Exam 4 Drugs to Treat Gout Flashcards
What is gout?
- Gout is a form of arthritis which is caused by the accumulation of uric acid crystals in joints due to a metabolic dysfunction.
- There is deposition of uric acid in/ around joints causing severe pain, swelling and restricted mobility of affected joint
Gout:
Overload of _____ leading to formation of tiny ___________ that deposit in tissues of the body, especially the __________.
When crystals form in the joints, it causes recurring ______ of joint inflammation/ ____
Gout is considered a ____ and ______disease
Chronic gout may also cause joint _____ and ______ kidney function
It is often related to an ______abnormality in the body’s ability to process _______
- **uric acid
- **crystals of urate
- joints
- attacks
- arthritis
- **chronic
- **progressive
- destruction
- **decreased
- inherited
- uric acid
What are the Symptoms of gout?
1) Intensely painful condition, which mostly affects only one joint at a time
(commonly the big toe)
2) may also affect elbows, knees, ankles, wrists or small joints of the hands and feet
3) excruciating + sudden pain, swelling, redness, warmth/ stiffness of the joint
- low-grade fever may also be present
- Skin overlying the joint can also be swollen, tender and sore if it is touched even lightly
- patients w/ longstanding hyperuricemia can have uric acid crystals deposits called tophi in other tissues as well
Pathogenesis:
- Uric acid is a breakdown product of ____that are part of many ____
- An abnormality in handling uric acid can cause ____ of painful _____ (acute gout attack), _________, and _____ of the kidney-filtering tubules with __________, leading to _____failure
- The term “gout” refers to the disease that is caused by an ______of uric acid in the body, resulting in painful arthritic attacks and _______ of lumps of uric acid crystals in body tissues
- The joint inflammation is precipitated by deposits of _____crystals in the synovial fluid and synovial lining.
- intense joint inflammation occurs as the immune system reacts, causing ____ blood cells to engulf the uric acid crystals and chemical messengers of ______ to be released, leading to ____, _____ and redness of the joint tissues
- purines
- foods
- attacks
- arthritis
- kidney stones
- blockage
- uric acid crystals
- kidney
- overload
- deposits
- acid crystals
- white blood cells
-inflammation
pain - heat
Gout:
progresses, the attacks of gouty ____ typically occur more _____ and often in additional joints.
-crystals form → white blood cells attack and _____crystals → crystals ‘pop’ the cell → cell _____ proteins → proteins ‘call in’ more _______ and cause inflammation/pain→ _______ lower pH making it possible for more crystals to ____→ attack starts………
-Some people may only develop ____blood uric acid levels without having clinical manifestations of _______
-The state of ____ levels of uric acid in the blood without symptoms is referred to as ________ hyperuricemia
________ state to developing gout
- arthritis
- frequently
- engulf
- releases
- WBC
- Proteins
- form
- elevated
- gout
- elevated
- asymptomatic
- precursor
4 distinct stages of gout?
1) Asymptomatic
- high levels of uric acid in blood but no joint complaints
2) Acute phase
- acute complaints occur for a brief period
3) Intercritical phase
- There is no pain or swelling of joints in this phase, the patient is relatively symptom free
4) Chronic
- Gout attacks may become frequent during this phase and the condition may affect many joints at a time
- Tophi formation may also be seen
What are the 2 types of gout?
1) Excessive production of uric acid
2) Reduced excretion of uric acid
What is the Predisposition of gout?
1) dehydration
2) injury to the joint
3) fever
4) excessive eating
5) heavy alcohol intake
6) recent surgery
How are gout attacks triggered?
By recent surgery are probably related to changes in body-fluid balance as patients temporarily discontinue normal oral fluid intake in preparation for and after their operation.
Which foods should be avoided?
