Gout Pathophysiology Flashcards
(39 cards)
Gout results from deposition of…
Monosodium ruate
Monosodium urate is formed from…
Uric acid
Monosodium urate often deposits in common areas such as…
Synovial fluids
Tissues
Kidney
Uric acid is the end product of…
Purine metabolism
No functional role
Overproduction, or under-excretion of uric acid results in…
Hyperuricemia
Uric acid can metabolize into…
Allantoin
Highly water soluble, excreted easily
Hyperuricemia is a serum acid concentration over…
420 micromol/L
Limit of solubility of uric acid
Solubility of uric acid decreases with…
Lower temperatures
Why it affects toes often
Precipitation of uric acid may require…
A trigger
Some dietary options that contribute to overproduction of uric acid are…
Anything rich in purines (meat)
Some disease states that contribute to overproduction of uric acid include…
Obesity
Hypertriglyceridemia - more metabolism into uric acid
Some drugs that can cause overproduction of uric acid include…
MOA of causation?
Diuretics - fluid leaves from synovial space and increases uric acid in joint
Cytotoxic drugs - increases cell turnover, byproduct = increased uric acid
Some disease states that will cause underexcretion of uric acid include…
CKD
Hypertension
Dehydration
Decreased blood flow in kidneys decreases uric acid secretion
Some common drugs that cause underexcretion of uric acid include…
MOA of causation?
Alcohol, ACEI/ARB - decrease renal blood flow
ASA - competes for uric acid elimination
Diuretics - decreases how much uric acid is excreted
Others include cyclosporine, levodopa, tacrolimus
On a regular diet, a patient can be labelled an overproducer if excretion of uric acid exceeds…
Greater than 1000mg/24 hours
This is only important for MOA of 1 drug
On a regular diet, a patient can be labelled anunder-excretor if excretion of uric acid exceeds…
Assuming high serum uric acid
Less than 1000mg/24 hours
This is only important for MOA of 1 drug
The four clinical phases of gout include…
- Asymptomatic hyperuricemia
- Acute gouty arthritis
- Intercritical gout
- Chronic tophaceous gout
Asymptomatic hyperuricemia is classified by…
Elevated uric acid levels (>420 micromol/L), with no symptoms
Majority DO NOT require drug treatment
Less than 25% actually develop gout
Potential consequences of asymptomatic hyperuricemia include…
Gout
Urate nepropathy
Nephrolithiasis
CKD
We may choose to treat asymptomatic hyperuricemia if the patient has…
Kidney impairment
Extreme uric acid levels (>800 micromol/L)
Acute gouty arthritis is caused by…
Precipitation of uric acid crystals in the joint space
Immune system involvement, causes vasodilation and increased permeability
Acute gouty arthritis is characterized by a sudden onset of…
Severe pain
Erythema
Limited range of motion
Swelling of the joint
Tends to occur in evening or overnight
Acute gouty arthritis often self-resolves in…
7-14 days
Joints that are most frequently affected by acute gouty arthritis include…
Toes>Instep>Ankle>Knee>Wrist>Fingers
