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22 Cards in this Set
- Front
- Back
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What is the form of uric acid that deposits in peripheral tissues.
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Monosodium urate.
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What is the form of uric acid that forms renal stones.
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Uric acid.
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How does uric acid behave in the kidney tubules.
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Freely filtered at glomerulus. Reabsorbed AND secreted in middle segment of proximal tubule.
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What is the name of an acute gout attach with deposition of crystals in toe.
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Podagra.
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What are extra-articular manifestations of hyperuricemia?
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Gouty nephropathy, obstructive nephropathy, nephrolithiasis
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What disease can cause under excretion of uric acid.
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Diabetes
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What are drugs that can cause hyperuricemia?
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Diuretics, aspirin, ethambutal, L-dopa, cyclosporine, alcohol, nicotine
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What are causes of overproductino of uric acid?
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increase rate of purine synthesis de novo. Decrease HGPRT or Increase PRPP synthetase.
Increase rate of cellular turnover- proliferative disorders, or cancer therapy. |
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Colchicine
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Does not affect metabolism. Binds intracellular protein tubulin preventing microtubule formation. Inhibits leukocytes migration and phagocytosis. Can get GI symptoms. Used to treat gout by raising pH by stopping glucose oxidation. Lowers deposition.
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Indomethacin (for gout)
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Inhibits PG synthetase. Inhibits urate crystal phagocytosis.
Naproxen and Sulindac also used for gout. |
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Uricosuric agents (probenecid and sulfinpyrazone
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inhibit uric acid reabsorption; decrease serum urate concentration; decrease body pool of urate inpts with tophaceous gout. Take large volume of water to avoid stones. Start small dose than increase
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Probenecid
(Benemid) |
Uricosuric agent (inhibit uric acid reabsorption). Start at 500mg than increase to a ax of 2g. GI effects and hypersensitivity possible.
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Sulfinpyrazone
(Anturane) |
Analong of phenylbutazone but no anti-inflammatory and analgesic. Blocks tubular reabsorption of uric acid. GI and hypersensitivity problems as well. Start at 100-200mg and increase to 200-800mg/d
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Allopurinol
(Zyloprim) |
Helpful in all forms of hyperuricemia or gout. Decrease uric acid production by 1)inhibition of xanthine oxidase and 2) lower intracellular concentration of PRPP. Metabolite(oxypurinol) is also a potent xanthine oxidase inhibitor
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Allopurinol drug interaction
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6-MP and azathioprine are inactivated by xanthine oxidase. Inhibit metabolism of oral anticoagulant. Increase rash hypersensitivity to ampicillin.
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Febuxostat
(Uloric) |
First nonpurine inhibitor of xanthine oxidase. Potent and selective inhibitor of xanthine oxidase. Good for allopurinol intolerance. 40 to 80 mg daily for prophylactics.
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Pegloticase
(krystexxa) |
PEGlyated uric acid specific enzyme recently approved. Treatment of chronic gout in patients refractory to normal treatment. * mg IV infusion every two weeks. It is a recombinant uricase which breaks down uric acid to a more soluble form.
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Idiopathic hyperuricemis
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Can be caused by renal retention of urate. Unexplained associations with hypertension, obesity, hyperlipidemia, increased urate production.
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HGPRT
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Decreased hypoxanthine0guanine phosphoribosyl transferase can cause hyperuricemia. Hypoxanthine is metabolized to xanthine which is metabolized to uric acid.
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PRPP
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Increased phosphoribosylpyrophosphate synthetase can cause hyperuricemia. PRPP turns Ribose-5-P + ATP to PRPP and glutamine
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Local factors in hyperuricemia
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Low temperature, low pH, possible tissue factors.
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What do synoviocytes to in the pathology of gout.
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Phagocytose urate crystals and secrete inflammatory mediators. These attract and activate PMN's and mononudlear phagocytes (macrophages)
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