Exam 4 Drugs for Gout Flashcards
What is gout?
A form of arthritis which is caused by build up of uric acid crystals in joints - usually due to metabolic dysfunction
Gout is considered a ___ and ___ disease. Chronic gout may also cause joint destruction and decreased ____ function. It is often related to an ____ _____ in the boys ability to process uric acid.
chronic and progressive
kidney
inherited abnormality
Symptoms of gout can be intensely painful, usually affects only one joint at a time commonly the ___ ___. May also affect elbows, knees, writs, or small joints of the hands/feet. Excruciating and sudden ____, swelling, _____, warmth, and ____ of the joint. Low grade ____ may be present. The skin over the joint can also be ___/___ if it touched. Patients with longstanding _____ can have uric acid crystals deposits called ____ in other tissues as well.
big toe pain redness stiffness fever tender/sore hyperuricemia tophi
Uric acid is a breakdown product of what?
purines
An abnormality in handling uric acid can cause attacks of painful arthritis (acute gout attack), what are 2 causes?
- kidney stones
2. blockage of kidney-filtering tubules with uric acid which leads to kidney failure
Intense joint inflammation occurs as the immune system reacts causing what?
WBCs to engulf the uric acid crystals and chemical messengers of inflammation to be released leading to pain, heat, redness of the joint tissues
4 distinct stages of gout
- asymptomatic
- acute
- intercritical phase (usually symptom free)
- chronic (frequent attacts/tophi may occur)
what are the 2 types of gout?
- excessive production of uric acid
2. reduced excretion of uric acid
6 factors that predispose you to gout
- dehydration
- injury to the joint
- fever
- excessive eating
- heavy alcohol intake
- recent surgery (due to changes in body/fluid changes)
4 foods to avoid with gout
(Purine rich foods)
- shellfish
- organ meats
- meat/seafood
- alcohol
8 protective foods to eat with gout
- cherry juice
- berries
- red tomatoes
- bananas
- dark chocolate/cocoa
- green leafy veggies
- pineapple (high in bromelain)
- vitamin c foods
name 3 drugs used to treat gout
- cochicine (Colcyrs)
- allopurinol (Zyloprim)
- probenecid (Benemid)
MOA of what drug = xanthine oxidase inhibits the synthesis of uric acid
allopurinol (Zyloprim)
allopurinol is used to treat CHRONIC gout by preventing formation of excessive uric acid, how else can it be used?
- lower blood and urine concentrations of uric acid
2. during chemo/radiation bc death of many cells results in large amounts of uric acid precursors
what is allopurinol not indicated for?
asymptomatic hyperuricemia
4 side effects of allopurinol
- hepatotoxic
2, pruritic rash - allergic skin reactions
- blood reaction
What gout drug’s MOA = inhibition of neutrophil migration and phagocytic activity in inflamed joints, which inturn inhibits PMNs engulfment of uric acid crystals, preventing release of destructive lysosomal enzymes into ECM?
colchicine (Colcyrs) - plant alkaloid
colchicine has only one indication for use what is it?
tx of acute attacks of gout - so specific, may also be used to dx the disease
4 side effects of colchicine
Many - taking hourly until side effects are intolerable
- GI toxicities
- bone marrow depression
- myopathy
- alopecia
What gout drug’s MOA = increases excretion of uric acid (uricosuric agent), blocks tubular reabsorption of filtered urate, increasing urinary excretion of urate, increasing urinary excretion of uric acid and decreasing plasma urate concentrations. prevents new tophi and mobilizes those present
probenecid (Benemid) - management of chronic gout - when acute gout attacks increase in frequency or severity
4 side effects of probenecid
- GI
2, headache - sore gingiva
- may lead to the formation of urate stones in the kidney
What drugs interferes with probenecid?
Low dose aspirin - interferes with the uricocuric action decreasing urate excretion
Penicillin - delays excretion bc bc probenecid is selectively filtered first from the kidneys
What drugs are used 1st to relieve gout pain
NSAIDS (indomethacin, naproxen, sulindac) - no mechanism against gout itself
