final lecture 3

Question 1

hyperuricemia

Answer 1

serum uric acid >7 in males & >6 in females

Question 2

acute gouty arthritis

Answer 2

accumulation of monosodium urate crystals in leukocytes in synovial fluid

Question 3

acute gouty arthritis is characterized by

Answer 3

rapid onset, excruciating pain, swelling, inflammation

Question 4

common joint affected

Answer 4

first metatarsophalangeal joint (MTP)

Question 5

uric acid nephrolithiasis

Answer 5

kidney stones of uric acid- high uric acid overproduction

Question 6

gouty nephropathy

Answer 6

deposition of uric acid crystals in renal tubules(acute) or monosodium urate in renal parenchyma (chronic)

Question 7

tophi

Answer 7

SQ solid deposits of monosodium urate crystals in soft tissue of the body

Question 8

primarily a disease of

Answer 8

middle-aged males

Question 9

____ years of hyperuricemia required to manifest symptoms of gout

Answer 9

10-20 years

Question 10

single most important risk factor for development of gout

Answer 10

sustained elevated serum urate levels

Question 11

uric acid is the final end product of

Answer 11

purine degradation & excreted primarily in urine

Question 12

xanthine oxidase

Answer 12

hypothanine->xanthine->uric acid

Question 13

predominate species of uric acid in plasma

Answer 13

urate (pk5.4)

Question 14

monosodium urate max solubilty

Answer 14

in water of 7mg/dL at 37*C & pH 7.4

Question 15

cytotoxic drugs can

Answer 15

increase uric acid

Question 16

genetic components of gout

Answer 16

phosphoribosylpyrophosphate (PRPP) synethate overactivity & hypoxanthine guanine phosphoribosyl transferase (HGPRT) deficiency

Question 17

PRPP synthetase hyperactivity

Answer 17

drives purine accumulation which is converted to uric acids

Question 18

HGPR deficiency

Answer 18

leads to increased metabolism of guanine & hypoxanthine-> uric acid

Question 19

___ genetic mutations known to be associated w/ overproduction of purines

Answer 19

5

Question 20

underexcretion of uric acid is ___ cause of hyperuricemia compared to overexcretion

Answer 20

main cause

Question 21

acute attacks mostly being

Answer 21

at night bc water reabsorption from joint space->supersaturated solution of monosodium urate

Question 22

uric acid nephrolithiasis

Answer 22

uric acid kidney stones in over producers

Question 23

acute urate nephropathy

Answer 23

precipitation of uric acid in ducts & ureters-> acute renal failure

Question 24

chronic urate nephropathy

Answer 24

urte crystal deposition in renal parenchyma

Question 25

tophaceous gout

Answer 25

SQ solid deposits; late complication

Question 26

treatment options for acute gouty attack

Answer 26

NSAIDs, steroids, colchicine

Question 27

propylactice therapy

Answer 27

allopurinol, febuxostat, rasburicase, peloticase, probenecid, sulfinpyrazone

Question 28

intraarticular steroids

Answer 28

limited to 1 or 2 joints; triamcinolone

Question 29

systemic steroids

Answer 29

for multiple joints

Question 30

colchicine MOA

Answer 30

antimitotic agent- binds to tubulin & blocks formation of mitotic spindle

Question 31

agents that block uric acid formation

Answer 31

allopurinol or febuxostat- xanthine oxidase inhibitors

Question 32

agents that enhance urate excretion

Answer 32

uricosuric agents- probenecid & sulfinpyrazone

Question 33

agents that enhance urate elimination

Answer 33

rasburicase- recombinant urate oxidase enzyme

pegloticase- recombinated pegylated porcine-like uriicase