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16 Cards in this Set
- Front
- Back
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Define gout. What is it caused by?
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Gout is an inflammatory joint disease caused by the deposit of uric acid crystals.
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Describe the pathophysiology of gout.
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- The end product of purine metabolicsm is uric acid.
- abnormal purine metabolism = decreased secretion of urates & increased blood levels of uric acid. |
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What's so bad about having too much uric acid?
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Uric acid forms a precipate in areas where blood flow is slowest.
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What can cause gout? (3)
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- a genetic defect in purine metabolism can cause overproduction of uric acid.
- chronic renal failure - decreased uric acid excretion |
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What is the normal uric acid level?
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3 - 7 mg/100 ml.
a little different for males & females so go look that up if you want to know. |
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What is secondary gout?
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Secondary gout is caused by another disorder (or treatment).
- eg. conditions of rapid cell turnover (leukemia, multiple myeloma, anemias, psoriasis) - some medications - alcoholism and starvation |
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What lab tests help diagnose gout?
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ESR: increased
Uric Acid: increased WBC: increased (20,000) Synovial fluid: has uric acid or sodium urate crystals |
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What's a tophi?
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Tophi are sodium urate crystals. They deposit in peripheral areas (toe, hands, ear) or in kidneys (renal urate lithiasis)
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There are three stages of gout.
Describe them. |
1. Hyperuricemia - asymptomatic
2. Acute, sudden onset - redness, swelling pain - one joint - 90% toe - "exquisite" - fever - anorexia - increased HR 3. Chronic gout: tophi - permanent changes in multiple joints - movement restricted - renal and cardiac problems |
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How is gout treated with diet?
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Low purine diet. Purine is found in shellfish and organ meats. ew.
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What is the big anti-gout medication? How does it act? What's the dosage?
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Colchicine: inhibits the migration of WBC into synovial fluid.
0.6 - 1.2 mg initial dose then 0.6 per hour until pain relieved or see toxicity (N/V/D) If given IV: depresses bone marrow |
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What do uricosuric drugs do? Give an example.
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Uricosuric drugs improve uric acid excretion. Don't start during acute attack & don't take with aspirin. ex: probenecid (Probalan) (Benemid)
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What are Xanthine Oxidase Inhibitors? Give some examples.
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Inhibits the activity of xanthine oxidase which is an enzyme involved in purine metabolism. So, these block uric acid production.
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Gout - Nursing - describe some interventions
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1. pain management
2. encourage fluids to 3 quarts/day 3. lose weight. 4. no alcohol 5. avoid foods high in purine (shellfish/organ meat/ew) 6. avoid fasting 7. reduce stress |
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What are two complications of gout?
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Renal calculi and GI bleeding (from NSAIDS)
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What NSAID is great for patients having a gout attack?
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Indocin: 2-7 days, high dose treats gout attack.
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