymerization of microtubules in granulocytes
inhibits granulocytes from migrating to inflamed area & goin’ crazy
less release of lactic acid
INHIBITS the release of histamine granules from mast cells

How is colchicine metabolized & excreted?

metabolized by CYP3A4 in liver
excreted in feces (mostly)
a little in urine

Most patients experience adverse side effects when taking colchicine. What are they?

nausea
vomiting
abdominal pain
diarrhea
IV admin reduces this
rare cases: liver damage

What is the MOA of uricosuric agents? What are 3 examples? Which one is also an NSAID?

**increase excretion of uric acid by kidneys by blocking its reabsorption Probenecid Sulfinpyrazone (NSAID) Benzbromarone

When should you use probenecid or sulfinpyrazone for gout?

when it is chronic gout | can be used in combo with colchicine

What is one of the tricky things about taking probenecid & sulfinpyrazone with other meds when treating gout?

inhibit the excretion of other drugs that are secreted by renal tubules like penicillin, NSAIDs, cephalosporins, methotrexate

What are some of the adverse side effects of probenecid & sulfinpyrazone? How can one of these be avoided?

kidney stones (potassium citrate-alkalinzation of urine or drink lots of water) GI dermatitis

What is another name for allopurinol? WHat is its MOA for treating gout?

zyloprim | inhibits the synthesis of uric acid by inhibiting xanthine oxidase

What are the common side effects of allopurinol? When should you NOT use it?

GI; dermatitis | not with patients who have liver disease or bone marrow depression

What are the FDA approved NSAIDs to use with gout?

indomethacin naproxen sulindac

T/F Corticosteroids are a frequently used & helpful treatment option for gout.

False. Usu not used.

Febuxostate aka uloric is a treatment for gout. How does it work?

lowers uric acid levels | non-purine inhibitor of uric acid by forming a complex with an enzyme

HOw is febuxostate aka uloric eliminated? WHat is its half life?

metabolized by CYP2C9 renal & hepatic elimination t1/2=5-8 hrs

When do you use febuxostate aka uloric? What are its potential side effects?

used for attacks, not for when patients are asymptomatic | liver toxicity & cardio problems are major side effects

What is rasburicase aka elitek?

pediatric management of uric acid | usu for patients receiving chemo or experiencing tumor lysis syndrome--often experience hyperuricemia with cell turnover

What is used to treat acute gout?

``` nonsalicylate NSAIDs (indomethacin, naproxne, sulindac) sometimes colchicine for a few weeks ```

What is used to treat chronic gout?

``` uricosuric agents (probenecid & sulfinpyrazone) +allopurinol ```

What are maintenance drugs for patients with gout?

allopurinol, probenecid, sulfinpyrazone