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PY6020 > Gout > Flashcards

Gout Flashcards

1
Q

What causes gout?

A

Abnormally high levels of uric acid, resulting in deposition of urate crystals in joints/soft tissue & urinary tract.

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2
Q

Which gender is gout more common in?

A

Males.

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3
Q

How can one obtain high levels of uric acid (hyperuricaemia)?

A
  1. Overproduction of uric acid
  2. Renal under excretion of uric acid
  3. Both of the above
  4. Overtaking high amounts of food rich in purines
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4
Q

What conditions can cause uric acid under-excretion (build-up)?

A
  1. Renal insufficiency
  2. Obesity
  3. Drug therapy
  4. Hypertension
  5. Hyperlipidaemia
  6. Lead toxicity
  7. Alcohol
  8. Glucose-6-phosphotase deficiency (where your body cannot metabolise glucose into lactic acid)
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5
Q

Which 2 drugs should never be given with a condition like gout?

A

Aspirin, or a thiazide-like diuretic.

Thiazides make you lose electrolytes & make you return uric acid/glucose.

Aspirin can increase uric acid retention.

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6
Q

Which disease goes hand in hand with gout?

A

CVD

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7
Q

What things are associated with an over-production of urate?

A
  1. PPS overactivity - synthesising more purines
  2. HGPRT deficiency - which is responsible for metabolising purines
  3. Cytotoxic drugs
  4. Dietary purines
  5. Tumours
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8
Q

What are some examples of foods/liquids that have high purine content?

A
  1. All alcohol
  2. Fish/seafood/shellfish
  3. Some meats - bacon, turkey, organ meats
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9
Q

What are the symptoms of an acute attack of gout?

A

Pain/redness/hotness of toe joints

Acute attack symptoms:

  1. Fever
  2. Raised number of leukocytes
  3. High ESR/CRP levels
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10
Q

What other joints in the body can gout present in?

A
  1. Knees
  2. Elbows
  3. Wrists
  4. Small joints of the hands
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11
Q

What is tophaceous gout?

A

Crystals of uric acid accumulating in the joints, forming bumps/raises

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12
Q

What are the main aims of treatment for gout?

A
  1. Terminate the acute attack
  2. Prevent future attacks from occurring
  3. Lower urate levels
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13
Q

What must you avoid while treating an acute attack of gout?

A

You must avoid fluctuations of uric acid levels in the body, as this can prolong the attack or trigger future ones.

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14
Q

What are the 4 treatment options for an acute attack of gout?

A
  1. NSAIDs
  2. Colchicine
  3. Corticosteroids
  4. Monoclonal antibodies
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15
Q

Which NSAID is the safest to use for an acute attack of gout, and why?

A

Naproxen, because it has the best safety profile for CV risk.

  • You can also use indometacin, ketoprofen, diclofenac, and etoricoxib
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16
Q

How is ibuprofen give for an acute attack of gout?

A

Off-licensed, so try to avoid.

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17
Q

How how you minimise GI toxicity with any NSAID?

A

By starting with a high dose, then reducing it.

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18
Q

How long are NSAIDs usually required for, for an acute attack of gout?

A

7-14 days till the attack goes away - depending on patients response

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19
Q

Why is colchicine less effective than NSAIDs?

A

Because they have a slower onset of action & higher number of side effects.

20
Q

When should colchicine be given, if it were to be used for an acute attack of gout?

A

Immediately after the symptoms appear, as its efficacy reduces over time.

21
Q

What is the dosing of colchicine for an acute attack of gout?

A

1mg initially, then 500mcg every 4h for 3 days

  • Max. 6mg /course
22
Q

In which patients should the dosing of colchicine need to be adjusted?

A

Elderly & renaly impaired.

23
Q

What are some side effects of colchicine?

A
  1. Nausea + vomiting
  2. GI haemorrhage
  3. Renal damage
  4. Blood disorders - with prolonged use
24
Q

If renal insufficiency is present, which class of drug is given for an acute attack of gout?

A

Corticosteroids.

