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29 Cards in this Set
- Front
- Back
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What is gout?
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systemic disease caused by build up of uric acid
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What can cause elevated uric acid levels?
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• liver produces more uric acid than the body can excrete in urine
• diet produces more uric acid than the kidney can filter (ex. red meat, creams, red wine) |
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What is the enzyme that converts hypoxanthine and xanthine to uric acid?
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xanthine oxidase
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What are signs and symptoms of gout?
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• inflammation
• pain (intense pain) • redness • stiffness • swelling • typically occur in 1 joint at a time • if untreated » can damage joints and cause deformity |
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What are risk factors for gout?
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• alcohol
• disesase (ex. diabetes, obesity, kidney disease, sickle cell anemia) • exposure to lead • family history (18% of patients have family history) • medications (ex. ASA, diuretics, levodopa) • purine diets (ex. meat) |
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Which type of diuretic has the highest incidence of causing gout?
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thiazide diuretics
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How is gout diagnosed?
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• sampling from joint
• sampling from blood (will show hyperuricemia) |
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True/False: Blood levels will always show hyperuricemia in an acute gouty attack
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• Elevated uric acid levels may not be present in an acute attack
• The correct answer is: False |
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What are goals of gout treatment?
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• decrease amount of uric acid in joints
• help reduce symptoms • prevent further attacks |
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What are drugs that can be used in the treatment of gout?
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• Colchine
• Allopurinol • Probenicid • Sulfinpyrazone • NSAIDS (not salicylates) • Corticosteroids |
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What is the MOA of Colchine?
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• binds to microtubules causing depolymerization
• reduces mobility of granulocytes » reduces phagocytes migration • reduces phagocytosis » reduces inflammation • blocks cell division |
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What are indications for using Colchicine?
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• reduce inflammation of acute attacks
• prophylactically to reduce the number of attacks |
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What is the dosing for Colchicine in an acute gouty attack?
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0.6 mg PO ever hour until patient has diarrhea
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What are adverse effects of Colchicine?
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• bone marrow suppression
• GI (nausea/vomiting/diarrhea) * diarrhea side effect is questionable, since it's a desired effect (especially in acute attack) |
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What is the MOA of Allopurinol (Zyloprim)?
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• purine analog that inhibits xanthine oxidase
• reduces the production of uric acid |
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True/False: Allopurinol (Zyloprim) is good for prophylaxis of gout, but not good to treat an acute attack
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The correct answer is: True
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What are other conditions, besides gout, that can be treated with Allopurinol (Zyloprim)?
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can treat hyperuricemia in patients w/ cancer or renal disease
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What are adverse effects of Allopurinol?
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• hypersensitivity
• acute attacks may happen during the first weeks of treatment |
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Give examples of uricosuric agents
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• Probenecid
• Sulfinpyrazone |
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What is the MOA of the Uricosuric agents?
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increases renal excretion of urate
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Why should uricosuric agents be taken with large amounts of water?
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to decrease incidence of renal stones
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What is the NSAID of choice for treating gout?
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Indomethacin
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What is the dosing for Indomethacin with an acute gouty attack?
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• 75 mg Q6hrs for 3 days
then • PRN |
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Give examples of long-acting corticsteroids that can be administered intrartcularly
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• Dexamethasone
• Methylprednisolone (Medrol) • Triamcinalone (Kenalog 40) |
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__ mg of Cortisone = __ mg of Hydrocortisone = __ mg of Prednisone = __ mg of Methylprednisolone = __ mg of Dezamethasone
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25 mg of Cortisone = 20 mg of Hydrocortisone = 5 mg of Prednisone = 4 mg of Methylprednisolone = 0.75 mg of Dezamethasone
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If you do not want to give intrarticular corticosteroids, what corticosteroid can be given orally instead?
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• Medrol dose pak
• a high dose of methylprednisolone that decreases over 7 days |
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What medications would you use for the treatment of an acute gouty attack?
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Allopurinol + Colchicine + Indometacin
* colchicine and indomethacin are the immediate-acting agents |
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What are measures that can be taken to prevent gouty attacks?
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• chronic medication treatment (low dose NSAID, colchicine, allopurinol, probenecid)
• diet (alcohol free, avoid purine-rich foods) • drink plety of fluids • exercise regularly • maintain healthy diet |
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What are normal uric acid levels?
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• males: 2.1-8.5 mg/dl
• females: 2.0-6.0 mg/dl |
