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Exam 1 Year 3 > Gout > Flashcards

Gout Flashcards

1
Q

Who is susceptible for gout?

A

Men aged 30-60, genetic link is possible

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2
Q

What happens for a patient to get gout?

A

1) Hypoxanthine
2) Xanthine
3) Uric acid
*Each step is facilitated by Xanthine Oxidase

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3
Q

How are uric acid levels during gout?

A

Formation and deposition of monosodium urate crystal are more likely to occur when levels are persistently above 380 micromol/ml

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4
Q

How are crystals formed from gout?

A

pH of 7.4 uric acid is ionised making monosodium urate, if supersaturation occurs crystals are formed

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5
Q

When do symptoms of gout occur?

A

When the crystals shed into the bursa this causes an inflammatory reaction, can be triggered by trauma, dehydration, weight loss, illness or surgery.

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6
Q

How is an inflammatory response initiated, amplified and sustained in gout?

A

-Humoural and cellular inflammatory mediators and the complement system causes
-Cascade of TNF/cytokines
-Inflammatory cell accumulation

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7
Q

What early cells respond in gout?

A

Monocytes, mast cells

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8
Q

What late cells respond in gout?

A

Neutrophils

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9
Q

What is stage 1 of gout?

A

Asymptomatic hyperuricaemia

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10
Q

What is stage 2 of gout?

A

Acute gouty arthritis
-Skin sheds after 7 days untreated
-Severe, red, hot, swollen, painful
-Starts abruptly
-Synovitis
-WBC increased
-Confusion

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11
Q

What is stage 3 of gout?

A

Interval / Inter-critical gout
*can be months/years between attacks

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12
Q

What is stage 4 of gout?

A

Chronic tophaceous gout
-White deposits of monosodium urate, nodule formation which effects the joints
-subcutaneous and periarticular areas (ear lobes, achilles tendon,fingers)

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13
Q

What is stage 5 of gout?

A

Gouty nephropathy
-Crystals deposited around renal tubules - inflammatory response
-Proteinuria - renal impairment, kidney damage, kidney stones,
-Protein in urine +++

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14
Q

Are uric acid levels always high in a gout attack?

A

No

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15
Q

What are 10% of gout cases caused by?

A

Overproduction

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16
Q

What are 90% of cases of gout caused by?

A

Under excretion
-Causes large urate loads to be filtered through the glomerulus , this increases urate reabsorption in proximal tubules meaning insoluble urate isn’t dumped into the urinary tract.
-This decreases tubular secretion and reduced urate secretion

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17
Q

What is primary gout?

A

Rare and inborn errors of metabolism or renal excretion

18
Q

What is secondary gout?

A

Caused by drugs or consequence of another disorder.

19
Q

Can overconsumption of high purine foods cause gout?

A

YES

20
Q

Can renal failure cause gout?

A

Yes, as uric acid isn’t being expelled

21
Q

Can drinking alcohol cause gout?

A

Yes, as they contain high levels of purines, = under excretion, breaks the purine and uric acid is formed

22
Q

What drugs can cause gout?

A

Diuretics, Aspirin, Ciclosporin, Omeprazole, Niacin, Levodopa

23
Q

What should be done in an acute attack of gout?

A

Rest
Full dose of NSAID

24
Q

What NSAID should be avoided in gout?

A

Aspirin

25
Q

What is first line for acute gout?

A

NSAID + PPI

26
Q

What is second line for gout?

A

Colchicine
0.5mg 2-4 times a day until relief

27
Q

If a patient has colchicine how many days do they have to wait until they have a repeat course?

A

No repeat course within 3 days!

28
Q

If a patient can’t have Colchicine, what should be offered?

A

Corticosteroids - prednisolone 30-35mg OD for 5 days

29
Q

If pain is persistent in gout what injection can be given?

A

Triamcinolone

30
Q

What is the triple therapy for gout?

A

NSAID + Colchicine + PPI

31
Q

If a patient on Colchicine has GI disturbances what must happen?

A

It must be stopped, could be a sign of toxicity!

32
Q

What is given for prophylaxis of gout?

A

1st line Allopurinol 00mg OD then titrate to 300mg-600mg OD
If intolerant swap to Febuxostat 80mg OD and increase to 120mg if uric levels above 357mmol/l after 2-4 weeks!

33
Q

What is second line prophylaxis for gout?

A

Uricosuric agents ‘ones’
-If renal impairment avoid

34
Q

If pt has severe gout what can be offered?

A

Canakinumab

35
Q

What is the MOA of Allopurinol?

A

Interferes with synthesis of uric acid, Xanthine Oxidase Inhibitor!

36
Q

What can there be a build up of when someone is on allopurinol?

A

Hypoxanthine and Xanthine - this is harmless and easily excreted!

37
Q

What is allopurinol metabolised to?

A

Oxypurinol

38
Q

What drug is better than Allopurinol?

A

Febuxostat

39
Q

What is the MOA of Febuxostat?

A

Binds to channel at active site of Xanthine Oxidase and blocks entry, this is very effective as it binds to oxidised reduced from

40
Q

What does taking Allopurinol and Azathioprine together do?

A

FATAL BONE MARROW SUPPRESSION!!!!!
Why?
-Azathioprine metabolised to mercaptopurine
-Mercaptopurine is metabolised by Xanthine oxidase
-Allopurinol causes accumulation

Exam 1 Year 3 (40 decks)

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