25
Q

How are corticosteroids given for an acute gout attack, & why is this way preferred?

A

They are given via injection directly into the affected joint(s).
They are given like this because if given orally, many side effects can arise.

26
Q

Which corticosteroid is given for an acute gout attack?

A

Methyl-prednisolone

- Dose depends on how big the affected joint is. Ranges from 4-10mg, or 20-80mg

27
Q

What type of drug is canakinumab?

A

It is a recombinant monoclonal antibody

28
Q

When is canakinumab used for an acute gout attack?

A

It is used for those having frequent gout attacks, & previous treatment has not worked.

29
Q

What lifestyle modifications can be done to help prevent future gout attacks?

A
  1. Weight loss
  2. Decrease alcohol
  3. Reduce dietary purine intake
  4. Increase water intake - to flush out the uric acid
  5. Basic drug e.g. Na+ bicarbonate can be given to help ionise the uric acid
30
Q

What determines after an acute gout attack whether the patient should start reducing their uric acid levels?

A
  1. If they have had >3 attacks + raised urate levels
  2. Evidence of joint damage
  3. Tophaceous deposits visible
  4. Evidence of renal failure
  5. Family history present
  6. Normal rate levels cannot be achieved through lifestyle changes
31
Q

What is given as prophylaxis along with the long term drugs for gout, & for how long?

A

NSAIDs/colchicine are given as prophylaxis for 3 months (given at low doses).

32
Q

What type of drug is allopurinol, & what is its mechanism of action?

A

Allopurinol is a xanthine oxidase inhibitor.

It inhibits the formation of uric acid from the precursor xanthines (a type of purine).

33
Q

When can you not start allopurinol? When should you start it?

A

It should never be started during an acute attack.

Must start it 1-2 weeks after acute attack has resolved.

34
Q

What is the dosing for allopurinol?

A

Initially 100mg daily, then adjusted according to conditions.
- Max. 900mg.

Higher the uric acid levels = higher the dose of allopurinol

35
Q

Why should plenty of water be taken while using allopurinol?

A

To flush out allopurinol’s metabolites from the kidneys.

36
Q

Why can allopurinol be given to renaly impaired patients?

A

Because allopurinol itself doesn’t work on the kidneys.

37
Q

What should you do if a patient taking allopurinol develops a rash?

A

It indicates that they have a severe skin condition, & you must stop allopurinol.

38
Q

What type of drug is febuxostat, and how does it work?

A

It is a selective xanthine oxidase inhibitor.

It works by decreasing the serum uric acid conc.

39
Q

Why is allopurinol used over febuxostat?

A

Because febuxostat has increased risk of CVD, and more GI side effects.

40
Q

Why should plenty of water be taken while using febuxostat?

Why would milk be preferable?

A

Because crystals can form in the kidneys, which need to be flushed out - this also means its not suitable for patients with renal failure

Milk is alkaline which can also remove these uric acid crystals.

41
Q

What is the dosing of febuxostat?

A

Recommended dose is 80mg OD.

Dose can increase to 120mg OD, depending on uric acid levels.

42
Q

When would febuxostat be the recommended option?

A
  1. Chronic hyperuricaemia present
  2. Those intolerant to allopurinol
  3. Those contraindicated to allopurinol
43
Q

How do uricosurics (e.g. sulfinpyrazone) work?

A

They increase urine excretion by blocking the tubular reabsorption of urate.

44
Q

In which patients is sulfinpyrazone contraindicated in?

A
  1. Those with renal failure

2. Those who have/had uric acid stones in their kidneys

45
Q

When should you start sulfinpyrazones after an acute gout attack?

A

3 weeks after the attack.

46
Q

Why is drinking plenty of fluids essential when taking sulfinpyrazone?

A

Because the risk of urate crystal formation is high in renal tubes, so they need to be flushed out.

47
Q

What is the dosing of sulfinpyrazone?

A

Initially 100-200mg daily, increasing up to 600mg. This is continued until uric acid levels are normal, then a maintenance dose (min. 200mg daily).

PY6020 (22 decks)

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