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31 Cards in this Set
- Front
- Back
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What does X ray show with a case of gout? |
it's normal at first but later will show rat bite lesions and erosiongs |
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best initial therapy for an acute gouty flare |
NSAIDS (better than colchicine) |
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What is the therapy if there some contraindication to NSAIDS such as PUD or CKD? |
steroid injections or oral steroids |
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When is colchicine used? |
only used in patients who cannot tolerate either steroids or NSAIDs |
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2 side effects of colchicine |
bone marrow suppression/neutropenia
diarrhea |
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first way that a patient can reduce gout flares |
diet- decrease consumption of alcohol (especially beer), lose weight, decrease meat and seafood |
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What diuretic gives high risk for gout flare? |
thiazides |
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What 2 other drugs can precipitate a gout attack? |
aspirin niacin |
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What BP med should you start if you stop HCTZ? |
you should start with losartan |
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mechanism for allopurinol |
inhibits xanthine oxidase and prevents formation of uric acid |
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the other xanthine oxidase inhibitor we use |
febuxostat |
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a drug used to DISSOLVE uric acid in maintenance |
pegloticase |
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Mechanism for probenecid and sulfinpyrazole |
increase EXCRETION of uric acid
but these drugs are rarely used now |
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major side effect of allopurinol |
SJS TEN |
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other reactions you see with uricosuric agents and allopurinol |
hypersensitivity |
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What is pseudogout? |
clinically very similar to gout but is due to deposition of calcium pyrophosphate crystals rather than uric acid |
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2 diseases that are big risk factors for pseudogout |
hyperparathyroidism--> hypercalcemia
hemochromatosis |
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3 other diseases that are associated with pseudogout |
Wilson disease diabetes hypothyroidism |
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Why is losartan the best choice for gout? |
because it has a double effect in that it lowers uric acid levels |
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Main contraindication to probenecid and sulfinpyrazole |
CKD, renal insufficiency |
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one clinical presentation difference between gout and pseudogout |
pseudogout doesn't really affect the first MTP. it doesn't show the podagra like gout does |
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so where does pseudogout tend to concentrate? |
it's more concentrated in large joints like the knees, wrists |
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How can you tell pseudogout from OA clinically? |
it spares both the DIP and the PIP joint |
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what are the uric acid levels in pseudogout? |
normal |
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What does X ray show with pseudogout? |
just calcification of the joint structures |
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the most accurate dx test for pseudogout |
arthrocentesis showing positively birefringent rhomboid crystals |
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what WBC is seen on arthrocentesis? |
it shows a high WBC from 2 to 50k but it's not distinguishable from gout or RA |
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Whereas septic arthritis will show |
much higher WBC over 50k |
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best initial therapy for pseudogout is |
NSAIDs |
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if pseudogout fails to respond to NSAIDs |
intra-articular steroids |
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prophylactic treatment for pseudogout to prevent further attacks |
colchicine |
