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40 Cards in this Set
- Front
- Back
Where does the word gout come from?
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Latin gutta for drops of poison
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Normal serum level of urate in adult males?
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5 mg/100 ml
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Normal urate serum level in adult females?
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3-4 mg/100 ml
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Level of urate excreted in urine/day
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600 mg
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Solubility of urinc acid in serum
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7 mg/100 ml *anthing over this is considered hyperuricemia
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What are tophi?
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Precipitations of monosodium urate crystals (ear, joints, kidney)
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Causes of hyperuricemia
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Increased production
Decreased renal clearance |
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Primary gout
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Disorder of overproduction
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Can primary gout be genetic?
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Rarely some individuals have a low enzyme level of HG-PRTase
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What happens in total loss of HG-PRTase?
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Lesch-Nyhan Syndrome
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Treatment regimen of gout
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Anti-inflammatory drugs
Drugs that decrease urate production Uricosuric drugs that enhance excretion |
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Colchicine
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Anti-inflammatory drug
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MA of Colchicine
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Binds to tubulin in mirotubules and affects phagocytosis of urate crystals, halting inflammation
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Duration of Cholchicine
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6-12 hours
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Why would you take Cholchicine prophylactically?
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Avoid gouty attacks, also prevent attacks of Familial Mediterranean Fever (AA amyloid)
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Is Cholchicine toxic?
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Toxicity is common and results in vomiting and diarrhea
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Who is Cholchicine toxicity most expected in?
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Elderly with reduced renal function, they may get muscle weakness and myopathy
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Phenylbutazone
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Anti-inflammatory effective in acute gouty attacks
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What has Phenylbutazone fallen out of favor?
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Severe toxicity- agranulocytosis and aplastic anemia. ESPECIALLY IN OLDER PATIENTS
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Allopurinol
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Xanthine oxidaese inhibitor
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MA of Allopurinol
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Analog of hypoxanthine, inhibits XO
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What is Allopurinol converted into?
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Alloxanthine- also an inhibitor of XO (less potent, but lasts longer)
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What is the consequence of XO inhibition?
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Decreased urate excretion and increased oxypurine (hypoxanthine and xanthine) excretion
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Does the total excretion of purines go down when gout patients are treated with allopurinol?
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YES, because increased IMP and GMP acts as feedback (-) on purine syn. so overall purine production decreases
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Why use allopurinol prophylactically?
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Prevent attacks in chronic gout
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What does an allergic rxn to allopurinol look like?
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Skin eruptions, fever, and leukopenia
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Are there any important drug interactions with allopurinol?
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YES, the anticancer drug 6-mercaptopurine (metabolized by XO) is more toxic in the prescence of allopurinol.
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Besides attacks, what eles does allopurinol prevent?
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Calcium oxalate stones in the kidney in patients with hyperuricosuria
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How do uricosurics work?
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Promote excretion of urate in the kidney by blocking reabsorption in proximal tubule
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Probenecid- low doses
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uricosuric, may cause urate retention
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Probenecid- high doses
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Inhibits both secretion and reabsorption of urate
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Probenecid- toxicity
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GI distress, skin rashes, hyper-sensitivity
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How do we prevent stone formation in those taking Probenecid?
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Hydration
Alkalining the urine |
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Should Probenecid be given during an acute gouty attack?
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NO
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Sulfinpyrazone
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Uricosuric and anti-platelet drug
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Sulfinpyrazone- toxicity
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Affects on GI, especially dangerous for patients with peptic ulcers
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What stage of gout are uricosuric drugs used?
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Chronic gout- can promote reabsoption of gouty tophi
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what are uricosuric drugs antagonized by?
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Salicylates
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Do you give Sulfinpyrazone during an acute attack?
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NO, like probenecid can exacerbate acute attacks.
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At what age does a fetus acquire fingerprints?
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3 months
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