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Pain > Gout > Flashcards

Gout Flashcards

1
Q

What is gout

A

immune system attacks uric acid accumulated at joints

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2
Q

Drugs and supplements for gout

A
  • NSAIDs
  • Glucocorticoid
  • Leucocyte mortality inhibitor: Colchicine
  • Uric Acid synthesis inhibitor: Allopurinol/ Febuxostat
  • Uricosuric Agent: Probenecid
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3
Q

what is the normal plasma rate concentration

A

2-7mg/dL

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4
Q

causes of gout

A
  1. family hx
  2. Iatrogenic (diuretica, salicyclates, niacin, nicotinic acid, cyclosporine, levodopa)
  3. renal impairment
  4. alcohol consumption
  5. obesity
  6. male
  7. HTN, HLD
  8. lead exposure (fish)
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5
Q

dietary factor that increases risk of gout

A
  1. Excessive alcohol (ethanol increases uric acid production)
  2. low fluid intake (reduces uric acid excretion in urine)
  3. high purine food (red meat, organs, shellfish, peas, beans)
  4. niacin (vit B3, competes with uric acid for excretion)
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6
Q

MOA of uric acid synthesis inhibitors

A

reduce uric acid synthesis by inhibiting xanthine oxidase (which promotes production of uric acid)

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7
Q

difference between allopurinol and febuxostat

A

allopurinol: purine; competitive inhibitor of xanthine
febuxostat: non-purine; non-competitive inhibitor of xanthine

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8
Q

ADR of allopurinol

A
  • rashes (severe cutaneous ADR for Han Chinese, Thai, Korean with HLA-B *58:01 genotype)
  • GI discomfort, n&v, diarrhoea
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9
Q

ADR of febuxostat

A
  • HA, dizziness (cannot operate machinery)
  • skin rash
  • diarrhoea, nausea
  • CVD ADR: MI (not recommended for Hx of ISD or CHF)
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10
Q

MOA of uricosuric agents

A

aka Probenecid:

  • increases uric acid excretion by direct action on renal tubule
  • binds to renal organic anion transporter and inhibit the reabsorption of urate
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11
Q

ADR of probenecid

A
  • kidney stone formation (advice to drink more fluids)
  • HA
  • Rashes
  • GI discomfort
  • can ppt gout attacks in first months of tx
  • RARE: nephrotic syndrome, hepatic necrosis, aplastic anemia
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12
Q

who should avoid probenecid

A
  • during gout attack (increase risk of kidney stones)
  • pt with uric acid kidney stones
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13
Q

MOA of colchicine

A
  • binds to tubular to prevent leukocyte migration and phagocytosis
  • prevent inflammatory glycoprotein production by neutrophils
  • more selective control of inflammation associated with gout than NSAIDs
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14
Q

ADR of colchicine

A
  • Diarrhoea, N&V, GI pain
  • peripheral neuropathy, myopathy
  • RARELY: hairless and bone marrow depression
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Pain (8 decks)

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