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PMY2107 Applied Clinical Pharmacology and Therapeutics > Gout > Flashcards

Gout Flashcards

1
Q

Describe the aetiology and pathophysiology of gout?

A

Acute inflammatory arthritis.
Induced by deposition of uric acid crystals in the joints.
Occurs with increase in uric acid production and decrease in uric acid output.

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2
Q

How is uric acid produced?

A

Uric acid crystals produced from the breakdown of purines or nucleic acids in the body by enzyme xanthine oxidase.
(this enzyme is targeted for prophylactic treatment)

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3
Q

Primary gout affects 90-95% of people. What is it?

A

Caused by inborn errors of metabolism causing over production of uric acid.
Unknown cause = idiopathic.

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4
Q

Secondary gout affects 5-10% of people. What is it?

A

Increased production or decreased output of uric acid.

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5
Q

List 5 risk factors of developing gout.

A 
Obesity
Increased tissue turnover
Drug therapy
High alcohol consumption
Genetic predisposition
Increased age
Gender
Renal dysfunction
Hypertension
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6
Q

What is podagra?

A

Acute attack of gout in big toe/metatarsophalangeal joint.

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7
Q

What common points are effected by gout?

A

Big toe, foot, ankle, knees, fingers, elbows, shoulders.

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8
Q

What are the symptoms of a gout attack?

A 
Hot, excruciating painful joint.
Red and dry skin.
Crystals in synovial fluid.
Low grade fever.
Raised WBC count.
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9
Q

What 4 points are used to diagnose gout?

A
  1. Demonstration of uric acid crystals in synovial fluid in joint (fluid removed from joint and looked for crystals)
  2. Elevated urate concentration in serum.
  3. Previous history.
  4. Evidence of good response to drug treatment.
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10
Q

After years of repeated gout attacks, patient can develop chronic gout. What are the characteristics of chronic gout?

A

Bone and cartilage destruction.

Deformity of joints.

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11
Q

Chronic gout can result in tophi. What is this?

A

Tophi is deposits of uric aid crystals within and around the joints.
- a chronic destructive inflammatory process.

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12
Q

What are the 4 agents used for treatment of gout attack?

Goal = prompt and effective pain relief.

A

Opioid analgesics
NSAIDs
Intraarticular/oral corticosteroids
Colchicine

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13
Q

What NSAID is commonly used to treat an acute gout attack? Write the dosing for this.
Also how long does it take for onset of action and complete symptom relief?

A

Indomethacin
50 mg tds until significant improvement then tailor dose as required.
Onset of action = 24-48 hours
Complete symptom relief = 5 days

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14
Q

Why might colchicine be used to treat an acute gout attack?

A

Used when NSAIDs are contraindicated.

NSAIDs not suitable for patients who have heart failure as NSAIDs can reduce fluid retention.

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15
Q

What is the mechanism of action of colchicine?

A

Action of tubulin disruption - leads to down regulation of multiple inflammatory pathways and modifications of innate immunity. Overall breaks the inflammation cycle.

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16
Q

What is the dose required for colchicine?

A

500 micrograms 2-4 times daily until relief pain, GI side effects or if a total of 6mg has been reached (only use for 3 days).

17
Q

80% of patients experience GI side effects from colchicine. List a few GI side effects.

A

Nausea
Vomiting
Diarrhoea
Abdominal pain

18
Q

Why might patients require simple analgesics or opioid analgesics?

A

Required until effects of other drugs take place as cinchocaine can take up to 6-12 hours to exert effect and NSAIDs can take up to 24-48 hours.

19
Q

When are corticosteroids given to treat acute gout attacks in patients?

A

When NSAIDs or colchicine are contraindicated.

20
Q

When would an intra-articular injection of corticosteroid be given for acute gout attack?

A

When one or two joints are affected.

Injection of methylprednisolone or triamcinolone.

21
Q

What dose of oral corticosteroid would be given to a patient suffering from an acute gout attack?

A

Prednisolone tablets - 30-40mg daily for 7 days.

22
Q

In what 5 conditions would prophylactic treatment be initiated for chronic gout?

A 
Frequent recurrence of acute attacks
Tophi present
Renal damage
If offending drug treatment cannot be stopped
If patient has persistent hyperuricemia
23
Q

Describe non-drug treatment of gout.

A

Decreasing food intake rich in purines
Reduce alcohol consumption
Weight loss

24
Q

What is hyperuricaemia?

A

High levels of uric acid in blood.

25
Q

What agents are used for the prophylaxis treatment of gout?

DO NOT USE PROPHYLACTIC TREATMENTS DURING ACUTE ATTACK - can cause flare ups.

A

Xanthine oxidase inhibitors - allopurinol, febuxostat.

Colchicine.

26
Q

In what two types of patients is allopurinol used?

A

Patients who have decreased clearance of uric acid.

Patients who have elevated synthesis of gout.

27
Q

What is the mechanism of action of allopurinol and febuxostat?

A

Xanthine oxidase inhibitor

- inhibits enzyme used to convert purines to uric acid.

28
Q

What is the dosing for allopurinol?

NSAID cover 4-6 weeks - required to prevent another flare up during initial allopurinol treatment.

A

100mg-300mg initially at night.
Use <300mg divided doses.
Max of 900mg.

29
Q

What are the side effects of using allopurinol?

A

Side effects are rare = <5% of patients.

Rash/hypersensitivity reactions if patient has renal impairment.

30
Q

According to NICE when should febuxostat be used in managing chronic hyperuricaemia in gout?

A

If patient is intolerant to allopurinol i.e. used as second line treatment.
If allopurinol is C/I.

31
Q

What is the dosing for febuxostat?

NSAID cover 4-6 weeks - required to prevent another flare up during initial febuxostat treatment.

A

80mg once daily

Increase to 120mg daily after 2-4 weeks if serum levels of uric acid = >6mg/100ml.

32
Q

What are some side effects of using febuxostat?

A

GI disturbances.

Rash.

33
Q

Colchicine can be used in acute gout attack and as prophylaxis. What is the dosing for prophylaxis?

A

Can be used as concomitant treatment with allopurinol.

500micrograms bd.

34
Q

Why does colchicine intake need to be monitored?

A

There is a risk of bone marrow suppression.

PMY2107 Applied Clinical Pharmacology and Therapeutics (21 decks)

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