- Dietary changes can help reduce uric acid levels in blood
- Since purine chemicals are converted by body into uric acid, purine-rich foods are avoided
- Shellfish + organ meats such as liver, brains, kidneys, and sweetbreads
- Meat or seafood consumption INCREASES risk of gout attacks
- Total alcohol intake is strongly associated / an increased risk of gout
- Beer + liquor are particularly strong factors
- Fructose from corn syrup in soft drinks also increases risk of gout
Which foods are OK to eat?
-Dairy food consumption seems to reduce risk
–protein intake or purine-rich vegetable consumption is not associated w/ an increased risk of gout (controversial literature)
–weight reduction is helpful in lowering risk of recurrent attacks of gout
- Best accomplished by reducing dietary fat and calorie intake, combined w/ regular aerobic exercise program
Which are Protective foods for gout?
- cherry juice
- fresh red-blue berries like cherries, blueberries, strawberries…
- red tomatoes
- bananas
- dark pure chocolate + cocoa
- green-leafy vegetables like celery, kale, cabbage, parsley
- pineapple + other food high in bromelain
- high amounts in vitamin C like raw red cabbage, raw red bell peppers, raw tangerines, raw mandarins + raw oranges
What is colchicine (Colcyrs)?
- Plant alkaloid
- One indication only : treatment of
- **acute attack of gout
-so specific in its action, may also be used to diagnose the disease
What is the MOA for colchicine (Colcyrs)?
- **inhibition of neutrophil migration + phagocytic activity in inflamed joints!
- This inhibits neutrophil engulfment of uric acid crystals, preventing release of destructive lysosomal enzymes into extracellular environment
What are the side effects for gout?
1) GI toxicity (nausea, vomiting, diarrhea)
2) bone marrow depression
3) myopathy
4) alopecia
–Taken hourly at onset of attack; taken until side effects are intolerable
What is the mechanism for allopurinol (Zyloprim)?
MOA:
xanthine oxidase inhibitor that **INHIBITS synthesis of uric acid
What is allopurinol (Zyloprim) used for?
-Used to prevent formation of excessive uric acid, and lower blood + urine concentrations
(NOT indicated for asymptomatic hyperuricemia)
-Management of ***chronic gout
**Also used during chemotherapy and radiation because death of many cells results in large amounts of uric acid precursors
What are the side effects for allopurinol (Zyloprim) ?
1) hepatotoxic
2) pruritic rash
3) allergic skin
4) blood reactions
What is the MOA of probenecid (Benemid)?
***INCREASES excretion of uric acid = uricosuric agents
–Block tubular reabsorption of filtered urate, increasing urinary excretion of urate, INCREASES urinary excretion of uric acid + DECREASING plasma urate concentrations
–PREVENTS new tophi and mobilizes those present
What is the use of probenecid (Benemid)?
Use: Management of chronic gout
***Indicated when acute gout attacks increase in frequency or severity
What are the Side effects of probenecid (Benemid)?
1) GI
2) Headaches
3) Sore gingiva
4) May lead to the formation of urate stones in the kidney
probenecid (Benemid):
____ dose of aspirin interferes w/ ______ of probenecid.
-___ dose of aspirin may ________urate excretion (use cautiously in patients taking probenecid).
________ plasma level of ______ (USED To _________ excretion of penicillin, b/c probenecid is _________ filtered first from the ___________)
- excreted by ______ competing w/ penicillin for _______
- has a greater ____ than penicillin for receptors
- if probenecid is given_____ penicillin, the penicillin is not excreted as _______
- Elevates blood level of penicillin_____ times; ______ effects of penicillin
Low uricosuric low decrease increase penicillin delay selectively kidneys Active transport recpetors affinity before rapidly 3-4 X prolongs
What are the non-opioid pain relievers that may be used in the management of gout?
- NSAIDS (SHORT term use during acute episodes)
- -indomethacin
- -naproxen
- -sulindac
- Also used to manage acute arthritis pain + inflammation of gout
- Relieve pain, tenderness and swelling of affected joints = NO mechanism against gout itself
