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gout Flashcards

1
Q

gout (gout is pure crystal)

A

Gout : is a disorder of purine metabolism that is characterized by the deposition of sodium urate crystals in articular, periarticular (tissues around the joint) and subq tissue.

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2
Q

GOUT: CLASSIFICATION - primary (Men vs. women, age, and history?)

A

Primary:
Most common gout
Middle aged men – 90%
25% have (+) family history
In women onset is post-menopausal

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3
Q

GOUT: CLASSIFICATION - secondary (and age groups?) (gout knows no boundaries)

A

Related to other disorders or meds
Affects people of all ages

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4
Q

PRIMARY GOUT: ETIOLOGY

A

Problem with purine metabolism
End product of purine metabolism is uric acid
Uric Acid accumulates in the blood and deposits in synovium and other tissues.
↑ serum uric acid levels = Hyperuricemia

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5
Q

HYPERURICEMIA - what causes it? (too much, can’t get it out, food)

A

is a biochemical abnormality that could be due:
Impaired renal excretion of uric acid
Over production /biosynthesis of uric acid
“over- consumption of food rich in purine”?

All patients with gout have hyperuricemia.

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6
Q

ACUTE GOUT: CLINICAL MANIFESTATION - when does it peak?

A

Acute onset of swelling and pain in affected joints.
Peaks in several hours

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7
Q

CHRONIC GOUT - tophi in what % of pts?

A

Tophi in 30% of pt’s

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8
Q

GOUT: DIAGNOSTICS - are uric acid levels usually high?

A

Single uric acid levels are normal in 25% -50% of acute gout attacks.

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9
Q

GOUT: MEDICAL MANAGEMENT - no what?

A

Anti-Inflammatory meds:
NSAIDS (Indocin, Motrin) Tx of choice. Anti-inflammatory medication & Analgesic
NO Aspirin-inhibits uric acid secretion

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10
Q

HOW TO PREVENT FUTURE GOUTY ATTACKS - what foods?

A

Avoid foods that are high purine that can precipitate a gout attack:
.
ETOH (beer, alcohol)
All meats and seafood
\

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11
Q

Probenicid - MOA

A

Can increase uric acid excretion

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12
Q

Allopurinol (Zyloprim) (Block ALL uric acid)

A

blocks the production of uric acid
can control serum levels to prevent renal stones.

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13
Q

Febuxostat - (Ted is Flumoxed)

A

New drug
xanthine oxidase inhibitor approved by the FDA in 2009
Reduces serum uric acid levels
second-line therapy
New research (Phase 3Trials)

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14
Q

secondary gout - causes (Ted - door)

A

DM
ETOH
HTN
Cancer
Sickle cell
chemotherapeutic agents

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15
Q

The higher the uric acid level, the earlier the appearance of

A

tophi

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16
Q

acute gout - how long does it last?

A

lasts 2 – 10 days with or without tx

17
Q

acute gout - main place there is inflammation?

A

75% experience acute inflammation and pain of the great toe (podagra: first metarsophalangeal joint).

18
Q

acute gout - what body parts? (gout is WAKE)

A

Can occur in ankle, knee, wrist, elbow

19
Q

acute gout - what plays a central role in acute attacks? (neutrophils are not Ted’s friend)

A

The phagocytosis of MSU crystal by neutrophil play a central role in acute attacks.

20
Q

chronic gout - where do you get it? (Chronic ted is all over)

A

Occur on tendons, bursa, skin, bone, cartilage and pharenchymal tissue as well.

21
Q

chronic gout - tophus

A

Tophi can become large and perforating.
Tophus: are deposit of MSU crystal surrounded by granulomatus inflammation.

22
Q

gout - serial uric acid levels (serial tells it all)

A

95% of serial uric acid levels during the course of an acute attack will be ↑ (>7.5)

23
Q

how to make a Definitive diagnosis

A

can be made by joint aspiration of urate crystals

24
Q

gout meds - COLCHICINE (chemo colchicine) and side effects?

A

COLCHICINE
Inhibits chemotaxis thus interfering with the inflammatory response to urate crystals.
80% can have GI upset (N/V/D, cramps)

25
Q

gout - steroids

A

Corticosteroids only if other meds ineffective

26
Q

how well do meds work?

A

Medications control symptoms 75% of the time

27
Q

avoid what foods? (Ted can’t have oatmeal or mushrooms)

A

Oatmeal
Mushrooms
Sardines
Herring

28
Q

probenicid - must have what? (creatinine is a pro)

A

Must have normal creatinine clearance
Avoid ASA as it counteracts effect

29
Q

probenicid - must do what? (Ted is a pro at urine)

A

Maintain urine output > 2 L/day to minimize uric acid precipitation in the urinary tract (Kidney stones)

30
Q

allopurinol - check what levels? and what number? (Al is less than 6)

A

Check serum uric acid levels: Goal: < 6 mg/dl.

31
Q

Benlysta (Ben an antibody)

A

Benlysta (antibody to fight dz, currently approved for SLE)
Stem cell transplants
DHEA hormone….

32
Q

gout attack - what foods (acidic foods)

A

Beans, peas, spinach, asparagus, cauliflower

XIO (393 decks)

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