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29 Cards in this Set

  • Front
  • Back
What is gout?
systemic disease caused by build up of uric acid
What can cause elevated uric acid levels?
• 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)
What is the enzyme that converts hypoxanthine and xanthine to uric acid?
xanthine oxidase
What are signs and symptoms of gout?
• inflammation
• pain (intense pain)
• redness
• stiffness
• swelling
• typically occur in 1 joint at a time
• if untreated » can damage joints and cause deformity
What are risk factors for gout?
• 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)
Which type of diuretic has the highest incidence of causing gout?
thiazide diuretics
How is gout diagnosed?
• sampling from joint
• sampling from blood (will show hyperuricemia)
True/False: Blood levels will always show hyperuricemia in an acute gouty attack
• Elevated uric acid levels may not be present in an acute attack
• The correct answer is: False
What are goals of gout treatment?
• decrease amount of uric acid in joints
• help reduce symptoms
• prevent further attacks
What are drugs that can be used in the treatment of gout?
• Colchine
• Allopurinol
• Probenicid
• Sulfinpyrazone
• NSAIDS (not salicylates)
• Corticosteroids
What is the MOA of Colchine?
• binds to microtubules causing depolymerization

• reduces mobility of granulocytes » reduces phagocytes migration

• reduces phagocytosis » reduces inflammation

• blocks cell division
What are indications for using Colchicine?
• reduce inflammation of acute attacks
• prophylactically to reduce the number of attacks
What is the dosing for Colchicine in an acute gouty attack?
0.6 mg PO ever hour until patient has diarrhea
What are adverse effects of Colchicine?
• bone marrow suppression
• GI (nausea/vomiting/diarrhea)

* diarrhea side effect is questionable, since it's a desired effect (especially in acute attack)
What is the MOA of Allopurinol (Zyloprim)?
• purine analog that inhibits xanthine oxidase
• reduces the production of uric acid
True/False: Allopurinol (Zyloprim) is good for prophylaxis of gout, but not good to treat an acute attack
The correct answer is: True
What are other conditions, besides gout, that can be treated with Allopurinol (Zyloprim)?
can treat hyperuricemia in patients w/ cancer or renal disease
What are adverse effects of Allopurinol?
• hypersensitivity
• acute attacks may happen during the first weeks of treatment
Give examples of uricosuric agents
• Probenecid
• Sulfinpyrazone
What is the MOA of the Uricosuric agents?
increases renal excretion of urate
Why should uricosuric agents be taken with large amounts of water?
to decrease incidence of renal stones
What is the NSAID of choice for treating gout?
What is the dosing for Indomethacin with an acute gouty attack?
• 75 mg Q6hrs for 3 days
Give examples of long-acting corticsteroids that can be administered intrartcularly
• Dexamethasone
• Methylprednisolone (Medrol)
• Triamcinalone (Kenalog 40)
__ mg of Cortisone = __ mg of Hydrocortisone = __ mg of Prednisone = __ mg of Methylprednisolone = __ mg of Dezamethasone
25 mg of Cortisone = 20 mg of Hydrocortisone = 5 mg of Prednisone = 4 mg of Methylprednisolone = 0.75 mg of Dezamethasone
If you do not want to give intrarticular corticosteroids, what corticosteroid can be given orally instead?
• Medrol dose pak
• a high dose of methylprednisolone that decreases over 7 days
What medications would you use for the treatment of an acute gouty attack?
Allopurinol + Colchicine + Indometacin

* colchicine and indomethacin are the immediate-acting agents
What are measures that can be taken to prevent gouty attacks?
• 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
What are normal uric acid levels?
• males: 2.1-8.5 mg/dl
• females: 2.0-6.0 mg/dl