Gout

Question 1

What is Gout?

Answer 1

its the precipitation of urate crystals in joints Or in and around or into tissue

Question 2

Where does Gout occur? and what does it cause?

Answer 2

in joints Or in and around or into tissue causing recurrent acute or chronic arthritis

Question 3

What are the classifications of gout?

Answer 3

Primary
Secondary
Idiopathic

Question 4

What is Primary gout?

Answer 4

its general gout cases which appear to be innate or have a genetic basis

Question 5

What is Secondary Gout?

Answer 5

Its gout cases that develop in the course of a disease or as a side effect of a drug therapy

Question 6

What is Idiopathic gout?

Answer 6

Its cases of gout where the cause is completely unknown

Question 7

What is Tophi?

Answer 7

its usually fine yellow or white papules or nodules

Question 8

Most common locations of Tophi

Answer 8

the fingers, hand, feet and the olecranon or Achilles tendon

Question 9

What is Acute gout?

Answer 9

Gout that often presents as involvement of a single joint or multiple joints in the lower extremities

Question 10

Characteristic of Acute gout?

Answer 10

pain, erythema, swelling, warmth, desquamation of skin, fever, leukocytosis

Question 11

How long does it take to for acute gout to reach maximal severity?

Answer 11

12-24 hrs

Question 12

Can an acute attack subside without treatment?

Answer 12

Yes, it can

Question 13

What is chronic gout?

Answer 13

Its caused by the deposition of monosodium urate crystals in tissues.

Question 14

What is uric acid?

Answer 14

Is a metabolite by product of purine catabolism

Question 15

Process of Purine Metabolism

Answer 15

Purines–> Hypoxanthine–> Xanthine–> Uric acid

Question 16

Purine metabolism is catalyzed by which enzyme?

Answer 16

Xanthine Oxidase

Question 17

Where is xanthine oxidase found?

Answer 17

In the Liver

Question 18

What does chronic gout eventually result in?

Answer 18

Arthritis, soft tissue masses, nephrolithiases and urate neuropathy

Question 19

Stages of gout

Answer 19

Asymptomatic tissue deposition
Acute Gouty Arthritis
Intercritical Gout
Chronic Articular and Tophaceous gout

Question 20

List the non-pharmacological treatments of gout.

Answer 20

Diet: patients should cut down on foods with high levels of purines
Weight loss
Elimination of Alcohol intake

Question 21

Which are the drugs used for Acute gout?

Answer 21

Colchicine
NSAIDs
Corticosteroids

Question 22

Which are the drugs used for Chronic gout?

Answer 22

Uric Synthesis inhibitors:
1. Allopurinol
2. Febuxostat
Uric acid excretion enhancers
1. Probenecid

Question 23

What is the MOA of Colchicine

Answer 23

-Inhibits phagocytosis
-inhibits granulocyte motility to site of inflammation: chemotaxis
-Arrests cell cycle in G1 by interfering with microtubule and spindle formation
-Decreases crystal-induced secretion of chemotactic factors and superoxide anions by activated neutrophils

Question 24

Does Colchicine affect the metabolism, synthesis and excretion of uric acid?

Answer 24

NOPE

Question 25

Is Colchicine an Analgesic

Answer 25

no

Question 26

What does colchicine do to pain and inflammation?

Answer 26

It does not relieve pain nor does it reduce inflammation

Question 27

What are the indications of Colchicine?

Answer 27

Its indicated more for patients than NSAIDs It can be used to treat gout in patients where NSAIDs have been CIed Can be used in conjunction with NSAIDs

Question 28

What are the CIs of Colchicine?

Answer 28

Hypersensitivity rxns Patients with GI, Renal, Hepatic, Cardiac disorders Those with Blood Dyscrasis

Question 29

How is it Colchicine given?

Answer 29

Via IV

Question 30

What can Colchicne also be used for?

Answer 30

As prophylaxis for episodes of severe gouty arthritis

Question 31

A/Es of Colchicine

Answer 31

Diarrhoea Nausea Vomiting Hair Loss Bone marrow suppression Abdominal Pain

Question 32

Which NSAID can not be used for gout?

Answer 32

Aspirin

Question 33

Which are the non-selective COX inhibitors that may be used?

Answer 33

Ibuprofen, Diclofenac, Indomethacin, Salicylates etc.

Question 34

What is the MOA of non-selective COX inhibitors?

Answer 34

they reversibly inhibit COX 1: decrease production of thromboxane A2 and COX 2: decrease prostaglandin production= Decrease inflammation, pain, fever

Question 35

Which are the Cox-2 Selective inhibitors?

Answer 35

Etericoxib and Celecoxib

Question 36

What is the MOA of COX 2 selective inhibitors?

Answer 36

Selectively inhibits COX 2: Decrease prostaglandins synthesis: Decrease pain and inflammation

Question 37

COX 2 inhibitors are CIed in?

Answer 37

They are Cardiotoxic and are associated with Gastroduodenal toxicity

Question 38

What are the CIs of NSAIDS

Answer 38

CI: renal, hepatic, gastroduodenal, cardiac disorders

Question 39

What is the MOA of uric acid synthesis inhibitors?

Answer 39

They inhibit Xanthine Oxidase and thus block uric acid formation

Question 40

What is Febuxostat?

Answer 40

Its a selective xanthine oxidase inhibitor

Question 41

Where is Febuxostat metabolised?

Answer 41

In the liver and is excreted by the kidneys

Question 42

What can Febuxostat be combined with?

Answer 42

NSAIDs and Colchicine during attack of gouty arthritis

Question 43

What are the DIs of Febuxostat?

Answer 43

Mercaptopurine, Azathioprine, Theophylline: these drugs are metabolised by Xanthine oxidase therefore they will stay in plasma longer

Question 44

What does Probenecid do?

Answer 44

It prevents the re-absorption of UA from the kidney at the Proximal Convulated Tubules therefore it increases the UA excretion

Question 45

What is the D/I of Probenecid?

Answer 45

Penicillin and Acyclovair